Exam 3 - Pancreatitis

Question 1

what is more common - acute or chronic pancreatitis?

Answer 1

chronic pancreatitis

Question 2

what are some challenges for diagnosing pancreatitis on ultrasound in regards to sensitivity?

Answer 2

sensitivity is largely operator dependent!!!!!

sensitivity is lower with less severe disease & limited operator skill

Question 3

what are some challenges for diagnosing pancreatitis on ultrasound in regards to specificity?

Answer 3

specificity is limited by other conditions being associated with similar changes - hyperplastic nodules on the pancreas, pancreatic edema, & peritoneal effusion

Question 4

what are some possible ultrasound findings for a patient with pancreatitis?

Answer 4

enlargement of the organ

fluid around the pancreas

echogenicity changes of the pancreas - if decreased, necrosis & if increased, peripancreatic fat necrosis

dilation of the pancreatic duct

Question 5

what are 4 components that make up the challenges encountered in using ultrasound to diagnose pancreatitis?

Answer 5

severity of disease

quality of the equipment used

level of suspicion

skill of the operator

Question 6

T/F: MRI is used for routine diagnosis of pancreatitis

Answer 6

false

Question 7

what is the best diagnostic imaging used in humans for diagnosing pancreatitis? is it the same in companion animals?

Answer 7

ct in humans

no - the organ is so small, CT isn’t too great

Question 8

the CBC & chemistry on a pancreatitis patient will have a variety of changes observed & none of which are specific for pancreatitis - why is it still important to run?

Answer 8

you need to evaluate the patient for systemic complications!!!

Question 9

is serum amylase activity useful in diagnosing pancreatitis in dogs & cats? why?

Answer 9

no - can be elevated in some dogs with pancreatitis but rarely in cats, can also be elevated in dogs with non-pancreatic conditions

low sensitivity & specificity

Question 10

T/F: most point of care analyzers for lipase activity are based on dry chemistry

Answer 10

true

Question 11

what is the most specific assay used for the measurement of pancreatic lipase?

Answer 11

spec cPL

Question 12

is serum lipase activity useful for diagnosing a dog or cat with pancreatitis? why?

Answer 12

NO - none of the substrates are truly specific for pancreatic lipase/pancreatitis

depends on the substrate elevated in dogs/cats with spontaneous pancreatitis

limited diagnostic value in dogs & cats - sensitivity/specificity are dependent on the substrate & cut-off values

Question 13

what is the most sensitive & specific test available for canine/feline pancreatitis?

Answer 13

canine pancreatic lipase immunoreactivity - cPLI, both spec & SNAP tests

feline pancreatic lipase immunoreactivity - fPLI, both spec & SNAP tests

Question 14

what does a negative SNAP cPLI/fPLI tell you?

Answer 14

rules out pancreatitis

Question 15

what does it mean if you have a patient that has a positive cPLI/fPLI SNAP test? what should you do next?

Answer 15

need to run a spec cPL/fPL to confirm your diagnosis & to get a baseline value for monitoring

Question 16

which of these cPLI/fPLI tests suggests an abnormal result?

Answer 16

the one on the right is abnormal - dot on the right is darker than the control dot on the left

Question 17

is the VetScan cPL test useful? why?

Answer 17

assay shows poor linearity - may be clinically relevant because the assays working range is only up to 600-700 ug/L

poor precision & poor reproducibility

Question 18

what is a pancreatic cytology useful for confirming? what is it not useful for ruling out?

Answer 18

high specificity for confirming an inflammatory process

not very useful to rule out an inflammatory process - low sensitivity

Question 19

what is the safest way to get cytology of the pancreas in dogs & cats?

Answer 19

FNA - safe

Question 20

why are multiple biopsies needed of the pancreas when trying to diagnose pancreatitis?

Answer 20

pancreatitis is highly localized - need to biopsy for confirmation of diagnosis

Question 21

what are the components of management for acute pancreatitis in dogs/cats?

Answer 21

treatment of identified risk factors - hypercalcemia, hypertriglyceridemia

treatment of hypovolemia - aggressive fluid therapy

limit exposure to unnecessary drugs - especially those associated in causing pancreatitis

nutritional support

rigorous monitoring & early intervention against complications

analgesia

antiemetics

Question 22

what are some complications seen in cats & dogs with acute pancreatitis?

Answer 22

electrolyte & acid/base imbalances

DIC

myocarditis

acute renal failure, pulmonary failure, & multi-organ failure

Question 23

T/F: routine NPO is no longer suggested for patients with acute pancreatitis

Answer 23

true

Question 24

how is nutritional support used in patients with pancreatitis?

Answer 24

enteral nutrition is preferred to parenteral nutrition

pre-pancreatic nutrition

Question 25

why is analgesia important for patients with pancreatitis?

Answer 25

abdominal discomfort is the key clinical sign in humans with pancreatitis but isn't commonly noted in veterinary patients becomes apparent after analgesic therapy has been started

Question 26

why not use metoclopramide in patients with pancreatitis?

Answer 26

weak anti-emetic & is a dopamine inhibitor, so it may have negative effects on pancreatic perfusion

Question 27

are antibiotics commonly used for patients with pancreatitis?

Answer 27

no - rare infectious causes dogs & cats with severe acute pancreatitis usually don't reach the late stage of disease

Question 28

what is fuzapladib?

Answer 28

novel drug that acts as a LFA-1 inhibitor that is approved for canine pancreatitis in Japan that has shown promise

Question 29

how is chronic pancreatitis managed?

Answer 29

treatment of the cause treatment of the concurrent conditions - such as IBD, hepatitis, & diabetes mellitus analgesia nutritional support - very important in dogs, very low fat diet & only low-fat treats anti-nausea drugs & appetite stimulants

Question 30

what drug is a very effective choice for appetite stimulation in cats?

Answer 30

mirtazapine

Question 31

what drug is a very effective choice for appetite stimulation that is licensed for use in dogs & cats?

Answer 31

capromorelin

Question 32

how are patients with chronic pancreatitis monitored?

Answer 32

serum spec cPL in dogs/serum spec fPL in cats every 2-3 weeks after resolution of pancreatitis with decreasing frequency

Question 33

what is the pathogenesis of autoimmune pancreatitis?

Answer 33

associated with lymphoplasmacytic infiltrates that is mostly centered around the pancreatic ducts with inflammatory cells staining positive for IgG associated with severe swelling of the pancreas - patients often suspected of having pancreatic neoplasia

Question 34

how are patients with autoimmune pancreatitis treated?

Answer 34

corticosteroids

Question 35

T/F: many dogs & cats with chronic pancreatitis have a lymphocytic-plasmacytic infiltration of the pancreas

Answer 35

true

Question 36

why are dogs & cats with chronic pancreatitis treated with immunosuppressive doses of steroids or cyclosporine instead of azathioprine?

Answer 36

azathioprine is associated with pancreatitis