Lecture Final Flashcards
What does the pancreas consist of?
The right lobe which is adjacent to the descending duodenum, the left lobe which is caudodorsal to the stomach, and the body which is located at the cranial duodenal flexure, close to the pylorus
Where do the excretory ducts of the pancreas exit?
They exit the pancreatic parenchyma to enter the duodenum
Where does the pancreatic duct enter the small intestine?
At the duodenum with the bile duct at the major duodenal papilla, which opens into the duodenum itself
Where does the accessory pancreatic duct enter the duodenum?
At the minor duodenal papilla
How does the pancreas receive blood?
From the branches of both the coeliac artery and superior mesenteric artery
What artery supplies the neck, body, and tail of the pancreas with blood?
The splenic artery, which runs along the top margin of the pancreas
What is the largest pancreatic arterial branch called?
The greater pancreatic artery
Where do lymphatics in the pancreatic duct drain into?
The duodenal, hepatic, splenic and mesenteric lymph nodes
What system supplies nervous function to the pancreas?
Both the sympathetic and the parasympathetic nervous system
What is the pancreas?
A highly lobulated gland invested by a thin, loose collagenous capsule which extends as a delicate septa between lobules
What does the exocrine portion of the pancreas consist of?
Closely packed Acini tissue, which drains into a highly branched duct system
What does the endocrine portion of the pancreas consist of?
It forms the islets of Langerhaans of various sizes scattered throughout the exocrine tissue
What is the majority of pancreatic tissue composed of?
98% is dedicated to exocrine (acini), about 2% is dedicated to endocrine secretion (islets)
What are the four cell types created in the islets of Langerhaans?
Alpha (glucagon), beta (insulin), delta (somatostatin), PP cells (pancreatic polypeptide)
What is the Fed state within the pancreas?
Insulin dominates with an increase in glucose oxidation, glycogen, fat, and protein synthesis
What is the Fasted state within the pancreas?
Glucagon dominates with an increase in glycogenolysis, gluconeogenesis, and ketogenesis
What is exoystosis?
A process by which the contents of a cell vacuole are released to the exterior through fusion of the vacuole membrane within the cell membrane
What else can glucose be used for when it is stored?
Metabolism
How is glucose driven from the blood into the cells?
A concentration gradient
What part of the pancreas secretes digestive enzymes?
The acini tissue
What does pancreatic secretion contain?
Enzymes for digesting all 3 major types of food (proteins, carbs, and fat), and large quantities of bicarbonate ions
Why are bicarbonate ions in pancreatic secretions important?
They play a role in neutralizing the acid chyme emptied by the stomach into the duodenum
What are the most important of the proteolytic enzymes?
Trypsin (most important), chymotrypsin, and carboxypolypeptidase
Which pancreatic enzyme helps digest carbs?
Amylase
What is the main enzyme for digesting fat?
Lipase, but also cholesterol esterase and phospholipase
What 3 secretions trigger pancreatic secretions?
Acetylcholine, cholecystokinin, and secretin
What is acetylcholine?
It is released from the parasympathetic vagus nerve endings as well as other cholinergic nerves in the enteric system
What is cholecystokinin?
CCK is secreted by the duodenal and upper jejunal mucosa when food enters the small intestine; it causes contraction of the gallbladder to trigger bile acids release
What is secretin?
It is secreted by the same duodenal and jejunal mucosa as CCK when highly acidic food enters the small intestine
How many phases of pancreatic secretion are there?
1 - Cephalic
2 - Gastric
3 - Intestinal
What occurs during the cephalic phase of pancreatic secretion?
About 20% of total secretion of pancreatic enzymes occurs because the brain is triggered by the thought of eating
What occurs during the gastric phase of pancreatic secretion?
About 5-10% of the total secretion of pancreatic enzymes which is triggered by the stomach once food is actually ingested
What occurs during the intestinal phase of pancreatic secretion?
About 70% of total secretion of pancreatic enzymes from the small intestine because digestion begins and enzymes are secreted
What is pancreatitis?
Acute or chronic inflammatory condition which results in intrapancreatic activation of enzymes that triggers autodigestion of the pancreas itself
What makes the pancreas digest itself with pancreatitis?
The pancreas is made of protein and trypsin that is activated from inflammation digests protein
What dogs typically become afflicted with acute pancreatitis?
