Investigating pancreatic disease Flashcards
What problems can you get with the pancreas?
- Pancreatitis
- Exocrine pancreatic insufficiency
- Neoplasia
How does acute pancreatitis occur?
- Trypsinogen gets activated to trypsin by an aetiological factor
- Trypsin activates other proteases and directly damages tissue
- The other proteases also cause tissue damage
- This leads to the cascade initiation = coagulation, fibrinolysis, complement + kallikrein-kinin
What are predisposing factors for acute pancreatitis?
- Breed - spaniels + terriers
- Sex - Female > Male, Neuter > Entire
- Obesity
- Drugs
- Concurrent diseases
- Dietary factors
What is feline pancreatitis associated with?
- Cholangitis
- IBD
- Hepatic lipidosis
- Diabetes mellitus
What are clinical signs of pancreatitis in dogs?
- Dehydration
- Anorexia
- Vomiting
- Weakness
- Abdominal pain
- Diarrhoea
- Jaundice
What are clinical signs of pancreatitis in cats?
- Lethargy
- Anorexia
- Vomiting
- Abdominal pain
- Diarrhoea
How is acute pancreatitis diagnosed?
1* History + physical exam
2* Lab tests
3* Diagnostic imaging - radiography + US
4* Pancreatic biopsy - only for chronic cases
What would you see on haematology and biochemistry with acute pancreatitis?
- Increased white blood cells
- Increased glucose / decreased calcium
- Increased liver enzymes
- Jaundice (increased bilirubin)
What are pancreatic enzyme tests?
- Total amylase + lipase
- Pancreatic lipase - more specific, less affected by azotaemia
What are your cut off values for amylase, lipase + pancreatic lipase?
- Amylase <2000iu/l
- Lipase <200iu/l
- Pancreatic lipase 2.2-102ng/ml
What is needed for definitive diagnosis?
- Pancreatic biopsy
- usally done at surgery - sometimes laparoscopy
- anaesthesia can exacerbate pancreatitis
What is treatment of pancreatitis?
- Supportive!!
- nutritional support
-pancreatic enzymes - fluid therapy
- analgesia
- anti-emetics
What is initial dietary therapy?
- First 3-7days
- Feed as soon as vomiting stops + nutritional support
- Use feeding tube if possible
What is interim diet therapy?
- From day 3-28ish
- Small amounts of water, start food cautiously
- Low fat diet, small frequent meals
What is long term diet therapy?
- From 3 weeks onwards
- weight management
What analgesia could you use to treat pancreatitis?
- Avoid NSAIDs
- Buprenorphine
- Paracetamol (dogs)
- Tramadol
- Gabapentin
What are the 3 aetiologies of exocrine pancreatic insufficiency?
- Pancreatic acinar atrophy - most common in dogs, (GSD + rough collies)
- Pancreatic hypoplasia - rare congenital (<6mo), associated juvenile diabetes mellitus
- Chronic pancreatitis - most common in cats
What are clinical signs of EPI in dogs?
- Faecal changes - large volumes, foul smelling, greasy, putty like
- Appetite changes - polyphagia, coprophagia, pica (depraved appetite)
- Vomiting
- Poor coat condition
- Weight loss
How is EPI diagnosed?
- Trypsin-like immunoreactivity
- normal dogs >5ug/l
- dogs with EPI <2.5ug/l
subclinical EPI = repeatedly 2.5-5ug/l
What is treatment of EPI?
- Pancreatic enzyme - mix with each meal + feed
-uncoated dry powder
-enteric coated granules
-fresh-frozen pancreas - Treat complications = antibacterials, acid blockers
What is dietary management of EPI?
- Feed highly digestible diet - NOT high fibre
- cobalamin supplementation if deficient (poor prognostic indicator)
What are clinical signs of EPI in cats?
- 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
How is EPI diagnosed in cats?
- Serum trypsin-like immunoreactivity
What is treatment of EPI in cats?
- Oral pancreatic enzyme
- Cobalamin
- Dietary modification
- Antibacterials
- Treat other diseases
