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Small Animal Medicine > Gastro - Exocrine Pancreas > Flashcards

Gastro - Exocrine Pancreas Flashcards

1
Q

What are the functions of the pancreas?

A

Secretes digestive enzymes, bicarbonate, and colipase

Antibacterial functions

Promotes SI function

Protects against autodigestion (both local and systemic inhibitors)

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2
Q

What pancreatic cells primarily control the exocrine function of the pancreas?

A

acinar cells

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3
Q

How does the pancreas defend against autodigestion?

A

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

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4
Q

What is exocrine pancreatic insufficiency (EPI)?

A

insufficient secretion of digestive enzymes

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5
Q

Is EPI more common in dogs or cats?

A

dogs

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6
Q

What disease processes can cause EPI?

A

Pancreatic acinar atrophy (PAA) - most common in young dogs

Chronic pancreatitis - in cats

Pancreatic neoplasia - adenocarcinoma

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7
Q

What imbalances is EPI associated with?

A

microbial imbalances with hypocobalaminemia

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8
Q

What history and signs is associated with EPI?

A

Weight loss but good appetite, small bowel diarrhea, flatulence, borborygmus, poor hair coat, coprophagia, and cats may have a reduced appetite

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9
Q

If a patient has both EPI and diabetes mellitus what clinical sign might it have?

A

PU/PD

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10
Q

What is coprophagia?

A

eating feces

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11
Q

How is EPI diagnosed?

A

based on clinical signs, hypocobalaminemia, TLI assay, and Cobalamin assay

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12
Q

What is the test of choice for diagnosing EPI?

A

TLI assay - species specific

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13
Q

What will the results of a TLI assay show if a dog has EPI?

A

The TLI levels will be subnormal levels

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14
Q

How is EPI treated?

A

highly digestible diets, oral pancreatic enzyme supplements, vitamine/mineral supplements, and/or high quality maintenance diet

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15
Q

What is given as treatment for ARD in non-responsive patients?

A

tylosin

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16
Q

When should EPI patients respond to therapy?

A

within 3-5 days

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17
Q

Once patients begin responding to EPI therapy, what should be done with the enzyme dosages?

A

You should gradually decrease the dose of enzymes

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18
Q

If there is no response to EPI therapy, what next step should be considered?

A

Dysbiosis - use tylosin

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19
Q

What is the prognosis of EPI?

A

good

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20
Q

True or False: Once EPI is treated initially, you do not need to continue to treat.

A

False - it requires life-long therapy

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21
Q

Is there permanent damage associated with acute pancreatitis?

A

There is rarely permanent damage

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22
Q

What are the two forms of acute pancreatitis?

A

edematous and necrotizing form

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23
Q

Is there permanent damage associated with chronic pancreatitis?

A

yes, it is associated with irreversible damage with fibrosis

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24
Q

What are the risk factors associated with pancreatitis?

A

Dietary indiscretion (high fat), pancreatic ischemia, hypercalcemia, disturbances in lipid metabolism, hepatobiliary disease, drugs, and some breed predispositions

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25
Q

What disease processes can cause disturbances in lipid metabolism?

A

Cushings and Diabetes mellitus

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26
Q

What species typically gets hepatobiliary disease?

A

cats

27
Q

What drugs can lead to pancreatitis?

A

Phenobarbital and azathioprine

28
Q

True or False: The underlying cause of pancreatitis is often known.

A

false - it is often unknown

29
Q

What are the mechanisms of injury to the pancreas?

A

Premature activation of zymogens, reactive oxygen metabolites cause direct cellular damage, and depletion of protease inhibitors

30
Q

A.

A

trypsin

31
Q

B.

A

other proteases - phospholipase, elastase

32
Q

C.

A

Direct tissue damage

33
Q

D.

A

Cascade initiation

34
Q

E.

A

Coagulation, fibrinolysis, complement, Kallikrein-kinin

35
Q

F.

A

inflammation

36
Q

What is the dog signalment for pancreatitis?

A

middle-aged, obese dogs with history of fatty meal

37
Q

What cats are prone to pancreatitis?

A

Cats with hepatobiliary disease

38
Q

What clinical signs do patients with pancreatitis have?

A

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

39
Q

What differentials should you consider along with pancreatitis?

A

Acute or chronic gastroenteritis, infectious disease, metabolic/systemic disease, cholangitis/hepatitis, CNS disease

40
Q

What tests should be done initially if you suspect pancreatitis?

A

Perform a CBC, biochemistry, urinalysis, and radiographs

41
Q

What are the localized complications associated with acute pancreatitis?

A

peritonitis, abscess, icterus, and ascites

42
Q

What are the gastrointestinal complications of acute pancreatitis?

A

hematemesis and hemorrhagic diarrhea

43
Q

What are the renal complications of acute pancreatitis?

A

azotemia and primary renal disease

44
Q

What are the hematologic complications of acute pancreatitis?

A

DIC

45
Q

What are the CNS complications of acute pancreatitis?

A

sepsis and vascular accidents

46
Q

What are the pulmonary complications of acute pancreatitis?

A

Pneumonia, pleural effusion, and RDS

47
Q

What are the metabolic complications of acute pancreatitis?

A

DKA, hypocalcemia, and hyperlipidemia

48
Q

What are the systemic complications of acute pancreatitis?

A

hypovolemic shock

49
Q

What CBC/Chem findings are associated with pancreatitis?

A

Increased PCV, leukocytosis (+/- a left shift), azotemia, increased ALT and ALP, increased total bilirubin, increased glucose, and hyperlipoproteinemia (cause or effect?)

50
Q

What test is best for diagnosing pancreatitis?

A

PLI

51
Q

What ultrasound changes are found in patients with pancreatitis?

A

Hypoechoic changes - whiteness

52
Q

What confirmatory testing can be done for pancreatitis?

A

Abdominal ultrasound - echogenicity, effusion, mass

SNAPcPLI

Spec PLI

53
Q

What should you do if you get a positive or negative SNAP cPLI result?

A

perform a Spec PLI to confirm the results

54
Q

What does Spec PLI measure?

A

serum pancreatic lipase

55
Q

What is Spec PLI highly sensitive for?

A

acute and chronic pancreatitis

56
Q

How do you treat pancreatitis?

A

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

57
Q

What is the prognosis for pancreatitis?

A

The prognosis relates to initial disease severity but it is generally good

58
Q

What parasite can cause feline pancreatitis?

A

Toxoplasma gondii and hepatic flukes

59
Q

What is triaditis?

A

multi-organ inflammation - gut, liver, and pancreas

60
Q

What clinical signs are common in feline pancreatitis?

A

lethargy and hyporexia - vomiting only occurs in 33% of cases

61
Q

What is the best test for diagnosing feline pancreatitis?

A

Spec fPL

62
Q

What are the treatment strategies for feline pancreatitis?

A

Analgesics, anti-emetics, and nutrition diet

63
Q

If a cat is not eating, what supplementation will be needed?

A

enteral nutrition - may need an NG tube or esophagoscopy if not eating after 3-4 days

64
Q

What are some warning signs of serious pancreatic disease?

A

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

Small Animal Medicine (100 decks)

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