Dogs greater than 5 years old, overweight and typically mini schnauzers, yorkies, and mini poodles
What cats typically become afflicted with chronic pancreatitis?
From 4 weeks to 18 years old, DSH and DLH, and also siamese cats
What is involved in the pathogenesis of pancreatitis?
Acinar cell membranes are damaged, which triggers the activation of trypsinogen, which then activates other digestive enzymes and a progressive cascade of autodigestion follows
Which animal is more likely to have smoldering, low grade chronic pancreatitis?
Cats, as their clinical signs are vague and nonspecific
How is pancreatitis typically diagnosed?
If the pet has had a recent fatty meal, falls into the identifiable risk group, and various lab results
What are some typical lab results from a pet with pancreatitis?
- CBC: neutrophilila, hemoconcentration
- Chem: azotemia, elevated ALT, ALKP and TBil
What is the test of choice for diagnosing pancreatitis?
cPLI which is a pancreatic lipase immunoreactivity test
What are the serum pancreatic enzymes which may indicate pancreatitis?
Amylase and lipase
What pancreatitis test checks for trypsin-like immunoreactivity?
TLI, it is also the test of choice for EPI is both dogs and cats
Which test is feline specific for pancreatitis?
SPEC-FPL
What may be visible on a radiograph of a pet with pancreatitis?
- Loss of abdominal contrast and detail in the right cranial quadrant, giving it a “ground-glass” appearance
- Displacement of the descending duodenum to the right and the pyloric atrium to the left, producing a widened angle or mass effect on VD projection
- Gastric distention or static gas pattern in the duodenum or transverse colon
What may be visible on an ultrasound of a pet with pancreatitis?
Irregular enlargement and mottled echogenicity, or different shades of the pancreas
How can mild acute pancreatitis be treated?
It is often self limiting and usually resolves itself in a few days
How can severe acute pancreatitis be treated?
It is a life threatening mulitisystem crisis and requires intensive therapy with fluids and pain meds while NPO the animal, although cats sometimes do better if they are fed
What is the goal of pancreatitis therapy?
To allow time for pancreatic inflammation to subside
What is involved in medical therapy of pancreatitis?
To prevent stimulation of pancreatic secretions with fluid replacement, antiemetics, broad spectrum antibiotics, analgesia and possibly surgery if abscessation occurs
What is EPI?
Exocrine pancreatic insufficiency, which is severe progressive loss of acinar tissue from atrophy or inflammatory destruction resulting in insufficient secretion of digestive enzymes
Which pancreatic disease may display clinical signs of malassimilation including maldigestion and malabsorption?
EPI
What causes EPI?
In young dogs less than 2 years, its a non-inflammatory pancreatic atrophy of acinar tissue, and it is rare in cats unless they have chronic pancreatitis or pancreatic duct occlusion
What kind of dogs are predisposed to EPI?
Large breed dogs, typically german shepards, as it may be inherited as a autosomal recessive gene
What can happen to an animal with EPI as a result from chronic relapsing pancreatitis?
Substantial islet destruction can result in diabetes mellitus
What are the clinical signs of EPI?
- Extreme appetite and increased food intake
- Weight loss or failure to gain weight
- Intense hunger than may cause pica or coprophagia
- Diarrhea with a rancid odor
- Dull hair coat and greasy perineum
How is EPI diagnosed?
Typically fecal tests using stains, TLI assay
How is EPI treated?
Enzyme replacement, low fiber/fat diet, supplement vitamins ADEK
What is pancreatic neoplasia?
Hormone secreting tumors that arise from islet cells called insulinomas, can also be andenomas and andenocarcinomas
Which pancreatic tumor is benign and rare?
Adenomas of the exocrine pancreas
Which pancreatic tumor is malignant and very common?
Adenocarcinomas of the exocrine pancreas digestive tissue
What organs do pancreatic adenocarcinomas typically metastasize to?
Liver, lymph nodes, mesentery, duodenum, stomach, occasionally the lungs
How is a pancreatic adenocarcinoma typically diagnosed?
Serum bilirubin and liver enzymes are elevated along with a right cranial mass palpated and chronic pancreatitis
Can pancreatic adenocarcinomas be treated?
