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SA Gastroenterology (Spring 2015) > L12: Pancreatic Dz in the Dog and Cat > Flashcards

L12: Pancreatic Dz in the Dog and Cat Flashcards

1
Q

secretory functions of the pancreas

A

exocrine: into duodenum
- acini release digestive enzymes and cofactors
- ducts release HCO3 buffer
endocrine: into portal blood
- islets release hormones

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2
Q

route of digestive enzymes from pancreas

A
  • packaged in membranes and transported toward the lumen

- routed through pancreatic acinar cell

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3
Q

pancreatic enzymes

A
  • amylase and lipase (active form)

- proteolytic enzymes (inactive zymogens; Ca needed to activate)

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4
Q

activation of ___ required for activation of all other pancreatic zymogens

A

trypsinogen

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5
Q

trypsinogen – ? –> trypsin + activation peptide

A

enteropeptidase (trypsin)

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6
Q

Pancreatic Secretory Trypsin Inhibitor (PSTI)

A

inhibits trypsin from binding

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7
Q

why doesn’t the pancreas digest itself?**

A
  • intracellular compartmentalization
  • proteases formed in inactive form
  • PSTI secreted in parallel with trypsinogen
  • enterokinase is extrapancreatic
  • low intracellular calcium (needed to activate proteolytic enzymes)
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8
Q

Colocalization theory

A

potential pathogenesis for Pancreatitis in which zymogens and lysosomes mix –> activation of trypsinogen –> autodigestion –> inflamm, edema, hemorrhage, necrosis, peripancreatic fat necrosis

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9
Q

Risk factors for pancreatitis

A
  • Dietary: fat, indiscretion
  • Pancreatic ischemia
  • Reflux of duodenal contents-bile
  • drugs
  • duct obstruction
  • genetic factors
  • idiopathic
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10
Q

chars. of pancreatitis

A
  • common
  • usually more severe in dogs
  • middle-aged dogs, all age cats
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11
Q

CS of pancreatitis (most to least common): DOGS

A
  • vomiting (90%)
  • weakness (80%)
  • abd pain (60%)
  • dehydration
  • diarrhea
  • anorexia
  • depression
  • fever
  • abd distention
  • cranial abd mass
  • shock
  • cardiac arrhythmia
  • resp. distress
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12
Q

CS of pancreatitis (most to least common): CATS

A 
lethargy (100%)
anorexia (97%)
dehydration
hypothermia
abd pain
palpable mass
dyspnea
ataxia
diarrhea (15%)
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13
Q

triaditis includes:

A

IBD, pancreatitis, colitis

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14
Q

clin path of pancreatitis: DOG SPECIFIC

A
  • neutrophilia and L shift (55%) (L shift due to inflamm, not infection)
  • thrombocytopenia (60%)
  • anemia (30%)
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15
Q

clin path of pancreatitis: CAT SPECIFIC

A
  • anemia (26%)
  • hemoconcentration (13%)
  • leukocytosis (30%)
  • leukopenia (15%)
  • changes may be due to stress alone!)
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16
Q

clin path of pancreatitis in general

A
  • azotemia
  • hypoalbuminemia
  • hyperglycemia
  • hypocalcemia (Ca can get sucked into suponification of fat)
  • hyperlipidemia (due to disturbed fat metabolism)
  • hyperbilirubinemia
  • inc. liver enzyme activity (as pancreas swells, bile duct obstructed and bile backs up –> secondary damage to liver, translocation of bacteria possible
17
Q

Dx of pancreatitis

A
  • cPLI and fPLI (however not 100% sensitive or specific; do not rely on for dx! Can also be FB, cushings, etc)
  • amylase and lipase and TLI unreliable
  • histology = gold standard
18
Q

cats more likely to get chronic/acute pancreatitis?

A

chronic, making fPL test less useful than in dogs because they can have intermittent fPL increases

19
Q

rad findings with pancreatitis

A
  • loss of serosal detail R cranial abd
  • duodenum displaced laterally
  • duodenum and colon gas-filled (sentinel loop)
  • corrugated duodenal wall and/or pancreatic mass
20
Q

pancreatitis on abd U/S

A
  • hypoechoic and enlarged pancreas

- peripancreatic fat hyperechoic

21
Q

when is biopsy indicated with pancreatitis?

A

(usually not indicated; changes may not correlate clinically)
chronic cases
mass lesions

22
Q

tx of pancreatitis

A
  • supportive (fluids, pain meds, anti-emetics)
  • GI rest? (cons: prolonged anorexia, GI mucosal barrier)
  • blood, plasma, or plasma expander
  • parenteral abx (usually not needed)
  • gradually reintroduce low fat food with clinical improvement
  • return to normal diet if isolated episode
  • keep on low fat diet if recurrent
23
Q

goals for fluid therapy in tx of pancreatitis

A
  • replace deficit
  • replace ongoing losses
  • maintenance
  • use balanced electrolyte solution (ie. LRS)
  • give K supplementation
24
Q

when is surgical exploration of pancreatitis indicated?

A
  • pancreatic abscess or mass

- prolonged bile duct obstruction

25
Q

tx of feline chronic pancreatitis

A

-anti-emetics

+/- steroids

26
Q

chars. of Exocrine Pancreatic Insufficiency (EPI)

A
  • lack of pancreatic enzymes
  • dogs with degenerative atrophy prone
  • cats with chronic pancreatitis prone
27
Q

CS of EPI

A

polyphagia
weight loss
steatorrhea
voluminous diarrhea

28
Q

Dx and Tx of EPI

A

Dx: low trypsin-like immunoreactivity
Tx: powdered enzymes, oral abx (for SIBO), cobalamin

SA Gastroenterology (Spring 2015) (9 decks)

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