Gastroenterology 2 AI Flashcards
How soon can neurological improvement be seen after administering a lactulose enema?
Neurological improvement may be seen within a 2-hour period.
When is oral administration of lactulose recommended?
Oral administration of lactulose is recommended when the patient is more stable.
What is the recommended dosage for oral administration of lactulose?
The dosage varies from 2.5-25 ml/kg orally q8h.
What is the purpose of administering oral antibiotics in patients with HE?
The purpose is to decrease the numbers of urease-producing bacteria in the GI tract and reduce the production of certain compounds by bacteria.
What are some antibiotics that have been successfully used in HE patients?
Metronidazole, amoxicillin, and neomycin have all been used successfully.
When should neomycin be avoided in HE patients?
Neomycin should be avoided if there is any evidence of intestinal bleeding, ulceration, or renal failure.
Which organs have extensive presence of Aspartate Aminotransferase (AST)?
skeletal muscle cells, heart, kidney, and brain
Where is most of the Aspartate Aminotransferase (AST) found within hepatocytes?
mostly mitochondrial bound
What do elevations of Aspartate Aminotransferase (AST) crudely correlate with?
degree of hepatocellular damage
What is Alkaline Phosphatase (ALP) associated with and where is it found?
microsomal induction, found within the biliary canaliculi membrane
What causes elevations in Alkaline Phosphatase (ALP)?
cholestasis or drug induction
In which animals is Alkaline Phosphatase (ALP) found in bone, kidney, placenta, intestine, and liver?
dogs
What is Gamma Glutamyl Transferase (GGT) important for?
amino acid transport across cell membranes, detoxification of chemicals, and glutathione metabolism
Where is the highest concentration of Gamma Glutamyl Transferase (GGT) found in the dog and cat?
pancreas and kidney
What is the normal width of the gallbladder wall in dogs?
2–3 mm
What is the normal width of the gallbladder wall in cats?
less than 1 mm
What percentage of clinically healthy cats had a non-visible gallbladder wall on ultrasound?
59.10%
What can cause gallbladder wall thickening?
inflammation, edema, cystic mucosal hyperplasia, or neoplasia
What is the normal diameter of the common bile duct in dogs and cats?
3–4 mm
What is the common bile duct diameter in cats with extrahepatic biliary obstruction?
wider than 5 mm
What is the reported prevalence of gallbladder sludge in clinically healthy animals?
53–57%
What is the most common breed affected by gallbladder sludge in dogs?
Labrador Retrievers, Yorkshire Terriers, Miniature Schnauzers, Beagles, Cocker Spaniels, Poodles, and crossbreeds
What are some specific treatments for drug intoxications?
Specific treatments for drug intoxications may include S-Adenosyl methionine (SAMe), vitamin E, silymarin, and N-acetyl cysteine (NAC).
What is the prognosis for acute hepatitis?
Many cases of acute hepatitis can be rapidly fatal. Severe hepatitis can cause hepatic encephalopathy, bleeding tendencies, hypoglycemia, DIC, and death. However, with prompt and aggressive therapy, mild to moderate cases of hepatitis can result in a full recovery.
What is Canine Infectious Hepatitis (CIH) caused by?
Canine Infectious Hepatitis (CIH) is caused by a non-enveloped double-stranded DNA virus called canine adenovirus type 1 (CAV-1).
How is Canine Infectious Hepatitis (CIH) transmitted?
Infection occurs through the ingestion of infected urine, feces, or saliva. The virus can be excreted in the urine for up to 6 months post-infection.
What are some clinical signs of Canine Infectious Hepatitis (CIH) in dogs?
Dogs often present with pyrexia and may have unilateral or bilateral corneal opacities (‘blue eye’). Petechial hemorrhages are common, while jaundice is uncommon.
What are the main sites of viral replication in Canine Infectious Hepatitis (CIH)?
Hepatic and renal parenchyma are the main sites of viral replication in Canine Infectious Hepatitis (CIH).
What is the mortality rate of Canine Infectious Hepatitis (CIH) in mature dogs?
The mortality rate of Canine Infectious Hepatitis (CIH) in mature dogs is often quoted to range from 10 to 30%.
What is the most common cause of acute hepatitis in dogs?
Leptospirosis is probably the most common cause of acute hepatitis in dogs. It is caused by the spirochaetal bacterium from the genus Leptospira.
What is fluorescence in situ hybridization (FISH) used for?
Fluorescence in situ hybridization (FISH) is a tissue staining technique used to locate and identify bacteria within formalin fixed tissues.
Which organisms were most commonly identified in cats with inflammatory liver disease?
Escherichia coli, Streptococcus spp., and Enterococcus spp. were the most common organisms identified in cats with inflammatory liver disease.
What antibiotics are recommended for moderate-to-severe cases of inflammatory liver disease in cats?
Metronidazole, amoxicillin-clavulanic acid, cephalosporins, or fluoroquinolones should be considered in these cases, ideally based on culture results.
What is the recommended treatment for cats with lymphocytic cholangitis?
Cats with lymphocytic cholangitis will generally require prednisolone therapy and sometimes even immunosuppressive therapy such as chlorambucil.
What supportive treatments are recommended for cats with inflammatory liver disease?
Supportive treatments include analgesia, fluid therapy, anti-emetics, vitamin supplementation, and nutritional support.
What is triaditis in cats?
Triaditis refers to a combination of three disease processes in cats including pancreatitis, cholangitis, and inflammatory bowel disease (IBD).
What is the coexistence rate of feline cholangitis with pancreatitis and IBD?
The coexistence of feline cholangitis with pancreatitis and IBD has been reported in 17-39% of cats examined.
