Exocrine Pancreas (Marin) Flashcards
the etiology of acute pancreatitis in dogs is most often
idiopathic
list some risk factors for acute pancreatitis in dogas
breed, females, high TG, obesity, trauma or surgery, neoplasia, toxins or drugs, middle or older aged dogs
what is thought to be the cause of acute pancreatitis in cats and what are some risk factors for disease?
we dont know what causes it
no association with breed, gender, diet, obesity, or drugs
being middle aged to older, bacterial infection more common but can be secondary, IBD, cholangitis, hepatic lipidosis secondary
briefly explain the pathophys of acute pancreatitis
pancreatic enzymes like trypsinogen inside the acinar cells become activated INSIDE the pancreas. Net result is intracellular digestive enzyme activation
the clinical signs of acute pancreatitis in dogs are highly variable and depend on the ___
degree of inflammation and whether it is local, systemic, or both
list some common C/S of acute pancreatitis in dogs and cats
dogs: lethargy, anorexia, vomiting, nausea, painful abdomen, diarrhea, fever, tachycardia, icterus
cats: lethargy, anorexia, weight loss, vomiting, icterus
A dog named Duchess Snugglepaws McFlooferton comes to see you because they are vomiting, very lethargic, and not interested in eating for the past few days. Besides pancreatitis, what other ddx are you going to have on your list?
Gi foreign body, gastric or duodenal ulcers, gall bladder disease, toxin ingestion, infectious gastroenteritis, neoplasia, metabolic disease
you do a CBC/chem on Duchess Snugglepaws McFlooferton who you think could have pancreatitis. What results do you expect?
neutrophilia +/- left shift, hemoconcentration, thrombocytopenia (can cause DIC so make sure you investigate this!!)
increased liver enzymes, hyper or hypo albuminemia, azotemia, hypocholesterolemia, hypocalcemia
true or false: serum lipase and amylase can be used to reliably diagnose pancreatitis in dogs.
false! they are not sensitive enough! lipase is normal in 60% of cases and amylase is normal in 50% of cases! they are also not specific enough! both can increase with hepatic or GI disease OR increased due to decreased renal clearance
what does the pancreatitis snap test actually test for
pancreatic lipase, using specific antibodies
can also do a spec test
the SNAP cPL test is the MOST useful for…
ruling OUT pancreatitis. if its negative, they are unlikely to have it
the Spec cPL test is the MOST useful for…
ruling IN pancreatitis, false positives are rare, but the test does work better in more severe cases
for the spec cPL test, the diagnostic cut off for pancreatitis is ____, and for thespec fPL test, the number consistent with pancreatitis is ____
400 mcg/L
more than 5.4 ug/L
you decide to do abdominal radiographs on Duchess Snugglepaws McFlooferton, who you suspect has pancreatitis. what are some things you suspect to see? if you see nothing on radiographs, then what?
decreased abdominal contrast/abdominal effusion, “signal loop” of duodenum.
if we see nothing this is still helpful because we can rule out other diseases!
you decide to do an abdominal ultrasound on Duchess Snugglepaws McFlooferton, who you think has pancreatitis. what do you expect to see?
hypoechoic pancreas
BUT this is HIGHLY dependent on operator skill and experience, can miss it!
Duchess Snugglepaws McFlooferton’s owner is a human nurse and is well versed in medical terminology, and she asks you if you could do an aspirate of the pancreas. What do you say to her?
there are some risks, you’re poking an already angry pancreas, and even if it comes back negative/no inflammation, this doesn’t mean there is no pancreatitis present because the inflammation can be localized
what is technically the gold standard for diagnosing acute pancreatitis but is almost never done?
a pancreatic biopsy usually via ex lap (incisional)
Duchess Snugglepaws McFlooferton’s radiographs and cPL test comes back suggestive for acute pancreatitis. What treatment options will you offer?
first tier: fluids, antiemetics, analgesia, nutrition
second tier: antibiotics, plasma
third tier: surgery
why are fluids indicated for pancreatitis?
a perfused pancreas is a happy pancreas! fluids keeps the microcirculation open and helps limit progression of disease. You can also supplement electrolytes like potassium.
what antiemetic options are there for Duchess Snugglepaws McFlooferton? (pancreatitis)
maropitant, metoclopramide, ondansetron
what is the proper way to provide nutrition for Duchess Snugglepaws McFlooferton? (panreatitis)
early feeding is beneficial (historically it was thought that fasting was the way to go)
ideally voluntary intake, but dont hesitate to place a feeding tube
use a low fat diet like royal canin GN or purina OM
what is specific about giving cats with pancreatitis nutrition?
palatability is more important than fat content, and make sure to consider other concurrent disease like IBD, cholangiohepatitis, hepatic lipidosis, when choosing a diet
why is plasma indicated for treatment of acute pancreatitis?
it provides alpha 2 macroglobulin, coagulation factors, and albumin
it is controversial and studies have mixed results, but you should consider it minaly in cases of DIC
the brand new drug, Fuzapladib, has become recently available and could potentially help treat pancreatitis. how does it work?
it blocks neutrophil activation, adhesion, and migration, and may limit progression of pancreatitis and associated systemic inflammation in dogs
chronic pancreatitis in dogs shows concurrent evidence of _____
endocrine and/or exocrine pancreatis function, like diabetes or EPI
with chronic pancreatitis in dogs, what concurrent diseases can they have because of this?
hepatic lipidosis, cholangitis/cholangiohepatitis, diabetes mellitus, IBD, CKD
what is the cause of EPI in dogs and cats?
in dogs, it can be from chronic pancreatitis, or it can be from pancreatic acinar atrophy (like in GSD)
in cats, it is ALWAYS from chronic pancreatitis
a dog named Fido Fluffernutter comes to you with chronic diarrhea paired with polyphagia. when you ask what his diarrhea looks like, the owner describes it as yellow and “fluffy”, like a slushie. what is your number 1ddx?
EPI
how will you confirm EPI in Fido Fluffernutter?
a TLI test: highly sensitive and specific
if the result is low, you have EPI
Fido Fluffernutter’s TLI comes back really low and you diagnose him with EPI. What treatment will you offer?
dried porcine pancreatic extract as a replacement therapy for the digestive enzymes, it’s a powder that you can sprinkle on your food
recommend a high quality diet
consider cobalamin supplementation
