Exocrine pancreas Flashcards
Frequency of pancreatitis btwn species
Dog = most common
• Hx of garbage eating
• obese female
• small breeds
• Commonly life long (smoldering, necrotizing)
Cat = Unknown how common, vague signs Horse = Rare
Amylase/ lipase removal
Filtered then degraded in tubules
– Pre-renal azotemia (elevation < 2-3X)
Mononuclear phagocytic system
– impaired by uremia
CBC leukogram assoc’d w/ pancreatitis
Indication of severity
• Inflammatory (leukmoid response)
– anemia of inflammatory dz
• +/- stress (glucocorticoid- induced lymphopenia)
Dx pancreatitis on chem profile
Higher enzyme values are more specifically confirmative for pancreatitis
Which criteria are used to asses the severity of pancreatitis process
Leukon &/or Clinical signs
Distinguish btwn • PLI • Spec cPL • Spec fPL • SNAP cLP
PLI assay
• GI Lab of Texas A&M
(not useful for acute pancreatitis)
Spec cPL / fCL
• send out IDEXX modified assay
• Quantitative (ug/L)
- >400 = positive
SNAP cPL
• in-house
• Qualitative (color)
interpretive significance of SNAP cPL vs Spec cPL
95% correlation w/ Spec cPL
- Negative --> R/O pancreatitis
- Positive -->Tx pancreatitis+submit Spec cPL
1° profile for Pancreatitis
- Amylase
- Lipase
- 1° Renal profile
What is the 1° R/O for pancreatitis
Acute gastritis
- Better prognosis than pancreatitis
- usually a one time event
What endocrinopathy are assoc’d w/ Pancreatitis?
What other dz processes maybe assoc’d?
1. Diabetes mellitus
• transient in acute phase
• persistant
2. Cushing's Dz
3. Hypothyroidism
4. Hyperlipidemia (schnauzer's)
---
- Hypercalcemia
- Renal failure (metastatic calcification)
- Glucocorticoidscomplications of pancreatitis
- DIC
- abscess
- DM
- exocrine insufficiency –> maldigestion
source of amylase & lipase
Amylase
- in many tissue
- 1° Pancreas, duodenal mucosa
- potentially liver
Lipase
- 1° Pancreas, gastric mucosa, adipose
- corticosteroids
- also implicated in causing pancreatitis - Dexamethasone (↑ Lipase ONLY)
how does renal dz affect amylase/lipase levels?
- prolonged 1/2 life
- 2° pancreatitis
- due to metastatic calcification & uremic toxin
why should you test both, lipase/amylase?
Lipase = more specific , unpredictable
Main ddx for Amylase OR lipase (>3x)
- Pancreatitis
- Renal azotemia
- Dexmethasone
Extremely high lipase ( 30-50,000)
Suspect pancreatic carcinoma
Pancreatitis in cats
• if enzymes are not elevated?
• what is the test of choice?
- Elevated = supports pancreatitis
- not elevated = Not R/O
- ↓ amylase is common
• fPLI
2° pancreatic profile
- Leukon
- Calcium
- Liver – ALT, SDH, & cholestasis marker
- Glucose
- Fasting hyperlipidemia
- TLI
- PLI
Ddx for SEVERE inflammation
- Pancreatitis
- Pyelonephritis
- pyometra
- IMHA
- Prostatitis
Calcium’s assoc w/ pancreatitis
- ↓ serum calcium (acute phase)
- fat necrosis –> soaks up Ca
- damage to alpha cells –> ↑ glucagon release –> ↑ calcitonin –> ↓ Ca
- hypoalbuminemia
Classic acute pancreatitis picture
Acute Post-hepatic obstruction
- bilirubin build up 1st –> enzymes
- eventually cholestasis markers
Causes of increased glucose
- Glucocorticoids
- Epi
- Glucagon (alpha cell)
- HYPOinsulin
–> diabetes
Cause of increase cholesterol
Pancreatitis –> ↓ lipoprotein lipase activation –> ↓ triglyceride uptake –> lipemia
Hypercolesterolemia commonly seen
What is TLI & main use?
Trypsin-like Immunoreactivity
• 1° for pancreatic insufficiency
- measures typsinogen & trypsin
- levels ↑ w/ pancreatic necrosis
- ↑ before Amylase/lipase (< 30 mins)
What is PLI & main use?
Pancreatic Lipase Immunoreactivity
• 1° for Pancreatitis (species specific)
• 3 types of test
Peritoneal effusion assoc’d w/ pancreatitis
- Serosanguinous, non-exudate
- Pancreatic abscesses –> septic
** fluid > serum Lipase/amylase
