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VET433: Gastroenterology > Exocrine Pancreatic Insufficiency > Flashcards

Exocrine Pancreatic Insufficiency Flashcards

1
Q

what does the exocrine pancreas secrete

A
  • digestive enzymes
  • bicarbonate
  • intrinsic factor
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2
Q

digestive enzyme release and activation

A
  1. stored as inactive zymogens
  2. released into duodenum in response to CCK and Ach/vagal stimulation
  3. enterokinase in duodenum activates zymogens into proteases
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3
Q

role of bicarbonate

A

neutralize gastric acid in the small intestine

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4
Q

role of intrinsic factor

A

stimulate absorption of B12

produced in the:
dogs: pancreas + gastric mucosa
cats: pancreas only

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5
Q

exocrine pancreatic insufficiency

A

pancreas fails to produce digestive enzymes, bicarb, and intrinsic factor

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6
Q

EPI signalment

A

dogs: young adult (3-4)
- females > males
- GSDs, CKCS, collies

cats: adults (7-8)
- males > females

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7
Q

EPI pathogenesis in dogs

A
  1. hereditary acinar atrophy (PAA)
  2. immune mediated
  3. secondary to chronic pancreatitis
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8
Q

EPI pathogenesis in cats

A

secondary to chronic pancreatitis

causes lymphocytic inflammation

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9
Q

general EPI clinical signs

A

arises when 90% of exocrine pancreatic function is lost

unkempt with poor body condition
+/- bleeding due to vitamin K malabsorption

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10
Q

EPI clinical signs - dogs

A
  1. weight loss
  2. polyphagia
  3. small bowel diarrhea (voluminous steatorrhea)

coprophagia, vomiting

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11
Q

EPI clinical signs - cats

A
  1. weight loss
  2. small bowel diarrhea
  3. polyphagia (or anorexia)

coprophagia, vomiting, PU/PD

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12
Q

what are the differentials for weight loss + polyphagia

A

extra GI: EPI, hyperthyroidism, diabetes Cushing’s

GI: PLEs (GI lymphoma, lymphangiectasia), severe GI parasitism

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13
Q

EPI diagnostics

A

serum TLI
serum B12

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14
Q

serum TLI

A

measures trypsin, trypsinogen, and complexes in serum
- 12 hour fasted sample

dogs: TLI < 5.5 is diagnostic
cats: TLI < 8.0 is diagnostic

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15
Q

chem panel changes with EPI

A

maldigestion –> panhypoproteinemia, hypocholesterolemia, low Ca and Mg

diarrhea –> electrolyte imbalances

reactive hepatopathy

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16
Q

EPI treatment

A
  1. pancreatic enzymes
  2. highly digestible diet
  3. vitamin B12
  4. antibiotics - if refractory
17
Q

pancreatic enzyme treatment

A

requires lifelong treatment with every meal

NOT curative

18
Q

is there a benefit to low fat diet with pancreatitis

A

no, does not change prognosis

19
Q

EPI prognosis

A

good with treatment

poor prognostic indicator - hypocobalaminemia (improves with supplementation)

VET433: Gastroenterology (16 decks)

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