What factors may contribute to ascending bacterial infections in both the liver and pancreas of cats?
The feline gastrointestinal (GI) tract anatomy, including the joining of the pancreatic duct with the bile duct and the shorter length of the small intestine in cats, may contribute to ascending bacterial infections in both the liver and pancreas.
What are the recommended dosage and administration instructions for SAMe?
SAMe is recommended at a dosage of 20 mg/kg PO q 24 h on an empty stomach.
What are the potential side effects of SAMe in dogs and cats?
SAMe has rarely been reported to have side effects in dogs or cats other than causing occasional nausea, vomiting, and a decreased appetite.
What is the clinical benefit of SAMe according to the available evidence?
The clinical benefit of SAMe has not been rigorously investigated, although a few clinical trials in humans suggest benefit in improving biochemical tests of liver function, but not in overall outcome.
What is the role of N-acetylcysteine (NAC) in liver injury treatment?
NAC helps replenish hepatic intracellular cysteine and glutathione concentrations, providing protection against oxidative injury.
What is the recommended dosage and administration instructions for N-acetylcysteine (NAC)?
NAC is usually given as a 10% solution diluted 1 to 2 with saline as an IV bolus over 20 minutes through a 0.25 micron non-pyrogenic in-line filter at a dosage of 140 mg/kg initially followed by dosages of 70 mg/kg q 8-12 h.
What is the most common use of intravenous NAC in dogs and cats?
Intravenous NAC has been most commonly used to treat acetaminophen intoxication in dogs and cats.
What is the main active component of silymarin and what effects does it have?
Silibinin is the most abundant and biologically active component of silymarin and is thought to have antioxidant, anti-inflammatory, anti-fibrotic, and choleretic effects.
What is the usual dosage of alpha-tocopherol (vitamin E) for dogs and cats?
Alpha-tocopherol is usually given at a dosage of 10-15 IU/kg PO q 24 h to dogs and cats.
According to the World Small Animal Veterinary Association (WSAVA) Liver Standardisation Group, how is cholangitis classified in dogs?
Cholangitis is classified into four groups: neutrophilic cholangitis, lymphocytic cholangitis, destructive cholangitis, and chronic cholangitis associated with liver fluke infestation.
What are the two forms of hepatitis seen predominantly in dogs?
The two forms of hepatitis seen predominantly in dogs are acute and chronic forms.
What are the possible causes of acute hepatitis?
Possible causes of acute hepatitis include chemicals/toxins, drugs, viruses, bacteria, and mycotoxins.
What clinical signs may be seen in cases of acute hepatitis?
Clinical signs in cases of acute hepatitis can include lethargy, anorexia, vomiting, diarrhea, pyrexia, abdominal pain, and jaundice.
How is a diagnosis of acute hepatitis made?
A diagnosis is based on the clinical presentation, results of serum biochemistry, and ultimately from liver biopsy.
What is the recommended treatment for acute hepatitis?
Treatment involves addressing or removing the underlying cause (if known) and providing supportive treatment for the liver.
Which types of cholangitis are found almost exclusively in cats?
Neutrophilic and lymphocytic cholangitis are found almost exclusively in cats.
What are the possible causes of vacuolar hepatopathy?
The possible causes of vacuolar hepatopathy include high concentration of corticosteroids, deficiency or toxicosis, hepatic insult from another disease process, lysosomal storage diseases, and hepatic hypoxia or intoxication.
How can vacuolar hepatopathy lead to hepatocyte death?
If hepatocyte swelling is severe and chronic, it can cause hepatocyte death, fibrosis, and even cirrhosis.
What breed is associated with glycogen-like vacuolar hepatopathy?
Scottish Terriers are associated with glycogen-like vacuolar hepatopathy.
What are the clinical signs of glycogen-like vacuolar hepatopathy in Scottish Terriers?
Clinical signs of glycogen-like vacuolar hepatopathy in Scottish Terriers include hepatomegaly, pot-bellied appearance, polydipsia, and polyuria.
What is the most common primary liver tumor in dogs?
The most common primary liver tumor in dogs is hepatocellular carcinoma.
What are the clinical signs of liver neoplasia in animals?
Clinical signs of liver neoplasia in animals include reduced appetite, weight loss, lethargy, depression, reluctance to exercise, vomiting, diarrhea, abdominal enlargement, and jaundice.
What is the treatment of choice for primary liver tumors?
The treatment of choice for primary liver tumors is surgical removal, although it may not always be possible.
How can nodular hyperplasia be differentiated from neoplasia?
Nodular hyperplasia, a condition common in older dogs, can be difficult to differentiate from neoplasia. Ultrasound can be used to identify hypoechoic nodules.
What is the prognosis for cats with triaditis?
Prognosis is fair and patients can make a complete recovery with appropriate treatment, (4-6 weeks of the appropriate antibiotic).
What is the characteristic inflammatory infiltrate in lymphocytic cholangitis?
Lymphocytic cholangitis is characterized by infiltration of lymphocytes and plasma cells confined around portal areas with variable degrees of fibrosis and biliary hyperplasia.
What are the clinical signs of lymphocytic cholangitis?
Clinical signs of lymphocytic cholangitis are similar to neutrophilic disease and include anorexia, lethargy, vomiting, and weight loss.
What are the typical laboratory abnormalities seen in lymphocytic cholangitis?
Typical laboratory abnormalities include variable lymphocytosis, elevations in serum ALT, AST, total bilirubin, and hypergammaglobulinemia.
What are the diagnostic findings for lymphocytic cholangitis?
Diagnostic findings include typical laboratory abnormalities, abdominal radiography confirming free abdominal fluid and hepatomegaly, and ultrasonography demonstrating diffuse heterogeneous hepatic echogenicity with segmental dilatations in intrahepatic and extrahepatic bile ducts.
