Gastroenterology - Pancreas and Liver

Question 1

What are zymogens?

Answer 1

digestive enzymes released in the inactive form

- prevent enzymes from digesting origin cells

Question 2

Describe the pathology of pancreatitis

Answer 2

• zymogen activation in pancreatic tissue
• inflammation and necrosis of pancreatic cells
• clinical signs caused by cell death and inflammation

Question 3

What is the pathology of pancreatitis?

Answer 3

auto-digestion of the pancreas

- edema, hemorrhage, necrosis, inflammation

Question 4

What are the common clinical signs of pancreatitis?

Answer 4

• vomiting, diarrhea
• abdominal pain
• lethargy
• inappetence

Question 5

What are the clinical signs of acute pancreatitis?

Answer 5

• “ADR”
• vomiting, diarrhea, abdominal pain, lethargy, inappetence
• “prayer position” or “meatloaf”
• cats may present with only anorexia

Question 6

What are the inciting causes of pancreatitis in the dog?

Answer 6

• dietary indiscretion, high fat diet
• organophosphate toxicity
• hypertriglyceridemia
• drugs
• trauma and/or hypoperfusion
• neoplasia
• hypercalcemia

Question 7

What are the inciting causes of pancreatitis in the cat?

Answer 7

• infections
• neoplasia
• organophosphate toxicity
• concurrent GI disease or liver disease

Question 8

What is seen on CBC with pancreatitis in the dog and in the cat?

Answer 8

dog: leukocytosis with left shift, thrombocyotosis/penia
cat: heinz body anemia, same as dogs

Question 9

What is Pancreatic Lipase Immunoreactivity?

Answer 9

• measures lipase of specific pancreatic origin
• released into blood in higher quantities with pancreatic inflammation
• increases with inflammation and necrosis

Question 10

What is the most definitive test for pancreatitis?

Answer 10

pancreatic biopsy

Question 11

How is pancreatitis treated?

Answer 11

supportive and symptomatic therapy

Question 12

What are the therapies used for pancreatitis?

Answer 12

• fluids
• pain management
• antacids
• antiemetics
• prokinetics
• anti-clot
• antibiotics
• vasopressors
• gastric decompression
• supplemental enzymes

Question 13

What are the possible findings associated with liver disease?

Answer 13

• lethargy
• peritoneal effusion
• acholic feces
• hepatic encephalopathy
• pain

Question 14

What are the diagnostics for liver disease?

Answer 14

• CBC/Chem
• Urinalysis
• liver function tests
• imaging
• biopsy

Question 15

What is indicated by increased and decreased cholesterol?

Answer 15

increased - cholestatic disease

decreased - shunts and liver dysfunction

Question 16

What is indicated by increased and decreased BUN?

Answer 16

increased - GI bleed

decreased - shunting or liver dysfunction

Question 17

What is indicated by decreased albumin?

Answer 17

shunts and liver dysfunction

Question 18

What is indicated with hypoglycemia in regards to the liver?

Answer 18

75% or more hepatic dysfunction

- some shunts

Question 19

What breed is predisposed to copper hepatopathy?

Answer 19

Bedlington Terrier

- deletion of exon 2 in COMMD1 gene

Question 20

How is canine copper hepatopathy treated?

Answer 20

• D-Penicillamine: mobilizes copper from tissues. increases urine secretion, and increases metallothionein
• Zinc: increases metallothionin
• Trientine HCl: increases urine excretion

Question 21

What is vacuolar hepatopathy?

Answer 21

excess glycogen accumulation in the liver often secondary to excess glucocorticoid exposure

Question 22

What is hepatocutaneous syndrome?

Answer 22

pronounced skin lesions associated with primary hepatic disease

Question 23

What are the two forms of cholangitis/cholangiohepatitis syndrome?

Answer 23

suppurative - neutrophilic, associated with bacteria

non-suppurative - lymphocytic/lymphoplasmacytic

Question 24

Which antibiotics are used to treat cholangitis/cholangiohepatitis syndrome?

Answer 24

• amoxicillin/clavulanic acid

- metronidazole and enrofloxacin

Question 25

What are the lab changes associated with hepatic lipidosis?

Answer 25

• heinz body anemia
• increased ALP
• increased bilirubin
• +/- hypokalemia
• bilirubinuria