Lab 8 - Pancreatic Function and GI Flashcards
1
Q
What is ileus
A
- lack of movement somewhere in the intestines that leads to a buildup and potential blockage of food material.
- can lead to an intestinal obstruction. This means no food material, gas, or liquids can get through. It can occur as a side effect after surgery.
- can be a blockage, can be outside of intestine - tumor, or inside - an irritant
2
Q
Neustigmin
A
Parasympomimetic which is rarely used
A) Locally: sm contraction, incr metabolism -> gas formation and accumulation is caused by gas from mouth
B) Systemic effect: incr mm (sm and striated) irritability (used in treatment)
3
Q
Atropine:
A
Parasympatholytic effect, only used in life saving occations
4
Q
Adrenaline
A
Sympathomimetic effect only used in life saving occations
5
Q
What are the GENERAL local and systemic effects if ileus
A
Local effects occur at the intestines
general effects: changes of circulation, electrolyte and water balance, acid-base balance etc
6
Q
What symptom means we need to check for ileus
A
Vomiting always
could also be pancreatitis
7
Q
effect of distal ileus (jejunum and more distal parts)
A
metabolic acidosis
8
Q
effect of proximal ileus (stomach, proximal duodenal part)
A
metabolic alkalosis in the beginning and metabolic acidosis follows.
Foreign body in or near stomach causing gas and fluid accumulation. This will activate the tensor receptors which will incr HCl production, which will be vomited. This loss of acids leads to metabolic alkalosis in the beginning. Then lactic acid is produced in anaerobic glycolysis, and met acidosis occurs.
9
Q
Symptoms of distal ileus (jejunum and more distal parts)
A
- no eating, empty stomach
- reflux: vomit contains small int fluids = high pH (out of body)
- dehydration
- anaerobic glycolysis=lactic acid ➡️ metabolic acidosis
- miserere: vomiting intestinal contents(feces)
10
Q
Symptoms of proximal ileus (jejunum and more distal parts)
A
severe vomiting, dehydration, anorexia, depression, etc.) are more prominent, and the general state of the animal is worsening more quickly, than in case of distal ileus.
11
Q
Local and general consequences in ileus
A
1️⃣ INTESTINAL SPASM onto foreign body
2️⃣ as decomposition of irritant begins it will not move aborally STASIS ➡️ GAS ACCUMULATION
3️⃣ aborally intestines are empty and sometimes stuck together
4️⃣ bv are COMPRESSED at ileus site
5️⃣ v/a flow is blocked; HYPOXIA
6️⃣ Lactic acid prod ➡️ NECROSIS, inflammation locally ➡️ bacteria from int into peritoneal cabity ➡️ local/general PERITONITIS
7️⃣ cranial osmotic fluic accumulation in int., water influx (full cran, empty aboral well visible in xray)
8️⃣ water into abd cavity=ASCITES, if bacteria present septic peritonitis
9️⃣ DEHYDRATION: VOMIT water: ca/fe/su, REFLUX:ru, stomach RUPTURE:ep ➡️ HYPOVOLEMIC SHOCK, eq die first
1️⃣0️⃣ K into intestines (HYPOKALEMIA) ➡️ muscle weakness(hypoventilation)➡️ RESP ACIDOSIS ➡️ GENERAL LACTACIDOSIS(also caused by no eating bc pain)
1️⃣1️⃣ HCO3- influx cause METABOLIC ACIDOSIS ➡️ general lactacidosis
1️⃣2️⃣Met +res acidosis = MIXED ACIDOSIS
1️⃣3️⃣ accumulation of bacteria cause ENDOTOXEMIA(gram-) toxin out if bacteria when it dies, to bloodstream causing SEPSIS (or exotoxemia in gram+)
🔺 BILE! Slows down bacterial reprod, but its not prod if animal dont eat! Eq dont have gallbladder!
Others, BLAH Bleeding Lack of CNS function Acute kidney failure Hypoxic liver damage
12
Q
aims of the examination of pancreatic function
A
1️⃣ diagnose inflammatory (acute and chronic)
2️⃣ regressive (necrosis, fibrosis, atrophy) changes in the pancreas
3️⃣ neoplastic changes (but these very rarely occur in veterinary patients)
13
Q
Where are pancreatic enzymes produced
A
acinar cells, activated in lumen of duodenum, during harmful processes eg inflammation the activation could occur in pancreas if walls are degr. Sep from maturing enzymes
14
Q
Disruped structure of pancreas
A
Since the enzymes are now activated inside pancreas, they can harm pancreatic tissue but also high amounts in blood:
1️⃣ cause severe lesions in organs far from the pancreas (lungs, kidney, heart, blood vessels, etc…)
2️⃣ abdominal cavity, peritoneal irritation locally near the pancreas (local peritonitis, damage to the liver, gall blader, omentum, fundus of the stomach, duodenum, spleen, right kidney, colon ascendens, and transversus),
A) or in severe cases generally on the whole surface of the peritoneum (generalised peritonintis).
