Internal Medicine: Gastroenterology: Investigating Pancreatic Disease Flashcards
What anatomical associations does tha pancrease have?
Stomach
Liver
Duodenum
Colon
What causes acute pancreatitis?
Aetiological factors cause conversion of trypsinogen to trypsin inappropriately in the pancreas
* Direct tissue damage
* Cascade intiation- coagulation, fibrinolysis, complement
What anatomical associations does tha pancrease have?
Stomach
Liver
Duodenum
Colon
What are predisposing factors for acute pancreatitis?
- Breed- spaniels and terriers
- Gender- neutered female
- Obesity
- Drugs
- Concurrent disease
- Diet- high fat diet
What diseases are associated with feline pancreatitis?
- Cholangitis
- IBD
- Hepatic lipidosis
- Diabetes mellitus
What are the clinical signs of acute pancreatitis in dogs?
- Dehydration
- Anorexia
- Vomiting
- Weakness
- Abdominal pain- prayer position
- Diarrhoea
- Jaundice
What are the clinical signs of acute pancreatitis in cats?
- Lethargy
- Anorexia
- Vomiting
- Abdominal pain
- Diarrhoea
How is acute pancreatitis diagnosed?
- History/physical examination
- Lab tests
- Diagnostic imaging- radiography, US
- Pancreatic biopsy
What may acute pancreatitis show on haem and biochem?
What pancreatic enzyme tests can be done?
Haem and Biochem
* Increased WBCs
* Increased glucose/decreased Ca
* Increased liver enzymes
* Jaundice
Pancreatic enzyme tests
* Total amylase and lipase
* Pancreatic lipase
Why is diagnostic imaging indicated for potential acute pancreatitis?
Radiography
* rule out other disease
Abdominal US- see pancreases enlarged
What is needed for a definitive diagnosis of acute pancreatitis?
Pancreatic biopsy
* Usually done at surgery ± sometimes laparoscopy
How is acute pancreatitis treated?
All therapy is supportive
* Nutritional support
* Pancreatic enzymes
* Fluid therapy
* Analgesia
* Anti-emetics
* ABs
* Steroids
* Surgery?
What diet therapy can be used for acute pancreatitis?
3-7 days
* Feed as soon as vomiting stops
* Use feeding tube is possible
3-28 days
* Low fat diet
* Small frequent meals
3 weeks onwards
* Chronic phase- normal or thin (hypoallergenic, low fat
* Chronic phase- obese- weight managment
Are pancreatic enzymes orally indicated?
No evidence of efficacy
But use as long as doesn’t affect appetite
What analgesia can be used for acute pancreatitis?
Avoid NSAIDs
* Buprenorphine
* Paracetamol
* Tramadol
* Gabapentin
What is the aetiology of exocrine pancreatic insuffiency?
Pancreatic acinar atrophy
* Most common in dogs- GSD
Pancreatic hypoplasia- rare congenital
Chronic pancreatitis
* More common in cats- rare
What are the clinical signs of EPI?
Faecal changes
* Large volumes
* Foul smelling
* Greasy
* Putty like
Appetite changes
* Polyphagia
* Coprophagia
* Pica- depraved appetite
Vomiting
Poor coat condition
How is EPI diagnosed?
Trypsin-like immunoreactivity
* Blood test
* Best test
< 2.5 in EPI
How is EPI treated?
Pancreatic enzyme
* Uncoated dry powder
* Enteric coated granules
* Fresh-frozen pancreas
Mix and feed with every meal
Dietary managment
* Not high fibre
* 2x maintenance for ideal weight
Supplement cobalamin if deficient
