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Y4 SA - Internal medicine > Investigating pancreatic disease > Flashcards

Investigating pancreatic disease Flashcards

1
Q

Which structure in the pancreas is responsible for hormone production?

A

Islets of Langerhans

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2
Q

What is produced by acinar cells in the pancreas?

A

Digestive enzymes

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3
Q

Which structures are anatomically associated with the pancreas?

A

Stomach
Liver
Duodenum
Colon

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4
Q

Describe the pathogenesis of acute pancreatitis

A
  • Trypsin is activated in the pancreas
  • Sterile inflammation
  • Thought to be caused by inappropriate activation of digestive enzymes
  • Normally the pancreas produces enzymes in an inactive form or enzymes that don’t work without a co-enzyme
  • Necrosis, blood and inflammatory cells
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5
Q

What is the aetiological cause of most cases of pancreatitis?

A

Idiopathic

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6
Q

List some predisposing factors for pancreatitis

A
  • Breed - Spaniels & terriers especially
  • Female > Male
  • Neuter > entire
  • Obesity
  • Drugs
  • Concurrent diseases
  • Dietary factors
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7
Q

Which 4 diseases are associated with feline pancreatitis?

A

Cholangitis
IBD
Hepatic lipidosis
Diabetes mellitus

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8
Q

How does a high fat diet link to pancreatitis?

A

Hyperlipidaemia
- Obesity
- Diabetes mellitus
- Primary hyperlipidaemia
Dietary indiscretion: Raiding bins, table scraps etc

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9
Q

List the clinical signs of acute pancreatitis in dogs

A

Dehydration
Anorexia
Vomiting
Weakness
Abdominal pain - prayer position
Diarrhoea
Jaundice

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10
Q

List the clinical signs of acute pancreatitis in cats

A

Lethargy
Anorexia
Vomiting
Abdominal pain
Diarrhoea

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11
Q

List the diagnostic methods that can be used for acute pancreatitis

A
  • History / physical examination
  • Laboratory tests
  • Diagnostic imaging: Radiography, Ultrasonography
  • Pancreatic biopsy
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12
Q

Describe the haematology and biochemistry results seen in cases of acute pancreatitis

A
  • Increased WBCs
  • Increased glucose
  • Decreased calcium
  • Increased liver enzymes
  • Increased bilirubin
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13
Q

Why is decreased calcium seen in acute pancreatitis?

A

Decreased calcium due to fat necrosis -> calcium deposition in this area

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14
Q

When is jaundice seen in acute pancreatitis?

A

If there’s obstruction of the pancreatic duct

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14
Q

Name two pancreatic enzyme tests

A
  • Total amylase and lipase
  • Pancreatic lipase
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15
Q

Describe the pancreatic lipase test

A

More specific
Less affected by azotaemia?
SNAP test is available

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16
Q

If amylase and lipase results come back normal, what is the next step in reaching a diagnosis?

A

Diagnostic imaging

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17
Q

Describe the use of radiography in diagnosing acute pancreatitis

A

Rules out other disease
Not great for pancreatic disease

18
Q

Describe the use of ultrasound in diagnosing acute pancreatitis

A

Hyper-echoic or hypo-echoic
Pancreas enlarged & swollen
Mesenteric changes (hyper-echoic)

19
Q

Which test is needed for a definitive pancreatitis diagnosis?

A

Pancreatic biopsy

20
Q

List the treatment options for pancreatitis

A

All therapy is supportive
Nutritional support
Pancreatic enzymes
Fluid therapy
Analgesia
Anti-emetics
Antibacterials?
Steroids?
Surgery?

21
Q

Describe the initial diet therapy in the first 3-7 days of pancreatitis

A

Feed as soon as vomiting stops
Nutritional support
Use a feeding tube if possible

22
Q

Describe the diet therapy from around day 3-28 following acute pancreatitis

A
  • First, small amounts of water…If OK, start food cautiously
  • Low fat diet, small frequent meals
  • Can use pancreatic enzymes as long as they dont affect appetite
23
Q

Why do animals with pancreatitis need to be on a low fat diet?