15
Q
clinical signs and complications of pancreatitis
A
anorexia, depression, severe abdominal pain (at the epigastrium,in severe cases at the whole abdominal cavity), severe vomiting (pure water is also vomited!), exsiccosis, sometimes diarrhea, signs of heart failure, vasculitis, kidney failure, liver failure, dyspnoe, sometimes anaemia and/or icterus, sometimes signs of peritonitis, paralytic ileus, septicaemia, DIC, multi organ failure (MOF), abscess formation in the pancreas.
16
Q
Laboratory examination of pancreatic disease
A
requires haematological, serum biochemical, cytological and microbiological analysis.
17
Q
Haematological analysis checks
A
polycythaemia (due to dehydration)
degradation of red blood cells (membrane damage due to high activated enzyme level in the blood, schysiscytosis, acanthocytosis)
anaemia (in chronic sever cases)
leukocytosis (or leukopenia in case of abscess)
neutrophilia (or -penia), left shift
leukemoid reaction
18
Q
Serum (plasma) biochemistry checks what
A
1️⃣ activity or the concentration of pancreatic enzymes is increased in blood
2️⃣ determine glucose concentration, insulin production can be decreased by the organ damage, and diabetes mellitus can develop. (Function can restore after healing)
19
Q
❓Determination of pancreatic enzymes in the plasma:
A
alpha-amylase activity
lipase activity
phospholipase-a2 activity
trypsinogene - /trypsine/ concentration (RIA or ELISA methods)
elastase concentration (RIA or ELISA methods)
Best is: pancreas specific lipase (PSL) (ELISA method)
20
Q
❓Determination of substrates in pancreas:
A
glucose concentration (IDDM)
concentration of electrolytes (Na+, K+, Cl-) (alteration of isoosmosis, -ionia as a
consequence)
alpha2-macroglobulin concentration (it can be decreased because this protein is able to
bind to active pancreatic enzymes and deactivate them)
alpha1-antitrypsine concentration (it can also be decreased because of the intensive
utilisation, as it is an antiprotease which defends the plasma from trypsine and other
proteases)
triacylglycerol concentration (due to increased lipase activation, and/or IDDM)
Ca2+ concentration (Ca2+ can be depleted into the necrotised fat of the pancreas forming
“soaps”, “liponecrosis pancreatica”)
kidney, liver parameters and total protein, albumin concentration should be measured in
order to diagnose the effects of the complications.
21
Q
Name the parameters of pancreatitis
A
1+2 are the best
1️⃣ lipase (+ special lipase for cat and dog - Elisa)
2️⃣ alpha amylase
🔺 these two are not specific or sensitive for pancreatitis (except the special lipase!)
3️⃣ TLI
4️⃣ alpha amylase:creatinine
24
Q
What cause alpha-amylase activity increase
A
1️⃣ATLES acute pancreatitis acute 2️⃣ABSURDE Acute/subacute kidney failure 3️⃣FAR FIP 4️⃣LIKER lymphoma, myeloma 5️⃣DAG dm 6️⃣IKKE ileus 7️⃣GAUTE gastroc or int perforation 8️⃣PÅ parotitis 9️⃣CAMPING chronic enteritis
25
Q
Starch digestion test:
A
Spectrophotometric method! measure alpha-amylase activity
Starch absorb stain, when alpha-amylase digests it in alkaline environment stain become free. More free stain - more enzyme activity in plasma sample.
26
Q
p-nitrophenol method:
A
Spectrophotometric method! measure alpha-amylase activity
p-nitrophenol is bound to oligosacharides. Alpha-amylase splits oligosacharides to smaller parts (disacharids, monosacharids) freeing p-nitrophenol which is yellow. More yellow more alpha-amylase activity!
27
Lipase isoenzymes
As lipase is produced in stomach and intestines aswell damage to those qill incr the activity of pancreatic lipase. Its also secreted by kidney, but not as much as alpha amylase so incr act is less that that one.
28
Lipase activity determination by laboratory test, normal range
ELISA: acute pancreatitis in cats and dogs; pancreatic specifc lipase is measured.
Below 800
29
Turbidimetric method:
spectrophotometer. Reagent contains triolein (lipid) which is split by lipase. This will decr the turbidity of lipid reagent, the time of changed turbidity is prop to lipase activity.
30
Increased lipase activity is found in case of:
```
ATLES1️⃣acute pancreatitis
ABSURDE 2️⃣acute, subacute kidney failure
IDIOTI3️⃣ileus,
GIR4️⃣gastric or intestinal perforation
chronic enteritis.
CD5️⃣ chronic enteritis
```
31
Alpha-amylase/creatinin-ratio
- acute pancreatitis incr amylase and lipase activity
- kidney failure and pancreatitis incr creatinine, amylase and lipase
In order to estimate the real problem we can check the excretion of alpha-amylase and creatinin
32
Lab signs for pancreatitis in Alpha-amylase/creatinin-ratio
```
Pancreatitis:
⬆️ urine amylase
⬆️ plasma amylase
⬆️ urine creatinin
⬆️↔️ plasma creatinin
```
33
Lab signs for kidney failure in Alpha-amylase/creatinin-ratio
```
kidney failure:
⬇️ urine amylase
⬆️ plasma amylase
⬇️ urine creatinin
⬆️ plasma creatinin
```
34
Normal value Alpha-amylase/creatinin-ratio
1-6%, more than 6% means pancreatitis
35
mechanism of TLI (Trypsine like immunoreactivity)
Expensive, used in cat only
TLI is determined by RIA(radioimmunassay). Marked Ab`s are prod against trypsinogen(same hapten as tryspin): increased radioactivity that can be measured by specific analyser
In case of pancreatitis more trypsinogen or active trypsine can get into the blood stream and the concentration will be 15 times more than the normal value (2,5-5 μg/l). (Usually mostly into duodenum, little in blood)
36
TLI may not incr in case of pancretitis bc: (imp)
There is a strong defense mechanism against active enzymes entering the bloodstream. This consists of different antiprotease molecules (alpha 1-antitrypisine, alpha 2- macroglobulin) which bind active proteolytic enzymes in the blood and deactivate them. In some individuals this defense can be so strong, that it prevents the increase of TLI level in case of pancreatitis.
37
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
38
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
39
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
40
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
41
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
42
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
43
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
44
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
45
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
46
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
47
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
48
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
49
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
50
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
51
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
52
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
53
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
54
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
55
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
56
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
57
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
58
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
59
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
60
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
61
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
62
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
63
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
64
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
65
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
66
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
67
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
68
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
69
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
70
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
71
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
72
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
73
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
74
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
75
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
76
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
77
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
78
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
79
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
80
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
81
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
82
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
83
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
84
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
85
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
86
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
87
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
88
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
89
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
90
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
91
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
92
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
93
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
94
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
95
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
96
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
97
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
98
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
99
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
100
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
101
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
102
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
103
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
104
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
105
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
106
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
107
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
108
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
109
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
110
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
111
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
112
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
113
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
114
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
115
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
116
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
117
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
118
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
119
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
120
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
121
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
122
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
123
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
124
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
125
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
126
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
127
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
128
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
129
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
130
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
131
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
132
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
133
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
134
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
135
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
136
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
137
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
138
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
139
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
140
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
141
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
142
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
143
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
144
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
145
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
146
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
147
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
148
Pancreatitis vs. EPI
Pancreatitis
🔺Beautiful but unhappy
🔺 acute and painful! (No time to get "ugly")
EPI
🔺 ugly but happy
🔺 chrpnic and no pain, lack digestive enzymes
149
exocrine pancreatic insufficiency (EPI) - why does it develope
due to chronic necrotic or atrophic damage (caused by chronic inflammation, fibrosis, etc...) to the pancreas, or sometimes it is an inherited disease (pancreatic acinar atrophy=PAA, mostly in german shepherd dogs)..
150
exocrine pancreatic insufficiency (EPI) - how does it work
decreased production of digestive enzymes, or the enzymes do not get out from the organ into the intestines, they are very important in the digestion of lipids, proteins and carbohydrates
151
Symptoms of EPI
1️⃣ Undigested fat of surface of feces or light grey color
| 2️⃣ vit deficiancy -> skin and fur problems
152
EPI mechanism
Animals with EPI will loose weight, coprophagia can show. Undigested food in int ➡️ bacterial growth, products incr osmolarity ➡️ water influx from bv ➡️ intermittent diarrhea, incr gas(flatulence), bacterial eteritis
153
EPI treatment
Usually lifelong: parental admin vitamins, pancreatic enzymes orally, easily digested food etc
154
EPI tests
THE 1️⃣ TLI conc ↔️⬆️
BROWN2️⃣ BT-PABA⬇️
DOGS3️⃣ dyed agar-gel digestion & schwachmann filmtest
LIKES4️⃣ lipid absorption test⬇️
FRIED5️⃣ fecal elastase test⬇️
EGGS 6️⃣ examination of undigested particles in fecal samples⬆️
155
TLI-concentration:
examination of EPI (and pancr!)
If EPI is caused by obstruction of the pancreatic duct, TLI level is normal or high!
156
BT-PABA test mechanism
PABA will be low in blood, urine if EPI bc. Needs to be split BT-PABA to be absorbed
157
❓BT-PABA test method
If it is determined from blood plasma we have to take blood samples before giving BT- PABA to the animal as a basal value, then give BT-PABA orally, and take blood samples after 15, 30, 60, 90, 120 minute.
158
Schwachmann-filmtest: mechanism
determine enzyme activity from faecal samples. Chymotrypsine and elastase can digest gelatine. Uncharged X-ray film contains gelatine so it can be used for this test
159
Schwachmann-filmtest method
Mix fecal sample with sodiumbicarbonate solution to maintain alkalytic pH. This and the xray film is put into a tube. Maintaining 37 oC in a thermostat, after 30-60 minutes the x-ray film strip becomes transparent if faecal sample contains enough digestive enzymes to digest gelatine on the film.
Transparent = enzymes are present
160
Dyed agar-gel digestion test
stained (usually with a blue dye) agar gel should be prepared to have a stable pH value of 8, and poured into Petri-tray.. One peace of faecal sample should be put onto the middle of the gel and maintaining 37 oC in a thermostat after 30-60 minutes we can see wide digested circle around the sample if faecal sample contains enough digestive enzymes.
Wide digested circle = enzymes are present
161
Lipid absorption test mechanism, normal value
Will be decreased!
determine whether there is existing lipid malabsorption, maldigestion , especially in EPI or chronic small bowel disease. When there is fast lipid intake in normal conditions, plasma triglycerol (TG) concentration rises to twice as the
normal value (normal for dogs: 1 mmol/l).
162
Lipid absorption test method
1️⃣ blood sampling
2️⃣ corn oil is given orally
3️⃣ Blood sampling should be performed at 1st, 2nd, 3rd, 4th, 5th hours after admin
Min twofold rise is normal in TG. No change: give enzymes and corn oil mix, incubate at 37˚C, check conc every hour.
No change: exocrine pancreatic insufficiency (EPI), intestinal absorption defect
163
Faecal elastase test
low!
Similar diagnostic value has the faecal elastase test which is performed by ELISA method. In this case a specific method is used to determine whether the faecal sample contains elastse or not. In case of EPI elastase is generally not found in measurable quantity.
164
Examining undigested particles in faecal sample. Mechanism
Three faecal smears should be prepared.
1️⃣) One smear is stained with Giemsa - striated mm
2️⃣) Second is stained with Lugol-solution (containing. Iodine) - starch
3️⃣) Third sample is stained with Sudan III.-solution. - fat
4️⃣ gram stain for bacterial flore
165
undigested particles in faecal sample interpretation
1) In Giemsa-stained smear undigested striated muscle fibers (from meat) can be seen.
2) In Lugol-stained smears we can see undigested starch particles as bluish patches
(Lugol-solution is brown and it turns blue when starch is added to it)
3) In Sudan III-stained smears undigested lipid particles can be seen as red droplets
If EPI is suspected to be complicated with severe bacterial enteritis, Gram-staining of one faecal smear can help us choosing the right antibiotic before bacterial culture of the faeces is ready (it tekes some days, but severe enteritis should be treated immediately).
166
A amylase production and excretion, normal range
Production: pancreas, small intestines, parotid gland
Exretion: kidney and liver
Below 1000
167
Name the tests for acute pancreatitis
1️⃣ SE startch digestion test (a amylase)
2️⃣ PÅ P-nitrophenol test (aa)
3️⃣ TUVAS turbidimetric test (lipase)
4️⃣ TÅ TLI conc in cats (TLI)
