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Clin Chem 2 > Exocrine pancreas > Flashcards

Exocrine pancreas Flashcards

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1
Q

Frequency of pancreatitis btwn species

A 
Dog = most common
    • Hx of garbage eating
    • obese female
    • small breeds
    • Commonly life long (smoldering, necrotizing)
Cat = Unknown how common, vague signs
Horse = Rare
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2
Q

Amylase/ lipase removal

A

Filtered then degraded in tubules
– Pre-renal azotemia (elevation < 2-3X)

Mononuclear phagocytic system
– impaired by uremia

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3
Q

CBC leukogram assoc’d w/ pancreatitis

A

Indication of severity
• Inflammatory (leukmoid response)
– anemia of inflammatory dz
• +/- stress (glucocorticoid- induced lymphopenia)

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4
Q

Dx pancreatitis on chem profile

A

Higher enzyme values are more specifically confirmative for pancreatitis

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5
Q

Which criteria are used to asses the severity of pancreatitis process

A

Leukon &/or Clinical signs

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6
Q 
Distinguish btwn 
• PLI
• Spec cPL
• Spec fPL
• SNAP cLP
A

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)

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7
Q

interpretive significance of SNAP cPL vs Spec cPL

A

95% correlation w/ Spec cPL

    - Negative --> R/O pancreatitis 
    - Positive -->Tx pancreatitis+submit Spec cPL
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8
Q

1° profile for Pancreatitis

A
  1. Amylase
  2. Lipase
  3. 1° Renal profile
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9
Q

What is the 1° R/O for pancreatitis

A

Acute gastritis

  • Better prognosis than pancreatitis
  • usually a one time event
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10
Q

What endocrinopathy are assoc’d w/ Pancreatitis?

What other dz processes maybe assoc’d?

A 
1. Diabetes mellitus 
        • transient in acute phase
        • persistant
2. Cushing's Dz
3. Hypothyroidism
4. Hyperlipidemia (schnauzer's)
---
- Hypercalcemia
- Renal failure (metastatic calcification)
- Glucocorticoids
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11
Q

complications of pancreatitis

A
  1. DIC
  2. abscess
  3. DM
  4. exocrine insufficiency –> maldigestion
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12
Q

source of amylase & lipase

A

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)
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13
Q

how does renal dz affect amylase/lipase levels?

A
  • prolonged 1/2 life
  • 2° pancreatitis
      • due to metastatic calcification & uremic toxin
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14
Q

why should you test both, lipase/amylase?

A

Lipase = more specific , unpredictable

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15
Q

Main ddx for Amylase OR lipase (>3x)

A
  • Pancreatitis
  • Renal azotemia
  • Dexmethasone
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16
Q

Extremely high lipase ( 30-50,000)

A

Suspect pancreatic carcinoma

17
Q

Pancreatitis in cats
• if enzymes are not elevated?
• what is the test of choice?

A
  • Elevated = supports pancreatitis
  • not elevated = Not R/O
  • ↓ amylase is common

• fPLI

18
Q

2° pancreatic profile

A
  1. Leukon
  2. Calcium
  3. Liver – ALT, SDH, & cholestasis marker
  4. Glucose
  5. Fasting hyperlipidemia
  6. TLI
  7. PLI
19
Q

Ddx for SEVERE inflammation

A
  1. Pancreatitis
  2. Pyelonephritis
  3. pyometra
  4. IMHA
  5. Prostatitis
20
Q

Calcium’s assoc w/ pancreatitis

A
  • ↓ serum calcium (acute phase)
    • fat necrosis –> soaks up Ca
  • damage to alpha cells –> ↑ glucagon release –> ↑ calcitonin –> ↓ Ca
  • hypoalbuminemia
21
Q

Classic acute pancreatitis picture

A

Acute Post-hepatic obstruction

    • bilirubin build up 1st –> enzymes
    • eventually cholestasis markers
22
Q

Causes of increased glucose

A
  • Glucocorticoids
  • Epi
  • Glucagon (alpha cell)
  • HYPOinsulin

–> diabetes

23
Q

Cause of increase cholesterol

A

Pancreatitis –> ↓ lipoprotein lipase activation –> ↓ triglyceride uptake –> lipemia

Hypercolesterolemia commonly seen

24
Q

What is TLI & main use?

A

Trypsin-like Immunoreactivity
• 1° for pancreatic insufficiency

  • measures typsinogen & trypsin
  • levels ↑ w/ pancreatic necrosis
  • ↑ before Amylase/lipase (< 30 mins)
25
Q

What is PLI & main use?

A

Pancreatic Lipase Immunoreactivity
• 1° for Pancreatitis (species specific)
• 3 types of test

26
Q

Peritoneal effusion assoc’d w/ pancreatitis

A
  • Serosanguinous, non-exudate
  • Pancreatic abscesses –> septic

** fluid > serum Lipase/amylase

Clin Chem 2 (6 decks)

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