Exocrine Pancreas Flashcards
Exocrine function of the pancreas
Bicarbonate production
Enzyme secretion
Dysfunction of pancreas
Dec bicarbonate production —> duodenal not properly buffered (pH decreases)
Decreased enzyme secretion (pancreatic insufficiency)
Activation of enzymes in pancreas (acute pancreatic necrosis)
Pancreatic exocrine atrophy is a response to…
Starvation
Neoplasia
Duct obstruction
Necrosis
Inflammation
What happens to the Acinar cells in pancreatic exocrine atrophy
Cells shrink and zymogen granules are reduced or absent
Possible initiating factors of pancreatic necrosis
Duct obstruction (not likely in domestic animals)
Direct Acinar injury
Pathogenesis of pancreatic necrosis
Insult —> inhibition of enzyme secretion —> colocalization of lysomes and secretory granules —> lysosomal hydroplanes + trypsinogen —> trypsin activation —> activation of other zymogens —> autodigestion of pancreas
Autodigestion of pancreas
Fat necrosis + Ca —> asponification of fat
Necrosis of blood vessels (thrombosis, edema, hemorrhage) —> more necrosis
Inflammation —> further necrosis due to neutrophil enzymes
**if still alive, fibrosis will develop
Systemic effects of pancreatic necrosis
Activation of:
- Kinin system
- Coagulation system
- Fibrinolytic system
- Complement system
Shock
DIC
Systemic inflammatory reaction syndrome
Death
Gross lesions of pancreatic disease
Swollen firm hemorrhage and/or necrotic pancreas
Peripancreatic fat saponification
Thrombi
Serosanguineus peritoneal effusion with fat droplets
Peritonitis with adhesions (fibrinous adhesions between pancreas and adjacent organs)
Bile duct may obstruct —> icterus
Fibrosis
Interstitial collagen accumulation
Associated with prior necrosis or inflammation
Usually incidental, but may be associated exocrine pancreatic insufficiency if severe atrophy
Congenital pancreatic disease
Hypoplasia
Atrophy (EPI)
Ectopic pancreatic tissue (incidental)
Exocrine pancreatic atrophy
Clinical presentation: exocrine pancreatic insufficiency (EPI)
Some associated with lymphocytic pancreatitis
Clinical signs: maldigestion (diarrhea/steatorrhea), weight loss, poor coat, ravenous appetite
Pancreatic necrosis and inflammation
Common cause of death in dogs
Less common in cats
Can be seen in horses, swine, birds
Feline triaditis
Cholangitis + pancreatitis + enteritis
Chronic lymphoplasmacytic interstitial pancreatitis, enteritis, cholangitis
Variable plasma cell and eosinophilic infiltrate with chronic triaditis