What is the third distinct type of feline cholangitis associated with?
The third distinct type of feline cholangitis is chronic cholangitis associated with infection by liver flukes (family Opisthorchiidae).
What is the management of cholangitis based on?
The management of cholangitis is based in part on culture results and histopathology.
What is the recommended duration of antibiotic therapy for neutrophilic cholangitis?
In general, a 4-week course of antibiotic therapy is indicated for neutrophilic cholangitis, with the acute form usually responding more quickly than chronic cases.
What is the definitive proof of infection for leptospirosis?
A positive culture of biological samples (blood, urine, tissue) is the definitive proof of infection for leptospirosis.
Why is culturing leptospires difficult?
Culturing leptospires is difficult because it requires up to six months and is not routinely performed by diagnostic laboratories.
What is the recommended diagnostic tool for detecting leptospiral DNA?
The polymerase chain reaction (PCR) is currently one of the most useful diagnostic tools for detecting leptospiral DNA.
What is the optimal treatment for leptospirosis?
The optimal treatment for leptospirosis is unknown.
What are the antimicrobials of choice for treating leptospirosis in humans and dogs?
Penicillins or doxycycline traditionally have been the antimicrobials of choice for treatment of humans and dogs with leptospirosis.
What is the consensus panel’s recommendation for treating canine leptospirosis?
The consensus panel recommends treatment of canine leptospirosis with doxycycline, 5mg/kg PO or IV q12h for 2 weeks.
What medication can be used to treat dogs with leptospirosis if doxycycline administration is not possible?
If doxycycline administration is not possible, dogs with leptospirosis can be treated with ampicillin, 20mg/kg IV q6h, with dose reduction for azotaemic dogs.
What is the most common canine chronic hepatopathy?
Chronic hepatitis is the most common canine chronic hepatopathy.
What is cholecystitis?
Cholecystitis is used to define both inflammatory conditions of the gallbladder and gallbladder-related symptoms in the absence of gallstones.
What are some predisposing factors for the development of cholecystitis?
Bile stasis, gallbladder mucocoeles, ascending bacterial or parasitic diseases, and biliary neoplasia are predisposing factors for the development of cholecystitis.
What is necrotising cholecystitis?
Necrotising cholecystitis is a more severe form of cholecystitis, often referred to as a separate disease, and has a higher mortality rate.
What is the mainstay of medical therapy for cholecystitis?
Intravenous fluids, antibiotics, and analgesia are considered the mainstay of medical therapy for cholecystitis.
When is cholecystectomy considered in the treatment of cholecystitis?
Cholecystectomy may have to be considered in severe cases of cholecystitis or in patients with bile peritonitis.
What are some recognized tumors of the biliary tree?
Biliary cystadenomas and biliary adenocarcinomas are recognized tumors of the biliary tree.
What is the second most common form of liver disease in cats?
Feline cholangitis is the second most common form of liver disease in cats, after hepatic lipidosis.
What are the most common bacterial isolates in neutrophilic cholangitis in cats?
The most common bacterial isolates in neutrophilic cholangitis in cats are Escherichia coli, Streptococcus spp., Clostridium spp., and Salmonella enterica serovar Typhimurium.
What are choleliths?
Choleliths are commonly recognized abnormalities of the gallbladder.
Which dogs are predisposed to choleliths?
Older female dogs, particularly Miniature Schnauzers and Miniature Poodles, are predisposed to choleliths.
What factors may promote the formation of choleliths?
Factors that may promote the formation of choleliths include gallbladder dyskinesia, hypercholesterolemia, hypertriglyceridemia, hyperbilirubinemia, endocrine disease, and cholesterol absorption.
What are choledocholiths?
Choledocholiths are stones in the common bile duct.
How are acute obstructing choleliths usually treated?
Medical dissolution is not recommended, and treatment is aimed at supportive care until the stone or stones pass, with intravenous fluids, antibiotics, and analgesia for mild to moderate biliary obstruction.
What surgical procedures are commonly used for severe obstruction in choleliths?
Cholecystectomies and choledochotomies are the treatments of choice, while other procedures such as cholecystoduodenostomy may be necessary depending on factors like viability of the bile ducts and location of the biliary obstruction.
What is the most common gallbladder disorder in dogs?
Gallbladder mucocoeles are the most common gallbladder disorder in dogs.
What factors are known to predispose dogs to gallbladder mucocoeles?
Known predisposing factors for gallbladder mucocoeles include dyslipidaemias, dysmotility of the gallbladder, endocrine disease, and exogenous steroid administration.
What is cholangitis?
Cholangitis is a condition characterized by inflammation of the bile ducts.
What are the common causes of feline mortality?
Cholangitis is not a common cause of feline mortality.
What is the relationship between cholangitis and concurrent disease in cats?
Most cats that succumb to cholangitis have a concurrent disease.
What is the potential correlation between the severity of IBD lesions and the number of comorbidities?
A mild, positive correlation was detected between the severity (score) of IBD lesions and the number of comorbidities.
How can vomiting contribute to pancreatitis and biliary tree infection?
Vomiting can cause reflux of duodenal juice into the pancreatic and bile duct, spreading enteric bacteria into the pancreas and biliary tree.
What is the most common liver disease in cats?
Hepatic lipidosis is the most common liver disease in cats.
What are the potential causes of hepatic lipidosis in cats?
Hepatic lipidosis can be primary or secondary to other diseases, such as diabetes mellitus, pancreatitis, inflammatory bowel disease, and neoplastic diseases.
What is the mechanism behind the development of hepatic lipidosis in cats?
