Lecture 19 11/12/24 Flashcards
What is the cycle of pancreatitis?
-trigger leads to inflammation
-inflammation causes cell damage +/- cell death
-cell damage/death leads to enzyme leakage
-enzyme leakage worsens the cell damage and causes more inflammation
What are the characteristics of pancreatitis?
-mostly seen in dogs and cats
-acute or chronic
-severity is highly variable
What are the clinical signs of pancreatitis?
-abdominal pain
-loss of appetite
-vomiting
What are the potential consequences of pancreatitis?
-affects peritoneum
-obstructive cholestasis
-secondary exocrine pancreatic insufficiency
-secondary diabetes mellitus
What are the components of pancreatitis diagnosis?
-clinical history
-physical exam
-minimum database
-specialized lab tests
-parasite/infection testing
-abdominal imaging
-possible pancreatic cytology/histopath.
What are the characteristics of exocrine pancreatic insufficiency?
-failure of pancreatic digestive function
-can be primary/breed-associated
-can be secondary to chronic pancreatitis
What are the steps of exocrine pancreatic insufficiency?
-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
What are the components of exocrine pancreatic insufficiency diagnosis?
-clinical history
-physical exam
-minimum database
-specialized lab tests
-parasite/infection testing
-possible abdominal imaging
-possible intestinal histopath.
How does pancreatitis differ from EPI?
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
What are the characteristics of lipase measurement?
-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
What are the characteristics of pancreatic lipase concentration?
-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
What is a positive and negative result on the Idexx SNAP cPL?
negative: patient spot being lighter than the control
positive: patient spot being as dark or darker than the control
What steps should be taken when working with SNAP tests to avoid error?
-don’t use expired tests
-warm components to room temp.
-place kit on horizontal surface
-measure drops carefully
-snap the test correctly
What is the take home regarding quantitative PLI results?
the higher the PLI conc., the more supportive of a pancreatitis diagnosis
What are the characteristics of exocrine pancreatic insufficiency lab. diagnosis?
-use trypsin-like immunoreactivity test
-fasting, non-hemolyzed serum sample
-TLI values are decreased in EPI patients
What are the general characteristics of enteropathy?
-many potential disorders
-can cause maldigestion, malabsorption, and protein loss
-chronic diarrhea and weight loss possible
-gut microflora may be abnormal
-vomiting may occur
What are the characteristics of protein-losing enteropathy?
-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
What are the possible pathologic alterations of the intestinal microbiome?
-altered bacterial numbers
-altered bacterial subpopulations
-altered bacterial function
-combination
What are the characteristics of cobalamin?
-microflora use it
-absorbed in ileum
-crude biomarker of intestinal dysbiosis, maldigestion, and malabsorption
What are the characteristics of folate?
-microflora make it
-absorbed in proximal small intestine
-crude biomarker of intestinal dysbiosis, maldigestion, and malabsorption
What are the characteristics of cobalamin measurement?
-serum sample
-project from light
-measured in ng/L
What are the characteristics of folate measurement?
-serum sample
-project from light
-measured in ug/L
What are the typical indications for cobalamin testing?
-chronic small bowel diarrhea +/- weight loss
-suspected EPI
What is the typical principle and interpretation of cobalamin testing?
-low cobalamin conc. occurs due to overgrowth of bacterial flora and/or maldigestion
-low cobalamin conc. suggests intestinal dysbiosis and/or cobalamin malabsorption
What is the “zebra” indication for cobalamin testing?
suspected congenital cobalamin deficiency
What is the “zebra” principle and interpretation of cobalamin testing?
-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
What are the characteristics of low cobalamin due to nutritional deficiency?
-very unlikely to occur
-can be seen in cattle with low-cobalt diets
-body stores take a long time to become depleted
What are the most common diagnoses when cobalamin is decreased?
-intestinal dysbiosis
-ileal disease/malabsorption
What are the indications for folate testing?
-chronic small bowel diarrhea +/- weight loss
-suspected EPI
What is the principle and interpretation of folate testing?
-overgrowth of bacterial flora causes increased folate conc.
-increased folate conc. suggests intestinal dysbiosis
-decreased folate conc. suggests intestinal malabsorption
What are the characteristics of low folate due to nutritional deficiency?
-extremely unlikely to occur
-can see deficiency with chronic antibiotic use and methotrexate treatment
What is the most common diagnosis when folate conc. is decreased?
proximal intestinal disease; maldigestion or malabsorption
What is the most common diagnosis when folate is increased?
intestinal dysbiosis
What are the steps of a small intestine permeability/absorption test?
-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
What is the usefulness of a small intestine permeability/absorption test?
-time to peak absorption
-fold-change over baseline
-curve shape
-AUC
What are the indications for glucose absorption testing?
-suspect IBD
-diarrhea
-poor body condition
-mild/recurrent colic
What is the principle behind glucose absorption testing?
SI inflammation impairs intestinal mucosal function and absorption of glucose
What is the test procedure for glucose absorption?
-fast animal for 12-18 hrs
-give oral glucose solution
-take timed blood samples
-measure glucose and plot results over time
What is the interpretation of glucose absorption testing?
delayed/subnormal absorption indicates compromised SI function and supports IBD dx
What can be measured in rumen fluid?
-microflora morphology and motility
-pH
-chloride conc.
