Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Path > GI & Pancreas Lecture 19 > Flashcards

GI & Pancreas Lecture 19 Flashcards

1
Q

what is the value of poop and fecal testing?

A

An incredibly important part of the laboratory work‐up
for GI disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the two main exocrine pacreatic disorders?

A

Pancreatitis
Exocrine pancreatic insufficiency (EPI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the mechanism of pancreatitis.

A
  • Trigger (may or may not be obvious) –> inflammation –> cell damage +/- death –> enzyme leakage –> worsening cell damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pancreatitis occurs in

A

Dogs & cats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pancreatitis can be

A

acute or chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the clinical signs of pancreatitis?

A
  • Severity highly variable
  • Abdominal pain
  • Loss of appetite
  • Vomiting
  • May affect peritoneum
  • Can cause obstructive cholestasis
  • Can cause secondary EPI
  • Can cause secondary DM

Clinical signs in cats may be subtle

EPI = exocrine pancreatic insufficiency
DM = diabetes mellitus

Inflamed pancreas can irritate gallbladder
Islet cell destruction results in DM
EPI and DM are relatively uncommon unless you have severe pancreatitis or constant reoccurance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you DX pancreatitis?

A
  • Clinical history
  • Physical examination
  • Minimum database
  • Specialized lab tests (more in a minute . . .)
  • Testing to rule out parasites or infections
  • Abdominal imaging
  • +/- Pancreatic cytology or histopathology

Diagnosis is based on looking at the
BIG PICTURE.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is exocrine pancreatic insufficiency (EPI)?

A
  1. Acinar cell destruction
    a. due to primary (breed-associated)
    b. secondary (to chronic pancreatitis)
  2. Lack of digestive enzymes & bicarbonate‐rich fluid
  3. Inability to digest
    nutrients (maldigestion)
  4. Typically also imbalance of intestinal flora (intestinal dysbiosis)
  5. Maldigestion: weight loss & chronic diarrhea (good appetitecommon with primary)

basically a “failure” of pancreatic digestive fxn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you DX EPI?

A
  • Clinical history
  • Physical examination
  • Minimum database
  • Specialized lab tests (more in a minute . . .)
  • Testing to rule out parasites or infections
  • +/- Abdominal imaging
  • +/- Intestinal histopathology (R/O other diarrhea causes)

Diagnosis is based on looking at the
BIG PICTURE.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T/F: Not all animals with pancreatitis
have secondary EPI

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

T/F: All animals with EPI have
underlying pancreatitis

A

False, Not all animals …

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Main differences between Pancreatitis and EPI?

A

Pancreatitis: pancreatic inflammation
EPI: Destruction of acinar
tissue
P: Enzyme leakage –>
inflammation
EPI: Pancreatic
insufficiency –>
maldigestion
P: Vomiting and abd. pain
EPI: chronic diarrhea and weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Indication for lipase test?

A

Suspected pancreatitis. May be part of a routine small animal biochemical profile (varies by laboratory).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

An increase on a lipase test means?

A

Increased lipase activity suggests leakage of lipase from damaged pancreatic tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the DGGR method of lipase measurement?

A

DGGR is a reagent (lipase substrate) in the test system. DGGR is not 100% analytically specific for pancreatic lipase, and presence of other lipase types in plasma will mildly increase DGGR lipase activity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What sample will you use to measure lipase?

A

serum or plasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you interpret an increase in lipase?

A
  • a 3 to 5 fold increase above URL considered consistet with pancreatitis
  • However this is TOTAL LIPASE ad is not specific for pancreas alone
  • It can also be impacted by decreased GFR ad dexamethasone injections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the indications for the Pancreatic Lipase Immunoreactivity (PLI) test?

A

Suspected pancreatitis. This test must be ordered specially (not part of a routine biochemistry panel).
- ELISA –> categorical ie neg or pos (IDEXX) or radioimmunoassay –> quantitative ie concentration (texas GI lab)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the principle interpretation of a PLI test?

A
  • Both tests use reagent antibody to detect pancreatic lipase specifically
  • Both use fasting sample –> optimally 12 to 18 hours
  • PLI is increased in pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you avoid error in the SNAP PLI tests?

