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Clinical Pathology > Exocrine Pancreas and Intestine > Flashcards

Exocrine Pancreas and Intestine Flashcards

1
Q

What causes exocrine pancreas insufficiency?

A

Incomplete digestion of foods leading to inadequate absorption of foods

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2
Q

What does incomplete digestion of foods lead to in dogs and cats?

A

Lost weight and malformed feces

Inadequate secretion of LPS, AMS, trypsinogen, chymotrypsinogen, carboxypeptides

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3
Q

What are 3 conditions associated with exocrine pancreas insufficiency?

A

Pancreatic acinar atrophy
Chronic pancreatitis
Pacreatic duct obstruction

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4
Q

What does pancreatic acinar atrophy in dogs lead to?

A

Immune-mediated, lymphocytic pancreatitis

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5
Q

What does chronic pancreatitis in dogs and cats lead to?

A

Destruction of pancreatic acinar cells

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6
Q

What does pancreatic duct obstruction in dogs and cats lead to?

A

Impaired secretion in the intestines that could cause maldigestion
Could lead to acute pancreatitis

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7
Q

What is a major consequence of pancreatitis?

A

Pancreatic acinar cell destruction

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8
Q

What happens in acute pancreatitis?

A

Release of cytoplasmic enzymes from damaged acinar cells –> increased AMS and LPS activity and increase serum PLI and TLI

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9
Q

What happens in chronic pancreatitis?

A

Repeated episodes of acute pancreatitis

Slowly progressive destruction of pancreatic acinar cells

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10
Q

When is inadequate intestinal absorption usually considered malabsorption?

A

When there is a concurrent malnourished state

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11
Q

What species are test used for intestinal malabsorption?

A

Dogs

Occasionally in cats and horses

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12
Q

What is the pysiologic processes of TLI?

A

Trypsinogen is secreted into intestines –> trypsin
Small amounts may be formed in pancreas
Health: small amounts escape pancreas and enter blood

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13
Q

What does TLI detect?

A

Trypsinogen and trypsin

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14
Q

What is TLI reportedly specific for?

A

Pancreas

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15
Q

What is TLI measured by?

A

Species-specific immunoassay

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16
Q

What is the sample needed for TLI?

A

Serum, EDTA plasma, or heparinized plasma

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17
Q

What causes increased TLI?

A 
Acinar damage caused by pancreatitis
Trypsinogen or trypisin is released from damaged cells and leaks into the plasma
Decreased renal clearance
Cobalamin deficiency in cats
High protein diets in dogs
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18
Q

What is the diagnostic specificity and sensitivity of TLI in dogs?

A

Specificity: 90%
Sensitivity: 33-50%

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19
Q

What is the sensitivity of TLI in cats?

A

80-86% for moderate to severe pancreatitis

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20
Q

What causes increased TLI in horses?

A

Strangulating intestinal obstruction and endotoxic shock

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21
Q

What causes decreased TLI?

A

Decreased release from pancreatic acinar cells (chronic pancreatitis, pancreastic acinar atrophy in dogs)
Maldigestion or malabsorption (due to EPI)

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22
Q

What is the physiologic process of PLI?

A

Most LPS into intestine: lipolysis to TGs
Health: small amounts enter blood
Kidneys remove LPS from blood

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23
Q

What assay is used to test PLI?

A

Species-specific immunoassay

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24
Q

What sample is used for PLI?

A

Serum

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25
Q

What cause increased PLI?

A

Increased release from damaged pancreatic acinar cells

Decreased renal clearance

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26
Q

Which has a better sensitivity in cats, PLI or TLI?

A

PLI

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27
Q

What causes decreased PLI?

A

Chronic pancreatitis in dos and cats causes decreased release due to fewer cells

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28
Q

What is preferred in dogs, TLI or PLI? Why?

A

TLI

Better in separating health vs affected dogs

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29
Q

What is the physiolic pricess of TAP?

A

After meal ingestion, trypsinogen enters intestinal lumen: cleaved by enterokinase –> trypsin and TAP

30
Q

Where can a very small amount of TAP be found?

A

Plasma and urine of health dogs

31
Q

What test is used for TAP?

A

Immunoassay

32
Q

What is the sample used for TAP?

A

EDTA plasma or urine in EDTA tube

33
Q

What causes increased TAP?

A

Acinar cell damage caused by panreatitis

Decreased renal clearance

34
Q

What had the best result in differentiating mild from severe pancreatitis?

