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Clin Chem exam 2 > Exocrine Pancreas > Flashcards

Exocrine Pancreas Flashcards

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1
Q

What is the primary profile for the pancreas?

A

Amylase
Lipase
Primary renal profile (BUN, creatinine, SG)

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2
Q

What is the secondary profile for the pancreas?

A 
Calcium
Albumin
Hepatobiliary profile
Glucose
Cholesterol
Leukon
\+/- triglycerides
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3
Q

What is a primary rule out when suspecting pancreatitis? Hint: this condition presents with many of the same clinical signs

A

Acute gastritis

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4
Q

What is the most common suspect for pancreatitis?

A

Dog

obese female, smaller breed

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5
Q

What are common signs of pancreatitis?

A

Vomiting
Weakness
Anterior abdominal pain (>50% of cases)

Less common signs:
Dehydration
diarrhea
fever

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6
Q

What endocrinopathies can pancreatitis be associated with?

A

Diabetes mellitus
Cushing’s disease
Hypothyroidism
Hyperlipidemia (Schnauzers)

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7
Q

What other associations besides endocrinopathies can there be for pancreatitis? These may cause pancreatitis…

A

Hypercalcemia +/-
Renal failure
Glucocorticoids +/-
Other drugs

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8
Q

What are 3 complications seen with pancreatitis?

A 
DIC
Abscess, sepsis
Diabetes mellitus 
- Transient diabetes is common during acute phase
- Persistent diabetes is possible
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9
Q

What are 5 potential outcomes of pancreatitis?

A

Recovery
Acute death
Chronic, recurrent pancreatitis &/or sepsis
Exocrine insufficiency (EPI) –> maldigestion
Diabetes mellitus

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10
Q

What is amylase and lipase? Where are they stored? How are they released with disease?

A

Enzymes/zymogens

stored in acinar cells that leak into blood from degenerating cells or obstructed ducts

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11
Q

Where are basal blood levels from? What tissues?

A

non-pancreatic origin
Amylase - many tissues: primarily pancreas, duodenal mucosa, and potentially liver

Lipase - primarily from pancreas, gastric mucosa, adipose

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12
Q

What are causes of increased lipase?

A

Pancreatitis
Corticosteroids – no histologic lesions
- Dexamethasone reported to increase lipase up to 5x (NO lesions/signs/increase amylase)

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13
Q

How is amylase and lipase degraded and excreted?

A

Associated with renal function! Especially amylase
filtered in kidney (~GFR) and then degraded in tubules

Some clearance by mononuclear phagocyte system – impaired by uremia – decrease clearance – increase amylase, +/- lipase

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14
Q

What will values look like with pre and post renal azotemia? Renal azotemia?

A

may cause 2-3x increase

no clear cutoff for increase – > 2-3x increase

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15
Q

What enzyme is more specific for pancreatitis? Why?

A

Lipase - amylase has more tissues involved

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16
Q

What is unpredictable about lipase values?

A

Rate of increase
Magnitude of increase
Rate of decline with resolution

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17
Q

What is amylase’s half life? Lipase?

- Not important to Dr. C -

A

Amylase - 5 hours

Lipase - 2 hours

18
Q

What is a nonspecific finding in dogs for pancreatic enzymes?

A

< 3x increase in amylase or lipase: doesn’t rule out pancreatitis, just doesn’t confirm!

uremia?/pancreatitis?/other tissue source?/combination?

19
Q

What are the 4 main differentials for a 3x increase in amylase or lipase in a dog?

A

Pancreatitis (diagnostic if renal azotemia is absent)
Renal azotemia (examine renal profile)
Combination
+/- Dexamethasone (lipase increase, not amylase)

20
Q

T/F

The magnitude of enzyme increase corelates with severity

A

False

improves specificity but won’t determine severity

21
Q

RED FLAG

What determines severity of pancreatitis?

A

severity of leukon changes and/or clinical signs

22
Q

What does the magnitude of enzyme increase positively correlate with in a dog?

A

Positively correlates with confidence in the dx – higher the values, the more specific they are for dx

23
Q

What if there are enzyme results w/in the reference range, can we rule out pancreatitis in a dog?

A

We can not rule out pancreatitis

24
Q

How can we monitor progression or resolution for dx of pancreatitis in dogs?

A

Follow enzymes

compare individual’s levels with reference ranges

25
Q

When is it appropriate to make a dx of pancreatitis with enzyme levels < 3x increase in dogs?

A

No renal abnormalities

Other parameters are strongly supportive

26
Q

What should your top differential be for a 30-50,000 IU/L range lipase and normal amylase?

A

Acinar cell adenocarcinoma of the pancreas

27
Q

What supports pancreatitis in cats?

A

Increased enzymes

  • lipase may be increased but is inconsistent
  • amylase may be normal or even decreased
28
Q

What is a classic leukon pattern associated with pancreatitis?

A

Inflammatory leukogram +/- stress (glucocorticoid-induced lymphopenia)

Inflammation: neutrophilia, left shift, toxicity, possible monocytosis

29
Q

What is an important differential diagnosis for severe inflammatory leukogram?

A 
Pancreatitis
Pyometra
Pyelonephritis
Abscess
Prostatitis
30
Q

What is seen with calcium during pancreatitis? Mechanism?

A

pancreatic enzymes released in omentum –> digestion of fat –> precipitation of calcium salts in areas of fat necrosis –> mild to moderate decrease during acute phase of the disease

Increase glucagon release –> increase calcitonin –> decrease calcium

31
Q

What are the potential markers for cholestasis associated with pancreatitis in order of what happens first?

A

increased serum bilirubin (Bc)
Increased urine bilirubin
Increase ALP
Increase GGT

32
Q

What is a classic acute pancreatitis picture called? What does it look like?

A

Acute post-hepatic obstruction

Increase urine bilirubin, increase Bc +/- Bd, normal enzymes

33
Q

What are the four mechanisms for elevated glucose levels with pancreatitis?

A
  1. Glucocorticoids
  2. Epinephrine
  3. Glucagon release (alpha cells)
  4. Hypoinsuilinism (+/- transient)
34
Q

What does TLI measure? What is an advantage or diadvantage of TLI for pancreatitis?

A

Measures trypsin and trypsinogen

Advantage: Increases earlier than amylase and lipase - useful for acute dz phase

Disadvantage: short half life and affected by renal excretion. Only useful for very acute dz phase. Little advantage over amylase/lipase

35
Q

What does TLI stand for? PLI?

A

TLI - Trypsin like immunoreactivity

PLI - Pancreatic Lipase Immunoreactivity

36
Q

What is the recommended test for identification of pancreatitis in dogs or cats? Why?

A

PLI

Identifies a pancreas specific lipase

37
Q

Can you use any PLI for testing cats or dogs?

A

No, they are species specific

38
Q

What test is preferred for detecting pancreatic insufficiency (EPI)?

A

TLI

39
Q

What are reported advantages of PLI?

A
  1. more sensitive than the TLI or lipase for pancreatitis

2. Not affected by gastritis, renal failure, or prednisone administration

40
Q

When looking at spec cPL results, when do you need to retest and when is it positive for pancreatitis?

A

200-400: retest

> 400 : positive

41
Q

What can you decide from a negative SNAP cPL? What if it’s positive?

A

100% rule out of pancreatitis

Positive – confirm with spec cPL

42
Q

What else can be done to look for pancreatitis?

A

Cytology of peritoneal effusion – often serosanguinous, non-septic exudate

Peritoneal effusion fluid enzymes: amylase and lipase in fluid > serum levels suggests pancreatitis

Clin Chem exam 2 (6 decks)

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