Lecture 2 1/24/25 Flashcards
What are the characteristics of pancreatic adenocarcinoma?
-highly malignant
-infiltrative
-poor prognosis
-must be differentiated from pancreatic adenoma
What are the characteristics of insulinoma?
-causes hypoglycemia
-patients present with weakness and collapse
-diagnosed by identifying hypoglycemia and high insulin levels
Which fluid types are used in pancreatitis supportive care?
-lactated ringers
-colloids
-electrolytes
-glucose
-plasma transfusions
What are the characteristics of feeding in patients with pancreatitis?
-nothing by mouth only if severely vomiting
-provide anti-emetic and/or anti-nausea medications in vomiting patients before feeding
-give low fat diet
-tube feed if not eating willingly
-must feed the enterocytes or they die; parenteral feeding not recommended
Which drugs can be used to stop vomiting and nausea?
-maropitant: stops vomiting but not nausea
-ondansetron: stops nausea
Which drugs can be used to control pain in pancreatitis patients?
-buprenorphine
-fentanyl CRI
-ketamine
-lignocaine CRI
Why is morphine avoided in pancreatitis patients?
morphine can cause vomiting, ileus, and effects at the sphincter of oddi
Why are antibiotics not used in pancreatitis patients?
bacterial complications are rare in dogs; antibiotic use is poor stewardship
What are the characteristics of gastric ulcer therapy in pancreatitis patients?
-case dependent
-blood in vomit can be an indicator of need for treatment
-treated with omeprazole
When is insulin used in pancreatitis patients?
when hyperglycemia persists despite fluid therapy
When is surgery recommended in pancreatitis patients?
-obstructing mass
-abscess that does not respond to antibiotics
How does panoquell function?
it reduces the extravasation of neutrophils into the tissues to reduce inflammation of the pancreas
What are the conclusion regarding corticosteroids in pancreatitis patients?
corticosteroids may have a positive outcome in the treatment of acute/acute-on-chronic phase canine pancreatitis
What are the characteristics of pancreatitis prognosis?
-early detection of severe pancreatitis leads to earlier treatment and improved outcome
-difficult to differentiate severe vs. mild disease
-complications such as DIC, shock, renal failure, and resp. distress are possible
-patients should be fed a lifelong low fat diet to prevent recurrence
What are the characteristics of pancreatitis in cats?
-often presents in a triad with hepatitis and IBD
-celiotomy and biopsy are diagnostic
-often chronic
-amylase and lipase measurements are useless
-ultrasound and fPLI are useful for diagnosis
What are the characteristics of chronic pancreatitis?
-patients present with GI signs and abdominal pain
-difficult to confirm
-can lead to diabetes mellitus and EPI
-co-morbidities include diabetes mellitus, hyperadrenocorticism, chronic inflammatory enteropathy, and cholangitis
What are the characteristics of exocrine pancreatic insufficiency?
-disease of pancreatic malfunction
-greater than 80% of pancreatic function must be lost
What are the steps of EPI?
-loss of pancreatic acinar cells leads to loss of digestive enzyme production
-patients have impaired mucosal and brush border enzymes and transporters
What are the consequences of EPI?
-loss of digestion and absorption
-malassimilation/inability to absorb food
-osmotic diarrhea
-severe malnutrition
-bacterial overgrowth
-cobalamin malabsorption
What are the causes of EPI?
-acinar atrophy
-chronic pancreatitis
-adenocarcinoma of the pancreas
What are the clinical signs of EPI?
-GSD, collie, or other large breed dog
-weight loss
-ravenous appetite
-coprophagia
-poor coat condition
-foul smelling
-small bowel diarrhea
-steatorrhea/fatty stool
-increased GI sounds and/or flatulence
How is EPI diagnosed?
-history and clinical signs
-trypsin like immunoreactivity/TLI
Why does TLI sometimes provide a diagnostic challenge?
there is a grey zone between the values diagnostic for EPI and values that are not indicative of EPI; up to the practitioner to choose when to treat
What are the treatments for EPI?
-powdered supplement enzymes
-frozen raw pork pancreas
-highly digestible, low fat diet
-cobalamin supplementation if necessary
What are the characteristics of EPI in cats?
-often results from chronic pancreatitis
-present with weight loss and greasy coat
-diagnose with species specific fTLI
-treat with enzyme powder, raw pancreas added to low fat meal
-always supplement cobalamin and folate
When should EPI be a differential in cats?
any case of unexplained weight loss and/or unexplained diarrhea
How does kidney disease affect EPI testing in cats?
azotemic cats will have a higher TLI than non-azotemic cats