The development of hepatic lipidosis in cats is likely multifactorial, with increased insulin resistance and the release of free fatty acids playing a role.
What are some possible observations in a cat with hepatic lipidosis?
Elevations of liver enzymes and bilirubin, disproportionate increase in ALP compared to GGT, hypercholesterolemia, hypoalbuminemia, hyperammonemia, prolonged PT or APTT, and a homogenous hyperechoic hepatic parenchyma on ultrasound.
What is the recommended diagnostic test for a definitive diagnosis of hepatic lipidosis?
Histologic assessment of a tissue biopsy, preferably an ultrasound-guided core biopsy or a wedge biopsy.
What is the significance of fine-needle aspiration (FNA) in diagnosing hepatic lipidosis?
FNA with cytologic evaluation of smears has been unreliable in some cases and can even lead to a false diagnosis of feline hepatic lipidosis (FHL).
What is the most important factor affecting prognosis in cats with hepatic lipidosis?
Early intensive feeding, usually requiring some form of tube feeding.
What is the recommended method of feeding in cats with hepatic lipidosis?
Tube feeding, which may be required for 4-6 weeks.
Why are appetite stimulants not effective in cats with hepatic lipidosis?
They are not effective enough in stimulating appetite in affected cats.
What should be added to the tube feed for cats with hepatic lipidosis?
Potassium chloride and, if necessary, potassium or sodium phosphate.
Why should serum phosphate and potassium levels be monitored in affected cats?
To avoid the re-feeding syndrome, which can lead to a precipitous drop in serum phosphate and potassium resulting in haemolysis.
What are the beneficial properties of UDCA?
- Antioxidant
- Choleretic
- Immunomodulatory
- Anti-inflammatory
What is the recommended dosage of UDCA for dogs and cats?
10-15 mg/kg PO q 24 h
What are the potential side effects of UDCA?
Occasional diarrhea
In which conditions is UDCA indicated for use in dogs?
Chronic hepatitis with evidence of cholestasis, inflammation involving bile ductules, and suspected bile-borne bacterial infection
Why is the use of UDCA in dogs and cats with complete bile duct obstruction controversial?
Some clinicians are concerned about it increasing the probability of gallbladder rupture
What is the recommended dosage of prednisolone/prednisone for dogs?
2 mg/kg once a day, gradually tapered to 0.5 mg/kg every other day
What are the adverse effects commonly caused by glucocorticoids (corticosteroids)?
Induction of liver enzymes, PU/PD, hypercoagulability, nausea/vomiting, catabolism, sodium retention, subclinical UTI, anabolism, sodium excretion, bradycardia
What is the recommended dosage of azathioprine for dogs?
2 mg/kg PO q 24 h for 2 weeks, then reduced to q 48 h
What is the most common method used for the diagnosis and characterization of chronic hepatitis in dogs?
Liver biopsy.
Why is liver biopsy not always an option for dogs with end-stage chronic liver disease?
Because the disease process may make them poor anaesthetic or surgical candidates.
What samples should be taken if the patient is a surgical candidate for chronic hepatitis?
Bile samples for culture, fresh liver tissue for culture and metal analysis, and formalin-fixed liver samples for standard histopathologic evaluation.
What advanced technologies are currently being employed as diagnostic tools in the search for infectious causes of hepatic inflammation?
Serologic testing, PCR testing, and fluorescence in situ hybridization (FISH).
What types of therapy are often used in the treatment of canine chronic hepatitis?
Anti-inflammatory and immunosuppressive therapy.
What is the most commonly diagnosed treatable component of canine chronic hepatitis?
Hepatic copper accumulation.
What genetic defect has been identified in Bedlington Terriers with copper hepatopathy?
A deletion in exon 2 of the COMMD 1 gene (copper metabolism gene MURR1-containing domain 1).
What is the pattern of inheritance for copper toxicosis in Bedlington Terriers?
Autosomal recessive.
What are the histological characteristics of neutrophilic cholangitis?
Variable infiltrates of neutrophils, lymphocytes, and plasma cells. Fibrosis and bile ductular proliferation may be seen in biopsy specimens depending on the chronicity of the disease.
What is often seen in cases of neutrophilic cholangitis?
Extrahepatic biliary obstruction (EHBO).
What percentage of cats with ANC had EHBO?
40%
What are the common clinical signs of cats with EHBO?
Jaundice, anorexia, lethargy, weight loss, and vomiting.
What imaging technique should be performed to evaluate abnormalities in gall bladder and hepatic morphology?
Abdominal ultrasound.
Can ultrasonography distinguish the different forms of cholangitis?
No, it is not possible to distinguish the different forms of cholangitis by ultrasonography.
What are the sonographic changes observed in cats with cholangitis?
Hyperechoic liver parenchyma, hyperechoic gallbladder contents, and increased pancreatic size.
What are the most consistent sonographic changes indicating extrahepatic bile duct obstruction (EHBO)?
Dilation of the common bile duct or gallbladder distension with or without increased bile sediment.
What are the most common side effects associated with D-penicillamine?
The most common side effects associated with D-penicillamine are proteinuria and skin eruptions.
What activity can D-penicillamine induce?
D-penicillamine can induce ALP activity.
What is the contraindication for concurrent treatment with D-penicillamine and zinc?
The contraindication for concurrent treatment with D-penicillamine and zinc is that each negates the benefits of the other.
What is the role of zinc in restricting enteral copper absorption?
Zinc induces increased synthesis of metallothionein by enterocytes, which binds copper with a higher affinity than zinc and prevents it from entering the circulation.
What is the recommended dosage of zinc for dogs with hepatic disease?
