Lecture 30 - Liver 5 Flashcards
Name the structures that are shown in the image below:
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- Ganglion
- Blood vessels
- Islets of Langerhans
Name the structure below and state what species you would expected to find it in:
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Pancinian Corpuscle
Name the species that the pancreas below came from:
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Came from a cat
What form is pancreatic amylase secreted in an what co-factor does it require?
secreted in active form - requires Ca2+ as a co-factor
What form is pancreatic lipase secreted in and how is it catalysed?
active form - requires Ca2+, colipase and bile salts as co-factors
How are the pancreatic proteolytic enzymes activated?
secreted as proenzymes (zymogens) - activated by trypsin and enterokinase in the duodenum
What are the three broad mechanisms of pancreatic damage?
- Obstruction of the duct
- Direct injury to acinar cells
- Disturbances of enzyme trafficking within cytoplasm of acinar cells
What are the events involved in pancreatic autolysis?
- Trypsinogen to trypsin
- Activated proelasatase and phospholipase –> digests pancreatic tissue
- Trypsin activates the kinin, complement and clotting cascades
- Process is amplified –> thrombosis –> haemorrhage –> inflammation
What animals is acute pancreatitis most common in?
obese, sedentry, middle aged female dogs
What are the potential sequalae of acute pancreatitis?
- Haemorrhage, DIC, multi-organ failure and death
- Release of myocardial depressent factor
- Liver often secondarily affected (by cholestasis)
What is the name of the process that is shown below?
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Acute pancreatitis
What are two potential complications that can arise from chronic pancreatitis?
If significant portion of pancreas is involved:
- Exocrine pancreatic insufficiency
- Diabeties mellitus
Name the process that is occuring below:
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Chronic pancreatitis
What is the result of exocrine pancreatic insufficiency?
- Maldigestion + malabsorption
- +/- diabeties mellitus
Provide an example of a clinical sign that may be seen with exocrine pancreatic insufficency:
- Diarrhoea + weight loss
- Flatulence and marked borborygymus
- Pale, soft malodorous faeces
- Concurrent SIBO
Name the process that is occuring in the image below:
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pancreatic atrophy
Why must serum amalyse be interpreted with care and what does a very high level mean?
- Also released by liver, pancreas and small intestine
- Higher level means > chance comming from pancreas
What are the sources that contribute to total lipase and what does a higher level indicate?
- Pancreas and gastric mucosa are the only two main sources
- The greater the increase the more likely it is to be pancreatitis
How does DGGR lipase work, what is the sensitivity and specificity like and what species can it be used in?
- Uses novel substrate and it is more specific for pancreatic lipase (and same day turnaround!)
- Very high sensitivity and specificity
- Useful in dogs and cats
What is the test is available for specifically testing pancreatic lipase in serum? These test have a long turn around time what is an alternative?
Pancreatic specific lipase immunoreactivity (PLI) and pancreatic specific lipase (Spec cPL/fPL)
Alternative is to use a snap ELISA test - one for canine and one for feline - they determine quantitative levels
What is the best diagnostic imaging modality to use in cases of pancreatitis?
Ultrasound is the DI method of choice
Is a high fat diet implicated in pancreatitis in cats?
NOOOOO NO NO NO NOOOOOO!
What is TAP and is it specific for pancreatitis?
Trypsin activation peptide (TAP) and is found in urine and serum - quite poorly specific for pancreatitis
Rate the following tests in terms of usefulness for detecting pancreatitis in cats: serum amylase, total lipase, DGGR lipase, fPL, fPLI, SNAP fPL
Serum amylase + total lipase = not very useful
DGGR lipase, fPL, fPLI, SNAP fPL = good
How do urea and creatinine levels appear in cats with pancreatitis and what further steps may need to be taken?
Pancreatitis in cats = urea and creatinine increase (azotaemia)
What does trypsin like immunoreactivity (TLI) detect and what effect will exocrine pancreatic insufficiency have on it?
detects serum trypsinogen, trypsin and tryspin molecules bound to protease inhibitors. Decreased with EPI
Name the condition that is shown below:
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Exocrine pancreatic carcinoma
Name the condition that is shown below:
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Pancreatoliths