A

Fat stimulates release of pancreatic enzymes

24
Q

Describe analgesia given to patients with acute pancreatitis

A

Essential part of treatment
Avoid NSAIDs
Buprenorphine
Paracetamol (DOGS ONLY)
Tramadol
Gabapentin

25
Q

Describe anti-emetic therapy for patients with acute pancreatitis

A

Vomiting & nausea are common
Use of anti-emetics advisable
Allows early enteral nutrition
Maropitant or metoclopramide

26
Q

When should antibacterials be considered in cases of acute pancreatitis?

A

Most cases of pancreatitis are sterile
But, intestinal wall ‘leaky’ -> bacteraemia
Therefore, consider prophylactic use

27
Q

Name the 3 aetiological causes of exocrine pancreatic insufficiency

A

Pancreatic acinar atrophy
Pancreatic hypoplasia
Chronic pancreatitis

28
Q

Describe the features of Pancreatic acinar atrophy

A

Atrophy – normal at birth and something has led to the destruction of those cells
- Most common in dogs
- 66% of cases are GSD
- Heritable in GSD and rough collies

29
Q

Describe the features of pancreatic hypoplasia

A

Rare congenital (<6 months) – never developed properly from birth
Associated juvenile diabetes mellitus

30
Q

Describe the features of chronic pancreatitis

A

Similar signs as acute but more subtle
More common in cats (still rare!)

31
Q

List the clinical signs of exocrine pancreatic insufficency

A
  • Faecal changes
  • Appetite changes
  • Vomiting
  • Poor coat condition
  • Poor BCS
32
Q

Describe the faecal changes seen in exocrine pancreatic insufficency

A

Large volumes
Foul smelling
Greasy (steatorrhoea)
Putty-like to overt diarrhoea

33
Q

Describe the appetite changes seen in exocrine pancreatic insufficency

A

Polyphagia (increased appetite)
Coprophagia (ingesting faeces)
Pica (depraved appetite)

34
Q

How is exocrine pancreatic insufficency diagnosed?

A

Trypsin-like immunoreactivity
- Blood test
- Best test: very specific
Normal dogs TLI = >5 μg/L
Dogs with EPI = <2.5 μg/L
Equivocal = 2.5-5.0 μg/L (repeat in 4wk)

35
Q

How is exocrine pancreatic insufficency treated?

A
  • Pancreatic enzymes
  • Dietary management
  • Cobalamin supplementation
36
Q

Describe dietary management to treat exocrine pancreatic insufficiency

A
  • Feed a highly digestible diet
  • No need to fat restrict: need calories for weight gain
  • NOT high fibre
  • Exclusion diet not necessary
  • Insure adequate food intake: 2x maintenance for ideal weight
37
Q

Describe cobalamin supplementation to treat exocrine pancreatic insufficiency

A
  • Dogs with EPI commonly have low cobalamin concentrations
  • Injection or oral vitamin B supplementation
  • Pancreas does not produce intrinsic factor
  • Poor prognostic indicator
  • Shorter survival in EPI with low cobalamin
  • Supplement cobalamin if deficient
38
Q

Describe the effects of bacterial overgrowth secondary to EPI

A

Bacterial overgrowth can occur secondary to EPI as food isn’t digested in the SI giving the bacteria a media for growth and proliferation -> worsening diarrhoea

39
Q

Is exocrine pancreatic insufficiency significant in cats?

A

A rare disease in cats
Median age 7 years (0.3-15 years)

40
Q

List the clinical signs of EPI in cats

A

Very similar to dogs
- Weight loss (or poor growth)
- Diarrhoea
- Polyphagia, coprophagia, anorexia, flatulence
- Vomiting
Signs of any concurrent disease - Lethargy, hair loss, PU/PD, weakness

41
Q

How is EPI diagnosed in cats?

A

Serum trypsin-like immunoreactivity

42
Q

How is EPI treated in cats?

A

Oral pancreatic enzyme
Cobalamin
Dietary modification
Antibacterials
Treat other diseases

Y4 SA - Internal medicine (7 decks)

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