Zinc is usually given to dogs at a dosage of 5-10 mg/kg elemental zinc PO q 12 h, ideally between meals.
Why is antioxidant treatment recommended during chelation treatment?
Antioxidant treatment is recommended during chelation treatment because copper causes oxidative liver injury.
What are some clinical signs of neoplasia in the liver?
Clinical signs can vary significantly and may depend on spread of disease.
What laboratory findings may be seen in neoplasia of the liver?
Increased liver enzymes and hypoproteinaemia.
What imaging technique may be required to assess the extent of liver lesions and spread?
More detailed imaging.
What should be assessed prior to considering aspirates or biopsies?
Coagulation ability.
What is the treatment of choice for most gallbladder or biliary tree tumors?
Partial or complete surgical resection.
What is the most common form of amyloidosis in cats?
Familial and systemic amyloidosis associated with SAA.
What are the two forms of amyloid protein?
The normal soluble form and the abnormal auto-aggregated fibrillar form of beta-pleated sheets.
What is the prognosis of liver failure in cats?
Generally poor once liver failure has occurred.
What is the most common form of amyloidosis reported in small animals?
Serum amyloid A (SAA)
Which organ is described as the primary site of clinical importance in hepatic amyloidosis?
Liver
What is the reason for clinical presentation or death in cats with hepatic amyloidosis?
Acute intra-abdominal bleeding
What is the definitive diagnosis for hepatic amyloidosis?
Histologic findings from a liver biopsy
What is the current standard of care for feline hepatic amyloidosis?
Supportive care and control of concurrent systemic inflammatory disease
Why is the liver more susceptible to oxidative damage compared to other abdominal organs?
Due to its central role in metabolism
What is the essential antioxidant mainly stored in hepatocytes?
Glutathione
What role does S-adenosyl methionine (SAMe) play in the synthesis of glutathione?
SAMe plays a central role in the synthesis of glutathione via the trans-sulphuration pathway
What are the two other metals most often quantified from hepatic biopsies?
Zinc and iron
What is the ideal quantitative measure of copper?
A quantitative measure of copper is atomic absorption spectroscopy.
What level of copper is considered abnormal?
A copper level >400 ppm dry weight is abnormal.
What stains are used to detect copper?
Rubeanic acid and rhodamine are copper-specific stains.
What is the characteristic feature of lobular dissecting hepatitis?
The characteristic feature is dissection of the hepatic parenchyma by fibrosis.
What is the most strongly justified treatment for hepatic copper accumulation?
In cases where hepatic copper accumulation is demonstrated, the long-term use of D-penicillamine, a chelation drug, is beneficial.
What are the most common vacuolar hepatopathies in small animals?
The most common vacuolar hepatopathies in small animals are steatosis, glycogen accumulation, and hepatocellular swelling.
What are the causes of steroid hepatopathy and cloudy change in the liver?
Steroid hepatopathy can be caused by prolonged steroid use.
What is the prevalence of IBD in cats with lymphocytic portal hepatitis?
28%
What is the prevalence of pancreatitis in cats with lymphocytic portal hepatitis?
14%
What is the prevalence of IBD in cats with cholangitis?
83%
What is the prevalence of pancreatitis in cats with cholangitis?
50%
What percentage of cats diagnosed with cholangitis also had IBD and pancreatitis?
39%
What is the prevalence of triaditis in cats?
17%
What percentage of cats with moderate to severe cholangitis had IBD?
50%
What percentage of cats with moderate to severe cholangitis had pancreatitis?
60%
What are the clinical courses of chronic pancreatitis?
The clinical course of chronic pancreatitis can be subclinical or recurrent, with episodes of more or less severe illness, as in acute-on-chronic pancreatitis.
What can occur due to the loss of pancreatic tissue in chronic pancreatitis?
In some cases, the loss of pancreatic tissue leads to decreased exocrine and/or endocrine function.
What is the pathophysiology of acute pancreatitis?
In acute pancreatitis, trypsin is prematurely activated, which in turn inappropriately activates zymogens causing inflammation, necrosis and peri-pancreatic fat necrosis.
What can happen if the activated enzymes enter the circulation in severe pancreatitis?
If the activated enzymes enter the circulation, they become inactivated by proteinase inhibitors. If the pancreatitis is severe, these inhibitors become exhausted and this leads to activation of the inflammatory cascade, systemic inflammatory response syndrome, vasodilation, activation of the clotting cascade and fibrinolysis, disseminated intravascular coagulation and multiple organ dysfunction syndrome.
What are some risk factors for acute and chronic pancreatitis in dogs and cats?
Some risk factors include breed predisposition (e.g. Miniature Schnauzers, Yorkshire and other Terriers), hypertriglyceridemia, obesity, dietary indiscretion, genetic associations, gender association, infections (e.g. Babesiosis, Canine monocytic ehrlichiosis, Leishmaniasis), drug reactions (e.g. Azathioprine, L-asparaginase, Meglumine antimoniate), and intoxications.
What is the association between hypertriglyceridemia and pancreatitis in Miniature Schnauzers?
Prospective case-control studies revealed that dogs with a history of pancreatitis were five times more likely to have hypertriglyceridemia. Dogs with serum triglyceride levels ≥9.7 mmol/L had a 4.5-fold higher likelihood of having serum canine pancreatic lipase immunoreactivity (PLI) values consistent with pancreatitis.
What infections have been reported in connection with canine and feline acute pancreatitis?
Some infections reported include Babesiosis, Canine monocytic ehrlichiosis, and Leishmaniasis, although the association is not strong and the majority of the information comes from a few case reports.
What role do drug reactions play in acute pancreatitis?
Most drug associations with acute pancreatitis are thought to be idiosyncratic and are mainly only described in isolated case reports. Some drugs that have been associated include Azathioprine, L-asparaginase, Meglumine antimoniate, Clomipramine, Phenobarbital, and Potassium bromide.
What are the two main functions of the pancreas?
The pancreas functions as an endocrine gland, producing hormones like insulin, glucagon, somatostatin, and pancreatic polypeptide. It also functions as a digestive organ, secreting pancreatic juice containing digestive enzymes.
How does the pancreas develop?
The pancreas develops from endoderm, with the connective tissue developing from splanchnic mesoderm. It begins with evaginations of the digestive tube caudal to the stomach. Two pancreatic buds form in the dorsal and ventral mesogastrium, which eventually fuse to form the left and right lobes of the pancreas.
What is the major duodenal papilla?
The major duodenal papilla is the opening where the common bile duct, formed by the fusion of the pancreatic and bile ducts, opens into the duodenum.
How is the pancreas anatomically structured?
The pancreas is roughly ‘V’ shaped in all species and can be divided into three parts: the body, left lobe, and right lobe. The left lobe lies in close association with the greater curvature of the stomach, while the right lobe lies along the length of the descending duodenum from the pylorus to the caecum. The lobes are united by interlobular connective tissue containing blood vessels, nerves, and lymphatics.
What are the species differences in the pancreatic ducts?
In general, the dog has two ducts associated with the pancreas: a pancreatic duct and an accessory duct. The pancreatic duct is smaller and joins the bile duct before opening into the major duodenal papilla. In the dog, the duct of the dorsal lobe (accessory duct) enters the duodenum at the minor duodenal papilla.
What are the learning objectives of the module?
The learning objectives include reviewing the anatomy of the pancreas, understanding the difference between the endocrine and exocrine functions of the pancreas, examining pancreatitis, exploring the diagnosis and treatment of feline pancreatitis, and detailing the pathophysiology, investigation, and treatment options for canine pancreatitis, exocrine pancreatic insufficiency, and pancreatic neoplasia.
What are the common hormones produced by the pancreas?
The pancreas produces insulin, glucagon, somatostatin, and pancreatic polypeptide as important hormones.
What is the function of the pancreatic juice?
Pancreatic juice contains digestive enzymes that assist with the absorption of nutrients in the small intestine.
How should cats with severe acute pancreatitis be treated?
Cats with severe acute pancreatitis will require aggressive therapy including hospitalisation, assisted feeding, fluid therapy, analgesics, and antiemetics.
What is the crystalloid of choice for intravenous fluid therapy in cats with pancreatitis?
Hartmann’s is the crystalloid of choice for intravenous fluid therapy in cats with pancreatitis.
What should be monitored and corrected closely in cats with pancreatitis?
Hypokalaemia and hypocalcaemia should be monitored closely and corrected in cats with pancreatitis.
Which pain medication provides a good level of analgesia in cats with pancreatitis?
Opioids such as buprenorphine, methadone, or fentanyl provide a good level of analgesia in cats with pancreatitis.
What are the two types of stimulation that can cause vomiting in cats with pancreatitis?
Vomiting in cats with pancreatitis can be caused by central stimulation (presence of circulating emetic factors) and peripheral stimulation (ileus, peritonitis, and pancreatic distension).
Which antiemetic is a very effective option for use in cats with pancreatitis?
Maropitant citrate is a very effective antiemetic for use in cats with pancreatitis.
What are the benefits of enteral nutrition in the management of feline pancreatitis?
Enteral nutrition stabilizes the gastrointestinal barrier, improves enterocyte health and immune function, improves gastrointestinal motility, prevents catabolism, and decreases morbidity and mortality.
When should nutrition be introduced gradually in cats with pancreatitis?
Nutrition should be introduced gradually over a few days to avoid refeeding syndrome in cats with pancreatitis.
When should the use of antibiotic agents be limited?
The use of antibiotic agents should be limited to those dogs that have a demonstrated bacterial infectious complication or where such an infectious complication is strongly suspected.
Which type of agents have been implicated in potentially causing pancreatitis?
Nonsteroidal anti-inflammatory agents
What is the recommended treatment for dogs with mild chronic pancreatitis?
- Treatment of the underlying cause, 2. Antiemetic and/or analgesic therapy if necessary, 3. Switching to an ultra-low-fat diet
What should be considered in cases of chronic pancreatitis in English Cocker Spaniels?
A treatment protocol using steroids can be considered.
What factors are directly related to the prognosis of dogs with pancreatitis?
Disease severity, extent of pancreatic necrosis, occurrence of systemic and pancreatic complications, duration of the condition, and the presence of concurrent disease.
What is exocrine pancreatic insufficiency (EPI)?
Exocrine pancreatic insufficiency is a syndrome characterized by the insufficient synthesis and secretion of digestive enzymes from the exocrine pancreas.
What is the main cause of exocrine pancreatic insufficiency in dogs?
Pancreatic acinar atrophy is the main cause of exocrine pancreatic insufficiency in dogs.
What is the most common cause of exocrine pancreatic insufficiency in cats?
If exocrine pancreatic insufficiency occurs in cats, chronic pancreatitis is the most common cause.
What off-label use of Mirtazapine can be beneficial for cats with pancreatitis?
Mirtazapine can be used off-label at a dose of 3.75mg/cat PO Q72h.
What is the purpose of antimicrobial therapy in moderate-to-severe cases of pancreatitis in cats?
Antimicrobial therapy is warranted in moderate-to-severe cases of pancreatitis to combat bacterial presence.
What staining technique is used to locate and identify bacteria within formalin fixed tissues?