A

TAP:Crt

35
Q

What is cobalamin a required cofactor in?

A

Folate pathways

Conversion of methylmalonyl coenzyme A to succinyl coenyme A

36
Q

What happens without the conversion of methylmalonyl coenzyme A to succinyl coenyme A?

A

Methylmalonic acidemia and aciduria and neurologic disease

37
Q

What sample is needed for cobalamin?

A

Serum(avoid heparin or hemolysis)

38
Q

What is cobalamin degraded by?

A

Light

39
Q

What happens to cobalamin in an acidic stomach environment?

A

Binds R protein

40
Q

What happens to cobalamin in an alkaline intestine?

A

Detaches R, bind intrinsic factor

41
Q

What happens to cobalamin one it reaches the ileum?

A

Cbl/IF enter enterocytes

42
Q

What happens to cobalamin in portal blood?

A

Binds to transcobalamin 2

43
Q

What causes increased serum cobalamin?

A

Supplementation

Release from damaged heptaocytes

44
Q

When will cobalamin be decreased?

A

When the body reserve is depleted

45
Q

What is cobalt needed for in cattle?

A

Rumen bacteria to produce cobalamin

46
Q

What causes a decrease in serum cobalamin?

A

Preabsorptive
Intestinal bacteria overgrowth
Defective absorption in the ileum of dogs and cats

47
Q

What causes preabsorptive decrease in cobalamin?

A

EPI

Intestinal bacteria overgrowth

48
Q

What is required for cobalamin to be activated?

A

Folate

49
Q

What sample is preferred when testing folate?

A

Serum

50
Q

What can cause increased folate concentration?

A 
SI bacterial overgrowth
Low intestinal pH
High dietary intake
Parenteral supplementation
Cobalamin deficiency in cats
51
Q

What causes decreased folate concentration?

A

Diseases of the small intestinal mucosa

Dietary deficiency

52
Q

What is the physiologic process of fecal α1 protease inhibitor?

A

Protein that inhibits the activity of proteases in feces

53
Q

What is α1PI present in?

A

Plasma, interstitial fluid, and lymph (not feces)

54
Q

What is the sample needed for α1PI?

A

3 separate voided feces samples

55
Q

What is the problem with mechanical collection for fecal α1PI?

A

May cause bleeding and flasely increase [α1 PI]

56
Q

What causes increased α1 PI concentration?

A

Protein losing enteropathies

Blood loss in the alimentary tract

57
Q

What sample is needed for D-xylose absorption test?

A

Serum

58
Q

What are xylose absorption tests?

A

Administer orally and collect multiple timed samples

59
Q

What are xylose absorption tests used for?

A

Evaluate SI function

60
Q

What is glucose absorption test mostly used in?

A

Horses with chronic weight loss

61
Q

What are the advantages to the glucose absorption test?

A

Readily available
Less expensive
Assays more readily available

62
Q

What can glucose absorption tests be used in?

A

Monogastric animals, but not ruminants

63
Q

What is the procedure for the glucose absorption test?

A

Feed withheld overnight
Sample collected as baseline
10/kg of glucose solution at 20% is administered
Samples at 30, 70, 90, 120, and 180 minutes

64
Q

What is the criteria for the glucose intolerance test?

A

Glucose of 85% to 100% of the baseline at 120 minutes

65
Q

What is the lactose intolerance test used in?

A

Foals to detect lactase deficiency typically secondary to intestinal mucosal damage

66
Q

What is lactose composed of?

A

Glucose and galactose

67
Q

What are the advantages to the lactose intolerance test?

A

Readily available
Less expensive
Assays more readily available

68
Q

What is the procedure for the lactose intolerance test?

A

Feed withheld 4 hs prior to the procedure
Sample collected as baseline
lg/kg of lactose solution at 20% is administered via stomach tube
Samples at 30, 60, 90 minutes

69
Q

What is the criteria for the lactose intolerance test?

A

[Glucose] is 150% to 250% of the baseline at 60 or 90 minutes
A peak of at least 35 mg/dl above the baseline

70
Q

What diseases require a lactose intolerance test?

A

Maldigestion caused by lactase deficiency (viral enteritis, Clostridium difficle entercoloitis)
Malabsorption of glucose due to the disease of the SI
Excessive cellular utilization of the absorbed glucose

Clinical Pathology (16 decks)

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