Gastro - Exocrine Pancreas Flashcards
What are the functions of the pancreas?
Secretes digestive enzymes, bicarbonate, and colipase
Antibacterial functions
Promotes SI function
Protects against autodigestion (both local and systemic inhibitors)
What pancreatic cells primarily control the exocrine function of the pancreas?
acinar cells
How does the pancreas defend against autodigestion?
Synthesis of inactive zymogens
Storage in the rough ER
Production of trypsin inhibitor (PSTi)
Plasma protease inhibitors (alpha-macroglobulins)
What he wants us to recognize is that there is a local and systemic inhibitor
What is exocrine pancreatic insufficiency (EPI)?
insufficient secretion of digestive enzymes
Is EPI more common in dogs or cats?
dogs
What disease processes can cause EPI?
Pancreatic acinar atrophy (PAA) - most common in young dogs
Chronic pancreatitis - in cats
Pancreatic neoplasia - adenocarcinoma
What imbalances is EPI associated with?
microbial imbalances with hypocobalaminemia
What history and signs is associated with EPI?
Weight loss but good appetite, small bowel diarrhea, flatulence, borborygmus, poor hair coat, coprophagia, and cats may have a reduced appetite
If a patient has both EPI and diabetes mellitus what clinical sign might it have?
PU/PD
What is coprophagia?
eating feces
How is EPI diagnosed?
based on clinical signs, hypocobalaminemia, TLI assay, and Cobalamin assay
What is the test of choice for diagnosing EPI?
TLI assay - species specific
What will the results of a TLI assay show if a dog has EPI?
The TLI levels will be subnormal levels
How is EPI treated?
highly digestible diets, oral pancreatic enzyme supplements, vitamine/mineral supplements, and/or high quality maintenance diet
What is given as treatment for ARD in non-responsive patients?
tylosin
When should EPI patients respond to therapy?
within 3-5 days
Once patients begin responding to EPI therapy, what should be done with the enzyme dosages?
You should gradually decrease the dose of enzymes
If there is no response to EPI therapy, what next step should be considered?
Dysbiosis - use tylosin
What is the prognosis of EPI?
good
True or False: Once EPI is treated initially, you do not need to continue to treat.
False - it requires life-long therapy
Is there permanent damage associated with acute pancreatitis?
There is rarely permanent damage
What are the two forms of acute pancreatitis?
edematous and necrotizing form
Is there permanent damage associated with chronic pancreatitis?
yes, it is associated with irreversible damage with fibrosis
What are the risk factors associated with pancreatitis?
Dietary indiscretion (high fat), pancreatic ischemia, hypercalcemia, disturbances in lipid metabolism, hepatobiliary disease, drugs, and some breed predispositions
What disease processes can cause disturbances in lipid metabolism?
Cushings and Diabetes mellitus
What species typically gets hepatobiliary disease?
cats
What drugs can lead to pancreatitis?
Phenobarbital and azathioprine
True or False: The underlying cause of pancreatitis is often known.
false - it is often unknown
What are the mechanisms of injury to the pancreas?
Premature activation of zymogens, reactive oxygen metabolites cause direct cellular damage, and depletion of protease inhibitors
A.
trypsin
B.
other proteases - phospholipase, elastase
C.
Direct tissue damage
D.
Cascade initiation
E.
Coagulation, fibrinolysis, complement, Kallikrein-kinin
F.
inflammation
What is the dog signalment for pancreatitis?
middle-aged, obese dogs with history of fatty meal
What cats are prone to pancreatitis?
Cats with hepatobiliary disease
What clinical signs do patients with pancreatitis have?
lethargy, anorexia, vomiting are the most common
Abdominal pain (50% of dogs and 25% of cats)
Diarrhea in 33% of dogs
Vomiting in 30% of cats
Fever and icterus in cats
What differentials should you consider along with pancreatitis?
Acute or chronic gastroenteritis, infectious disease, metabolic/systemic disease, cholangitis/hepatitis, CNS disease
What tests should be done initially if you suspect pancreatitis?
Perform a CBC, biochemistry, urinalysis, and radiographs
What are the localized complications associated with acute pancreatitis?
peritonitis, abscess, icterus, and ascites
What are the gastrointestinal complications of acute pancreatitis?
hematemesis and hemorrhagic diarrhea
What are the renal complications of acute pancreatitis?
azotemia and primary renal disease
What are the hematologic complications of acute pancreatitis?
DIC
What are the CNS complications of acute pancreatitis?
sepsis and vascular accidents
What are the pulmonary complications of acute pancreatitis?
Pneumonia, pleural effusion, and RDS
What are the metabolic complications of acute pancreatitis?
DKA, hypocalcemia, and hyperlipidemia
What are the systemic complications of acute pancreatitis?
hypovolemic shock
What CBC/Chem findings are associated with pancreatitis?
Increased PCV, leukocytosis (+/- a left shift), azotemia, increased ALT and ALP, increased total bilirubin, increased glucose, and hyperlipoproteinemia (cause or effect?)
What test is best for diagnosing pancreatitis?
PLI
What ultrasound changes are found in patients with pancreatitis?
Hypoechoic changes - whiteness
What confirmatory testing can be done for pancreatitis?
Abdominal ultrasound - echogenicity, effusion, mass
SNAPcPLI
Spec PLI
What should you do if you get a positive or negative SNAP cPLI result?
perform a Spec PLI to confirm the results
What does Spec PLI measure?
serum pancreatic lipase
What is Spec PLI highly sensitive for?
acute and chronic pancreatitis
How do you treat pancreatitis?
Remove the underlying cause if possible
Supportive care
Fluid therapy
Centrally-acting antiemetics
Antibiotics if confirmed infection
Analgesics for abdominal pain
Transition to a low-fat diet
What is the prognosis for pancreatitis?
The prognosis relates to initial disease severity but it is generally good
What parasite can cause feline pancreatitis?
Toxoplasma gondii and hepatic flukes
What is triaditis?
multi-organ inflammation - gut, liver, and pancreas
What clinical signs are common in feline pancreatitis?
lethargy and hyporexia - vomiting only occurs in 33% of cases
What is the best test for diagnosing feline pancreatitis?
Spec fPL
What are the treatment strategies for feline pancreatitis?
Analgesics, anti-emetics, and nutrition diet
If a cat is not eating, what supplementation will be needed?
enteral nutrition - may need an NG tube or esophagoscopy if not eating after 3-4 days
What are some warning signs of serious pancreatic disease?
Marked mental depression
Severe dehydration; shock
Severe, frequent vomiting
Hematemesis or melena
Yellow, pale, congested membranes
Vomiting food >10h post-prandial
Abdominal pain, distension, mass