Fluorescence in situ hybridization (FISH) is used for tissue staining to locate and identify bacteria.
What are some examples of antimicrobial agents that can be considered in cases of pancreatitis in cats?
Amoxicillin-clavulanic acid, cephalosporins, fluoroquinolones, or metronidazole can be considered.
What are the indicators of severe and life-threatening disease in cats with pancreatitis?
Hypoalbuminaemia and hypoglycaemia are strong indicators of severe and life-threatening disease.
What percentage of dogs in one study showed macroscopic evidence of pancreatitis at necropsy?
More than 8% of dogs showed macroscopic evidence of pancreatitis at necropsy.
What are the consequences of failing to diagnose subclinical pancreatitis in dogs?
The consequences of failing to diagnose subclinical pancreatitis are unknown.
What is believed to be the final common pathway triggering pancreatic inflammation in most cases of pancreatitis?
Inappropriate early activation of proteases within the pancreas, particularly the zymogen trypsinogen to trypsin, is believed to be the final common pathway triggering pancreatic inflammation in most cases.
What is the value of measuring serum amylase activity in diagnosing canine pancreatitis?
Measurement of serum amylase activity is of little value in the diagnosis of canine pancreatitis.
What is the total number of lipases in the body?
The exact number of lipases in the body is unknown.
What is the substrate used in many assays to measure total serum lipase activity?
Many assays utilize 1,2-diacylglycerol as a substrate.
Is 1,2-diacylglycerol-based assay highly specific for the exocrine pancreas in dogs?
1,2-diacylglycerol-based assays have a limited specificity (approximately 50%) for the exocrine pancreas in dogs.
What is Trypsin-Like Immunoreactivity (TLI) specific for?
TLI is specific for exocrine pancreatic function.
What is the most sensitive and specific serum marker for pancreatitis in dogs?
Serum cPLI (Canine Pancreatic Lipase Immunoreactivity) is the most sensitive and specific serum marker for pancreatitis in dogs.
What is the reported range of sensitivity for cPLI in 84 dogs?
The reported range of sensitivity for cPLI in 84 dogs was between 72 and 78%.
Is cPLI considered to have the highest specificity for pancreatitis compared to other serum tests?
Yes, serum cPLI is considered to have the highest specificity for pancreatitis compared with any other serum test currently available, with specificities ranging between 81 and 100%.
What are the most common clinical signs of exocrine pancreatic insufficiency?
Loose stools, poor hair coat, borborygmus, increased flatulence, increased appetite, coprophagia, pica, weight loss, greasy soiling of the hair coat in the perineal region (uncommon finding in cats)
What is the diagnostic criteria for exocrine pancreatic insufficiency in dogs?
A serum trypsin-like immunoreactivity (TLI) concentration of ≤2.5 µg/L is diagnostic for exocrine pancreatic insufficiency
What is the diagnostic criteria for exocrine pancreatic insufficiency in cats?
A serum trypsin-like immunoreactivity (TLI) concentration of ≤8.0 µg/L is diagnostic for exocrine pancreatic insufficiency
Are there any subclinical cases of exocrine pancreatic insufficiency?
Yes, it has been demonstrated that some dogs with severely decreased serum trypsin-like immunoreactivity (TLI) concentrations may not show any clinical signs
What are the possible causes of exocrine pancreatic insufficiency in dogs?
The second most common cause is a progressive destruction of endocrine and exocrine pancreatic tissue, concurrent with the development of diabetes mellitus
What is the role of pancreatic acinar enzymes?
Pancreatic acinar enzymes play an integral role in the assimilation of all major macronutrients and a lack of pancreatic digestive enzymes leads primarily to maldigestion
What is the recommended treatment for exocrine pancreatic insufficiency?
Most dogs and cats can be successfully treated by supplementation with pancreatic enzymes, with powder being more effective than tablets, capsules, and enteric-coated products
What are the possible vitamin deficiencies associated with exocrine pancreatic insufficiency?
Exocrine pancreatic insufficiency may lead to deficiencies in vitamin B12 (cobalamin) in both dogs and cats
What are some rare causes of acute pancreatitis?
Zinc intoxication and Organophosphate intoxication.
Which endocrine disorders have been linked to canine acute pancreatitis?
Hyperadrenocorticism, hypothyroidism, diabetes mellitus, and diabetic ketoacidosis.
What are the two main forms of feline pancreatitis?
Acute pancreatitis and chronic non-suppurative pancreatitis.
What are the clinical signs associated with feline pancreatitis?
Anorexia, lethargy, weight loss, dehydration, pallor, and icterus.
What is the prevalence of feline pancreatitis based on histopathological findings?
Between 0.6% and 67%.
What other diseases are commonly seen in cats with pancreatitis?
Idiopathic IBD of the small intestine, hepatic lipidosis, and cholangitis.
What are some common haematological findings for feline pancreatitis?
Normocytic, normochromic, regenerative or non-regenerative anaemia.
Which enzyme activity assay is more useful in diagnosing feline pancreatitis?
The 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6’-methylresorufin) ester (DGGR-lipase) catalytic assay.
What is fTLI used for?
fTLI is used to assess pancreatic function in cats.
What can cause elevated values of fTLI?
Renal disease can cause elevated values of fTLI.
How quickly do TLI values return to normal after pancreatitis?
TLI values return to normal very rapidly within 2-3 days.
What is the sensitivity of fTLI when the cut-off is decreased to 49 μg/l?
In one study, the sensitivity of fTLI increased to 86% when the cut-off was decreased to 49 μg/l.
What is the specificity of serum fTLI for the diagnosis of exocrine pancreatic insufficiency (EPI)?
In one study, the specificity of serum fTLI ranged from 85% to 100% for the diagnosis of EPI.