A

Follow manufacturer instructions carefully
* Don’t use expired tests
* Warm components to ROOM TEMPERATURE
* Place kit on horizontal surface
* Measure drops carefully
* “SNAP” (depress the activator) correctly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is EPI DX?

A

TLI = Trypsin‐like (trypsin + trypsinogen) immunoreactivity
* Fasting, non‐hemolyzed serum (Texas GI Lab)
* Decreased in EPI
* (Can be increased in pancreatitis & when GFR ↓)

EPI = exocrine pancreatic insufficiency
PLI = pancreatic lipase immunoreactivity
GFR = glomerular filtration rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the confirmatory test results for pancreatitis ?

A

Increased PLI
Increased Lipase
(Increased TLI) a

NOTE: For diagnosing pancreatitis, PLI is
MORE diagnostically sensitive than TLI!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the confirmatory test results for EPI?

A

Decreased TLI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Disorders that affect intestinal function may cause:

A

− Maldigestion (similar to EPI)
− Malabsorption
− Protein loss (of albumin & globulins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Enteropathy can also cause:

A
  • Chronic diarrhea & weight loss
  • Gut microflora may be abnormal (“dysbiosis”)
  • Vomiting occurs in some cases
26
Q

What is protein-losing enteropathy (PLE)?

A

A syndrome not a specific disease caused by various things, but usually diarrhea or weight loss.

27
Q

In Protein‐losing enteropathy (PLE) Excessive fecal protein loss can cause

A
  • panhypoproteinemia (decreased TP, ALB, GLOB) on a chem panel
  • May cause antithrombin loss and predispose to pathologic thrombosis
28
Q

Intestinal dysbiosis causes pathologic alteration of intestinal microbiome leading to..

A
  • Altered bacterial numbers
  • Altered bacterial subpopulations
  • Altered bacterial function
  • Or some combination of the above!
29
Q

The gut microbiome is an active research area in human and vet med because?

A
  • Flora impact immunity, gut fxn
  • Sophisticated molecular techniques
  • Relevant to fecal transplantation
30
Q

What is cobalaminn and folate used for?

A
  • Cobalamin is a required cofactor in metabolic pathways involving folate
  • Active Folate is used in DNA synthesis in many tissues
31
Q

How does the GI tract utilize cobalamin?

A
  • Microflora USE it
  • Absorbed in ILEUM*
  • Serum sample
  • Project from light
  • ng/L

*Requires INTRINSIC FACTOR (from the pancreas in dogs & cats)
Think of these as biomarkers of intestinal
dysbiosis, maldigestion, and malabsorption.
Realize these are VERY CRUDE indicators of what’s going on with the microflora!

32
Q

How does the GI tract utilize Folate

A
  • Microflora MAKE it
  • Absorbed in PROXIMAL SI
  • Serum sample
  • Project from light
  • microg/L

Think of these as biomarkers of intestinal
dysbiosis, maldigestion, and malabsorption.
Realize these are VERY CRUDE indicators of what’s going on with the microflora!

33
Q

Whats the most common indication for cobalamin testing?

A

Chronic small bowel diarrhea +/- weight
loss; suspected EPI.

34
Q

Whats the principle of cobalamin testing?

A

Low [cobalamin] due to overgrowth of bacterial flora and/or maldigestion.

35
Q

How do you interpret cobalamin tests?

A

Low [cobalamin] suggests intestinal dysbiosis and/or cobalamin malabsorption.

36
Q

Most cases of low cobalamin are due to what?

A

Most cases of low cobalamin are due to dysbiosis or an acquired malabsorption disorder.

37
Q

Low cobalamin in a zebra

Whats a A less common indication for low cobalamin testing?

A

Suspected congenital cobalamin deficiency

38
Q

Low cobalamin in a zebra

Whats the priniciple for low cobalamin?

A

Low [cobalamin] due to congenital defect
in cobalamin‐intrinsic factor complex receptor

39
Q

Low cobalamin in a zebra

How do you interpret low cobalamin in a zebra?

A

Low [cobalamin] supports this congenital deficiency in a young dog of certain breeds*

*Reported in giant schnauzers, Australian shepherd dogs, beagles, and border collies.

40
Q

How does low cobalamin manifest as?

