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Clin Path > Lecture 15/16 Gastrointestinal evaluation (test 2) > Flashcards

Lecture 15/16 Gastrointestinal evaluation (test 2) Flashcards

1
Q

what are your pancreatic serum tests?

A

Amylase
Lipase
TLI
PLI

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2
Q

what are your serum GI tests

A

Serum Folate
Serum Cobalamin
Serum Uncong. Bile Acids
GI “function” assay

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3
Q

what are the two major functions of the pancreas

A

Exocrine

Endocrine

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4
Q

what is the main function of the pancreas, and what are common disorders of the exocrine pancreas

A

Aids in digestion
production and secretion of digestive enzymes
regulated by hormonal and neuronal mechanisma
Many enzymses are preformed and stored as inactive zymogens

Exocrine pancreatic disorders
Pancreatitis/injury
EPI
Neoplasia

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5
Q

what are the 4 main enzymes that can help diagnosis pancreatitis

A

Amylase
lipase
PLI
TLI

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6
Q

what is the function of Amylase

A

slide 16

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7
Q

what is the function of lipase

A

slide 16

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8
Q

how is Amylase and Lipase cleared from the body

A

Excretion through urine

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9
Q

what can cause an ↑ in amylase and lipase?

A 
Pancreatic injury
Obstruction of pancreatic ducts
Non-Pancreatic 
   renal failure
   GI Dz
   Hepatobiliary Dz
   Some drugs (glucocorticoids and can ↑ lipase)
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10
Q

how much of an increase would you want to see in amylase to suspect pancreatitis?

A

at least 3-4 times

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11
Q

what other enzyme ifbe increased helps your R/O pancreatitis?

A

Azotemia

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12
Q

T or F

an Lipase value increased of 8X is diagnostic for pancreatitis

A

False
it is suggestive, Dogs with pancreatitis can have normal → 10X RI increase of Lipase

other factors should be addressed to confirm

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13
Q

what does PLI stand for and what is it used for?

A

Pancreatic Lipase Immunoreactvity

there is a specific pancreatic isoform that can be identified in the blood when pancreatic tissue is damaged

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14
Q

Is the PLI test species specific?

A

YES

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15
Q

what does TLI stand for, and what does it test

A

Tripsin Like Immunoreactivity

trypsin leaks from damaged pancreatic tissue

there is a small amount released into circulation in the healthy animal but is decreased in EPI

an increase “may” be seen with early acute pancreatitis (very low sensitivity)

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16
Q

Why might Azotemia R/O pancreatitis?

A

if your GFR is down, you will have an increased in proteins (azotemia), Amylase and lipase are cleared by the kidneys, so an increase of

17
Q

more lipase ?

A

j

18
Q

What is the cause and consequences of API

A

Failure to produce pancreatic enzymes and bicarbonate

Clinical signs

  • weight loss
  • normal to increased appetite
  • Steatorrhea
19
Q

what is a DfDx, and/or often a sequelea of EPI

A

SIBO

small intestinal bacterial overgrowth

20
Q

what is the best test for EPI diagnosis and why

A

TLI

  • best test to detect EPI in dogs and cats
  • intestinal Dz will not decrease this value
21
Q

what other tests might you use for EPI diagnosis or R/O’s.

A

Fecal elastase

  • specific for pancreas
  • species specific ELISA
  • 20% false (+) rate so better used to exclude than to diagnse EPI

Evaluation of feces for fat or starch

  • sudan stain is used to detect lipid
  • 2% lugol’s iodine is used to detect starch

Fecal proteolytic activity

  • if present, this R/O EPI
  • Common to have False (-)
22
Q

what two things should you consider when faced with chronic diarrhea and weight loss?

A

Consider

  • Maldigestion
    • Failure to adequately digest food: EPI is a DfDx
  • Malabsorption
    • Failure to absorb digested food particulate
      • Numerous reasons

the treatment and prognosis will vary depending on the primary cause

you NEED to determine the underlying process!!!

23
Q

what are the laboratory serum evaluations of GI Dz.

A 
Serum
Tests
– Folate
– Cobalamin
– Unconjugated bile acids
– Gastrin
– GI “functon” assays
24
Q

what are some laboratory Fecal evaluations for GI Dz

A

Fecal Tests
– Fecal floata.on, direct smear, wet mount

– Alpha-­‐1 anti‐protease inhibitor

  • Fecal occult blood
  • ELISA or PCR for pathogens
  • Cytology
  • Evaluation of feces for undigested materials (fat, starch)
25
Q

Where is Serum Folate absorbed, and what are the sources of it?

A

Serum Folate = Vit B9

It is absorbed in the PROXIMAL small intestine, and is absorbed in the diet and production by small intestinal bacteria

26
Q

What are you specifically measuring when you run a serum cobalamin test?

A

Vitamin B12

27
Q

when should you order a serum Folate and Cobalamin test?

A

patients with suspected small intestinal Dz (chronic weight loss, diarrhea)
- as long as EPI has been excluded

28
Q

where is Gastrin produced

A

Produced by the cells in the pyloric antrum and duodenum

29
Q

What does the Fecal Occult Blood test detect for identification of GI bleeding, and what might cause false positives?

A

Detects peroxidase activity from Hgb

False positives with meat (myoglobin, or certain plant peroxidases), or iron supplementation.

30
Q

Why might you use the Fecal Alpha-1 Protease Inhibitor?

A

Aids in detection of PLE

31
Q

What characteristic erythron would you have that you might want to run Fecal Occult Blood test

A

Microcytic Hypochromic anemia, for a small bleeding tumor, or loss of blood into the GI

32
Q

You are presented with a horse with a gastric pH of >6 which you know suggests intestinal reflux, what might be the cause of this?

A

suggests an outflow obstruction

33
Q

what is considered the GOLD standard for diagnosis of SIBO

A

GI content analysis

Duodenal contents may be sampled for bacterial culture

34
Q

what are some DfDx for Rumenal alkalosis (Ph>7)

A
  • decreased microbial fermentation

- excessive generation of ammonia (urea tosicosis)

35
Q

What are some DfDx for Rumenal acidosis (pH

A
  • carbohydrate overload

- Lactic acid accumulation

Clin Path (5 decks)

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