What are the two commercially available tests for measurement of fPLI?
The two commercially available tests for measurement of fPLI are Spec fPL and Snap fPL.
What is the concentration range for a positive fPLI result using the Snap fPL test?
A positive Snap fPL test result indicates a fPLI value >3.5 μg/l.
What is the gold standard for diagnosing pancreatitis in cats?
The gold standard for diagnosing pancreatitis in cats is histopathological analysis of pancreatic biopsies.
How does low pH in the stomach affect fat digestibility?
Low pH in the stomach decreases fat digestibility.
What potential benefit can be gained by increasing the pH in the stomach?
By increasing the pH in the stomach, the therapeutic response may improve.
What is the prognosis for dogs with exocrine pancreatic insufficiency?
Recovery is rare and it is estimated that 20% of dogs don’t respond to treatment, 20% have a partial response, and 60% have a good response.
What are the common metastatic sites for pancreatic adenocarcinoma?
The duodenum, regional lymph nodes, liver, and lungs are the most common metastatic sites.
What is the preferred chemotherapy drug for people with pancreatic adenocarcinoma?
Gemcitabine is the chemotherapy drug of choice for people with pancreatic adenocarcinoma.
How can pancreatic adenocarcinoma be diagnosed?
Diagnosis can be made through exploratory laparotomy, necropsy, fine-needle aspiration, or transcutaneous biopsy.
What is the most common primary neoplastic condition of the exocrine pancreas in dogs and cats?
Pancreatic adenocarcinoma is the most common primary neoplastic condition of the exocrine pancreas in dogs and cats.
What is the relationship between acute and chronic disease?
The relationship between acute and chronic disease is that many cases of chronic pancreatitis result from recurrent acute disease.
What are the systemic complications associated with canine pancreatitis?
Systemic complications of canine pancreatitis can include kidney injury, pulmonary failure, and pancreatic encephalopathy.
What are some common clinical signs associated with severe acute pancreatitis in dogs?
Some common clinical signs associated with severe acute pancreatitis in dogs include vomiting, abdominal pain, lethargy, dehydration, diarrhea, and pyrexia.
What are the limitations of evaluating the pancreas through abdominal ultrasound in dogs?
The sensitivity of evaluating the pancreas through abdominal ultrasound in dogs depends on factors such as equipment resolution, operator skills, level of suspicion of the ultrasonographer, and severity of the disease.
What imaging techniques are considered routine procedures in humans suspected of having pancreatitis?
Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) are considered routine procedures in humans suspected of having pancreatitis.
What can be detected through full haematology and biochemistry tests in patients with pancreatitis?
A wide variety of changes can be detected through full haematology and biochemistry tests in patients with pancreatitis, although none of these are specific for the degree of pancreatic inflammation and may indicate other systemic diseases.
What is the function of the accessory duct in the pancreas?
The accessory duct opens further distally to the pancreatic duct.
Which part of the pancreas receives blood from the cranial pancreaticoduodenal artery?
The right lobe of the pancreas receives blood from the cranial pancreaticoduodenal artery.
How does lymph drain from the pancreas?
Lymph drains into the pancreaticoduodenal lymph nodes and then into the coeliac center.
Which cells in the islets of Langerhans secrete insulin?
Beta cells secrete insulin and decrease glucose in the blood.
What are the two main functions of the exocrine pancreas?
The exocrine pancreas is responsible for the production of digestive enzymes and the secretion of a bicarbonate-rich fluid.
What activates trypsinogen in the duodenum?
Enterokinase, a proteolytic enzyme secreted by the duodenal mucosa, activates trypsinogen in the duodenum.
What is pancreatitis?
Pancreatitis is the inflammation of the pancreas, which can be acute or chronic.
What are the histological characteristics of acute pancreatitis?
The histological characteristics of acute pancreatitis are edema, neutrophilic infiltrate, and necrosis.
What diagnostic modalities are used to confirm a diagnosis of pancreatitis?
Ultrasonography, pancreatic cytology, and histopathology.
What does the presence of pancreatic acinar cells confirm in a fine-needle aspirate of the pancreas?
Successful aspiration of the pancreas.
What does the presence of inflammatory cells in a fine-needle aspirate of the pancreas confirm?
The presence of pancreatic inflammation.
What is the gold standard diagnostic tool for pancreatitis?
Histopathologic evaluation of a pancreatic biopsy.
Can the absence of pancreatitis be proven by histopathology?
No, even if multiple biopsies are taken.
What is the recommended treatment for dogs with severe pancreatitis?
Treatment of the cause, supportive care, nutrition, analgesia, antiemetics, and fresh frozen plasma.
What is the recommended diet for dogs with pancreatitis?
An ultra-low-fat diet.
What is the key clinical sign in human patients with both acute and chronic pancreatitis?
Abdominal pain.
What adverse effect has been reported in dogs with EPI treated with pancreatic enzyme supplements?
Oral bleeding
What is the recommended method to decrease the frequency of oral bleeding in dogs with EPI?
Moistening the food and pancreatic powder mix
What is the suggested alternative to the use of pancreatic powder in dogs with EPI?
Fresh pancreas
How much raw chopped pancreas can replace 1 teaspoon of pancreatic extract?
1–3 oz (30–90 g)
Is preincubation of the food with pancreatic enzymes or supplementation with bile salts necessary when using fresh pancreas?
No
What type of diet has sometimes been recommended for dogs with EPI?
Low-fat diet
Does fat restriction have a significant effect on treatment success in dogs with EPI?
No
What should be routinely evaluated in small animals with suspected exocrine pancreatic insufficiency?
Serum cobalamin and folate concentrations