A

Manifests as unthrifty, young animal.
May see non-regenerative anemia.

41
Q

Can low cobalamin be nutritional?

A
  • Extremely unlikely, if intestinal function is normal. –> This is why we can use it as a biomarker of
    intestinal dysbiosis or malabsorption!
  • In cattle, may be associated with low‐cobalt diet.
  • Body stores take a LONG TIME to get depleted.
42
Q

Summary

Altered cobalamin: Decreased due to? Increased?

A

Decreased:
- Intestinal dysbiosis
(due to EPI or other cause)
- Ileal disease (malabsorption)
Congenital defect in ileal receptor (rare)
- Nutritional deficiency (really rare)

Increased (rare):
- Over‐supplementation
- Hepatocyte damage

43
Q

What are the indications for folate testing?

A

Chronic small bowel diarrhea +/- weight
loss; suspected EPI

44
Q

Whats the principle of folate presence?

A

Overgrowth of bacterial flora causes
increased [folate]

45
Q

How do you interpret folate tests?

A

Increased [folate] concentration suggests intestinal dysbiosis; low [folate] suggests intestinal malabsorption (or certain
medications – see subsequent slide).

46
Q

Can low folate be due to nutrition?

A
  • Extremely unlikely, if intestinal function is normal. –> This is why we can use it as a biomarker of
    intestinal dysbiosis or malabsorption!
  • Chronic antibiotic use (kills microflora) can cause.
  • Methotrexate treatment can also cause.
47
Q

Summary

Folate is decreased because? Increased?

A

Decreased:
- Proximal intestinal dz
(maldigestion, malabsorption)
- Certain drugs
(e.g., antibiotics, other)

Increased:
- Over‐supplementation
- Intestinal dysbiosis
(due to EPI or other cause)

48
Q

Dog has decreased cobalamin, N folate, N TLI. Whats your DX?

A

Congenital cobalamin deficiency OR disease of distal small intestine (ileum).

49
Q

Dog has decreased cobalamin, increased folated, decreased TLI. Whats your DX?

A

EPI, with intestinal dysbiosis

50
Q

Dog has increased cPLI, N cobalamin, N folate. Whats your DX?

A

Pancreatitis

51
Q

Dog has N cobalamin, decreased folate, N TLI. Whats your DX?

A

Proximal small intestinal disease (duodenum, jejunum), or possibly antibiotic or methotrexate use

52
Q

Dog has decreased cobalamin, increased folate, N TLI. Whats your DX?

A

Intestinal dysbiosis (but not due to EPI)

53
Q

Dog has decreased alb, decreased glob, N TLI. Whats your DX?

A

PLE a top differential, assuming patient has GI signs & there is no other explanation for the protein changes!

54
Q

Dog has N cobalamin, N folate, decreased TLI. WHats your DX?

A

EPI (but no apparent dysbiosis)

55
Q

What are some tests of SI permeability/absorption?

A

Administer oral test substance –>substance absorbed
from gut to blood –> timed blood samples –> measure
substance –> plot absorption curve ([X] over time).
* Info about SI function from time to peak absorption,
fold‐change over baseline, curve shape, and AUC.
* Most commonly done in HORSES with chronic GI dz
(e.g., malabsorption and/or inflammatory bowel
disease suspected)

56
Q

What are some indications for glucose absorption testing?

A

Suspect IBD; diarrhea, poor body condition, mild/recurrent colic

57
Q

Whats the principle of glucose absorption testing?

A

SI inflammation impairs intestinal mucosal function & absorption of glucose

58
Q

How is the glucose absorption testing procedure done?

A

Fast horse 12 to 18 hr. Give oral glucose solution. Take timed blood samples.
Measure glucose & plot results over time.

59
Q

How do you interprate glucose absorption test?

A

Delayed or subnormal absorption indicates compromised SI function and
supports a dx of IBD.

60
Q

What components of rumen fluid are evaluated?

A
  • Microflora morphology and motility
  • pH
  • Chloride concentration
61
Q

When you work up a cow what is part of it?

A

Part of work‐up for any cow with signs of decreased rumen
motility.
Usually collected via orogastric tube. (May need rumen‐centesis if accurate pH is critical.)

Clin Path (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions