Lecture 1 1/23/25 Flashcards
How do the bile and pancreatic ducts differ between dogs and cats?
-dogs have separate bile and pancreatic ducts
-cats have a fused beginning of the bile and pancreatic duct
Which cell types are found within the pancreas?
-alpha cell
-beta cell
-delta cell
-exocrine pancreas (acinar and duct cells)
-F cell
What is the role of alpha cells?
secrete glucagon
What is the role of beta cells?
secrete insulin
What is the role of delta cells?
secrete somatostatin
What is the role of F cells?
secrete pancreatic polypeptide
What is trypsinogen?
inactive form of trypsin
What is the role of trypsin?
involved in the conversion and activation of all other exocrine pancreas enzymes
How can trypsinogen be converted into trypsin?
-enterokinase, which is physiologically released following ingestion
-pathologic stimuli including cathepsin B and ischemia
Why is trypsinogen important?
having an inactive form of trypsin prevents the pancreatic enzymes from being continuously produced and digesting the pancreas itself
What is the role of pancreatic secretory trypsin inhibitor?
to inhibit active trypsin and prevent pancreatic digestion by enzymes
Why is it important that the duct cells secrete NaHCO3?
this solution buffers pH and prevents an environment that would promote trypsinogen activation
Why is it important that there is a unidirectional flow of enzymes through and out of the pancreas?
prevents enzymes from remaining in the pancreas once activated and causing damage
What is the importance of an apical block?
it prevents the release of activated trypsin from the pancreatic cells, which leads to enzymes digesting the pancreas
What happens when pancreatic enzymes are released within the cells inappropriately?
the pancreatic fat becomes inflamed
What are the general characteristics of acute pancreatitis in dogs?
-inflammation of the pancreas
-sudden onset
-activation of enzymes within the gland leads to autodigestion
-tissue injury occurs
What is the “balancing act” that occurs within the pancreas?
-supportive care and treatment helps promote the protective mechanisms of the pancreas and allow for absence of disease
-genetic and/or environmental risk factors can increase stressors and result in pancreatic injury
What are the histological findings in acute pancreatitis?
-neutrophilic inflammation
-edema
-necrosis
What are the histological findings in chronic pancreatitis?
-fibrosis
-acinar loss
How do dogs and cats differ in terms of pancreatitis?
dogs are more likely to get acute pancreatitis while cats more commonly get chronic pancreatitis
What are the clinical signs of pancreatitis in dogs?
-vomiting
-abdominal pain
-depression
-anorexia
-fever
-shock and collapse
-coagulopathy/DIC
What are the clinical signs of pancreatitis in cats?
-anorexia and lethargy
-potential vomiting
-potential pain
-triaditis/inflammation of liver, pancreas, and small intestine
What are the predisposing factors for pancreatitis?
-dietary factors
-ischemia/reperfusion
-hyperlipidemia
-drugs/toxins
-breed predilection/schnauzers and terriers
-duct obstruction
-duodenal/biliary reflux
-trauma
-cryptogenic/unknown
What are the signs of pancreatitis on clin path?
-left shift neutrophilia
-hyperlipidemia
-increased amylase and/or lipase
-concurrent increase of liver enzymes
-hyper- or hypoglycemia
-hypocalcemia
-azotemia
What are the characteristics of canine pancreatic lipase immunoreactivity?
-quantitative assessment via Spec
-qualitative assessment via SNAP
-SNAP test is good for ruling out pancreatitis at GP level
-SNAP test assessment is either normal, grey zone, or abnormal
What are the characteristics of lipase DGGR?
-90% correlation to cPLI
-negative result excludes pancreatitis
What are factors that could increase cPLI and DGGR, and potentially cause a false positive pancreatitis?
-renal disease
-cardiac disease
-diabetes
-hyperadrenocorticism
-any upper GIT inflammation
Which tests are used for pancreatitis diagnosis in felines?
-feline pancreatic lipase immunoreactivity/fPLI
-lipase DGGR
What findings on radiographs can indicate pancreatitis?
-left-displaced pylorus
-right-displaced, enlarged duodenum
-visualization of pancreas as soft tissue opacity
-duodenal ileus
-peritonitis
Which imaging modality is the optimal choice for pancreatitis diagnosis?
ultrasound
Which findings on ultrasound can indicate pancreatitis?
-corrugated duodenum
-enlarged hypoechoic pancreas
-hyperechoic fat
What are the characteristics of hypovolemia associated with pancreatitis?
-associated with excessive vomiting and diarrhea
-can lead to peritonitis
-can cause pain
-can lead to acute kidney injury
What are the hepatobiliary consequences of pancreatitis?
-impaired liver function
-obstruction of the biliary duct/biliary statis (typically functional)
What are the respiratory consequences of pancreatitis?
-ALI or ARDS in up to 45% of severe panc. cases
-aspiration pneumonia from vomiting
-pleural effusion
What is the pathophysiology of DIC related to pancreatitis?
-digestive enzymes and inflammatory cytokines enter circulation
-enzymes and cytokines cause vasodilation
-vasodilation results in hypotension, pulmonary edema, and DIC
What are the three main considerations of pancreatitis treatment?
-never let them vomit
-never let them suffer
-never let them starve
