Lecture 19 11/12/24

Question 1

What is the cycle of pancreatitis?

Answer 1

-trigger leads to inflammation
-inflammation causes cell damage +/- cell death
-dell damage/death leads to enzyme leakage
-enzyme leakage worsens the cell damage and causes more inflammation

Question 2

What are the characteristics of pancreatitis?

Answer 2

-mostly seen in dogs and cats
-acute or chronic
-severity is highly variable

Question 3

What are the clinical signs of pancreatitis?

Answer 3

-abdominal pain
-loss of appetite
-vomiting

Question 4

What are the potential consequences of pancreatitis?

Answer 4

-affects peritoneum
-obstructive cholestasis
-secondary exocrine pancreatic insufficiency
-secondary diabetes mellitus

Question 5

What are the components of pancreatitis diagnosis?

Answer 5

-clinical history
-physical exam
-minimum database
-specialized lab tests
-parasite/infection testing
-abdominal imaging
-possible pancreatic cytology/histopath.

Question 6

What are the characteristics of exocrine pancreatic insufficiency?

Answer 6

-failure of pancreatic digestive function
-can be primary/breed-associated
-can be secondary to chronic pancreatitis

Question 7

What are the steps of exocrine pancreatic insufficiency?

Answer 7

-acinar cell destruction
-lack of digestive enzymes and bicarb.-rich fluid
-inability to digest nutrients
-imbalance of intestinal flora
-maldigestion; weight loss and chronic diarrhea

Question 8

What are the components of exocrine pancreatic insufficiency diagnosis?

Answer 8

-clinical history
-physical exam
-minimum database
-specialized lab tests
-parasite/infection testing
-possible abdominal imaging
-possible intestinal histopath.

Question 9

How does pancreatitis differ from EPI?

Answer 9

pancreatitis:
-pancreatic inflammation
-enzyme leakage and further inflammation
-vomiting and abdominal pain
EPI:
-destruction of acinar tissue
-pancreatic insufficiency and maldigestion
-chronic diarrhea and weight loss

Question 10

What are the characteristics of lipase measurement?

Answer 10

-total lipase can be found on routine chem panels
-total lipase is not specific for pancreas alone
-3-5 fold increase above upper reference limit is consistent with pancreatitis

Question 11

What are the characteristics of pancreatic lipase concentration?

Answer 11

-can be measured via pancreatic lipase immunoreactivity test
-ELISA (categorical) or radioimmunoassay (quantitative) options
-fasting serum sample
-increased values in pancreatitis cases
-specifically detects pancreatic lipase only

Question 12

What is a positive and negative result on the Idexx SNAP cPL?

Answer 12

negative: patient spot being lighter than the control
positive: patient spot being as dark or darker than the control

Question 13

What steps should be taken when working with SNAP tests to avoid error?

Answer 13

-don’t use expired tests
-warm components to room temp.
-place kit on horizontal surface
-measure drops carefully
-snap the test correctly

Question 14

What is the take home regarding quantitative PLI results?

Answer 14

the higher the PLI conc., the more supportive of a pancreatitis diagnosis

Question 15

What are the characteristics of exocrine pancreatic insufficiency lab. diagnosis?

Answer 15

-use trypsin-like immunoreactivity test
-fasting, non-hemolyzed serum sample
-TLI values are decreased in EPI patients

Question 16

What are the general characteristics of enteropathy?

Answer 16

-many potential disorders
-can cause maldigestion, malabsorption, and protein loss
-chronic diarrhea and weight loss possible
-gut microflora may be abnormal
-vomiting may occur

Question 17

What are the characteristics of protein-losing enteropathy?

Answer 17

-a syndrome, not a specific disease
-clinical signs include diarrhea and weight loss
-can see panhypoproteinemia (decreased TP, albumin, and globulins) on chem.
-may cause antithrombin loss and predispose to pathologic thrombosis

Question 18

What are the possible pathologic alterations of the intestinal microbiome?

Answer 18

-altered bacterial numbers
-altered bacterial subpopulations
-altered bacterial function
-combination

Question 19

What are the characteristics of cobalamin?

Answer 19

-microflora use it
-absorbed in ileum
-crude biomarker of intestinal dysbiosis, maldigestion, and malabsorption

Question 20

What are the characteristics of folate?

Answer 20

-microflora make it
-absorbed in proximal small intestine
-crude biomarker of intestinal dysbiosis, maldigestion, and malabsorption

Question 21

What are the characteristics of cobalamin measurement?

Answer 21

-serum sample
-project from light
-measured in ng/L

Question 22

What are the characteristics of folate measurement?

Answer 22

-serum sample
-project from light
-measured in ug/L

Question 23

What are the typical indications for cobalamin testing?

Answer 23

-chronic small bowel diarrhea +/- weight loss
-suspected EPI

Question 24

What is the typical principle and interpretation of cobalamin testing?

Answer 24

-low cobalamin conc. occurs due to overgrowth of bacterial flora and/or maldigestion
-low cobalamin conc. suggests intestinal dysbiosis and/or cobalamin malabsorption

Question 25

What is the “zebra” indication for cobalamin testing?

Answer 25

suspected congenital cobalamin deficiency

Question 26

What is the “zebra” principle and interpretation of cobalamin testing?

Answer 26

-low cobalamin conc. occurs cue to congenital defect in cobalamin-intrinsic factor complex receptor
-low cobalamin conc. supports this congenital deficiency in certain dog breeds

Question 27

What are the characteristics of low cobalamin due to nutritional deficiency?

Answer 27

-very unlikely to occur
-can be seen in cattle with low-cobalt diets
-body stores take a long time to become depleted

Question 28

What are the most common diagnoses when cobalamin is decreased?

Answer 28

-intestinal dysbiosis
-ileal disease/malabsorption

Question 29

What are the indications for folate testing?

Answer 29

-chronic small bowel diarrhea +/- weight loss
-suspected EPI

Question 30

What is the principle and interpretation of folate testing?

Answer 30

-overgrowth of bacterial flora causes increased folate conc.
-increased folate conc. suggests intestinal dysbiosis
-decreased folate conc. suggests intestinal malabsorption

Question 31

What are the characteristics of low folate due to nutritional deficiency?

Answer 31

-extremely unlikely to occur
-can see deficiency with chronic antibiotic use and methotrexate treatment

Question 32

What is the most common diagnosis when folate conc. is decreased?

Answer 32

proximal intestinal disease; maldigestion or malabsorption

Question 33

What is the most common diagnosis when folate is increased?

Answer 33

intestinal dysbiosis

Question 34

What are the steps of a small intestine permeability/absorption test?

Answer 34

-administer oral test substance
-substance is absorbed from gut to blood
-take timed blood samples
-measure substance in each sample
-plot absorption curve over time

Question 35

What is the usefulness of a small intestine permeability/absorption test?

Answer 35

-time to peak absorption
-fold-change over baseline
-curve shape
-AUC

Question 36

What are the indications for glucose absorption testing?

Answer 36

-suspect IBD
-diarrhea
-poor body condition
-mild/recurrent colic

Question 37

What is the principle behind glucose absorption testing?

Answer 37

SI inflammation impairs intestinal mucosal function and absorption of glucose

Question 38

What is the test procedure for glucose absorption?

Answer 38

-fast animal for 12-18 hrs
-give oral glucose solution
-take timed blood samples
-measure glucose and plot results over time

Question 39

What is the interpretation of glucose absorption testing?

Answer 39

delayed/subnormal absorption indicates compromised SI function and supports IBD dx

Question 40

What can be measured in rumen fluid?

Answer 40

-microflora morphology and motility
-pH
-chloride conc.