Surgery and chemo can be tried, but usually to little or no avail
What is a functional tumor of the islet cells called?
A pancreatic beta cell neoplasia, which secretes excessive amounts of insulin independent of normal regulatory mechanisms
What can result from a pancreatic beta cell neoplasia?
Hyperinsullinism which causes hypoglycemia and can metastasize to the lymph nodes, liver, mesentery and omentum
What animals are typically affected by pancreatic beta cell neoplasia?
Dogs ages 6-14 and it is extremely common in ferrets
What is diarrhea?
And increase in the frequency, fluidity and volume of feces
What can cause diarrhea, or a deranged transmucosal water and electrolyte fluxe
Maldigestion, malabsorption, abnormal secretory activity from parasites, increased permeability, or abnormal motility typical of parvo
What is hematochezia?
Obvious red blood, which usually indicates bleeding in the large intestine
What is melena?
Dark black blood, which has been digested and is therefore from the upper GI tract
What does mucus in the stool mean?
An issue in the colon
What does an bulky or scant volume of stool mean?
Bulky can mean upper GI problem, scant can be lower GI
What does a flattened stool shape possibly mean in a dog?
In a male dog, it could be a prostate problem
What is tenesmus?
Unproductive straining to defecate
What is borborygmus?
Intestinal grumbling
What makes diarrhea classified as mild?
Normal attitude of the animal, no weight loss, and no palpable abnormalities
What makes diarrhea moderate to severe?
The animal appears weak, may have weight loss, fever, anorexia, depression, significant dehydration or abdominal pain palpated
What tests can be run to determine the cause of diarrhea
Fecal floats, gram stains, or endoscopy
What test is the recommended minimum evaluation for all patients with diarrhea?
A fecal float, also use visual inspection of feces
What color does the feces of dogs, cats and birds of prey typically stain?
Their feces is gram negative, meaning it will stain red/pink
What color does the feces of psittacine birds typically stain?
Their feces is gram positive, so it will stain blue/purple
What are the two different types of endoscopy used for diagnosing the cause of diarrhea?
Gastroduodenoscopy or colonoscopy
What is involved in the patient prep for a gastrodupdenoscopy?
No food for 12-18 hours prior, no water for 4 hours prior and it is not to be performed within 12-24 hours of a barium series, unless a foreign body is seen
What is involved in the patient prep for a colonoscopy?
No food for 24-36 hours, and EITHER administer oral colonic lavage solution and a high enema 2 hours prior to the procedure OR perform 2 enemas the day prior and a high enema 2 hours before the procedure
What is protein losing enteropathy or PLE?
A syndrome caused by a variety of small intestinal diseases that is characterized by hypoproteinemia due to an accelerated loss of plasma proteins in the gut
How much plasma proteins are typically lost through the GI tract?
About 40% daily
What may result from PLE?
Edema and ascites
What may cause PLE?
Impaired intestinal lymphatic drainage or disruption of mucosal barrier due to severe inflammation of the GI tract
What is the most common cause of PLE in cats?
Lymphangiesctasia
What is bloat?
Acute gastric dilatation meaning the stomach is distended with gas, fluid and/or ingesta associated with impairment of gastric emptying
What is torsion?
Gastric volvulus, or bloat with a twist, meaning the stomach is twisted and the pylorus is rotated from the right to the left, dorsal to the cardiac sphincter
What are the clinical signs of GDV?
Abdominal distention with tympany, non-productive retching, ptyalism, restlessness or pacing, dyspnea, shock including increased HR, pale MM decreased CRT and weak femoral pulses
What are some important considerations for GDV?
RADS in right lateral recumbance is required for rapid diagnosis, then intensive treatment for shock, decompression and surgical correction of the rotation must be performed, also DO NOT use nitrous oxide for patient
What should be monitored for animal’s with GDV?
Serum electrolyte concentrations and acid-base status
How is decompression performed in a patient with GDV?
By placing an orogastric tube that should not be forced as it can rupture the lower esophagus; if a tube can not be passed, a large needle can be inserted into the stomach behind the last rib in the left flank
How should patients with GDV be monitored after they have been gastropexied?
ECG for 12-24 hours post-op to monitor for cardiac arrhythmias, particularly V-tach and VPC’s which are thought to be caused by poor myocardial perfusion
What is inflammatory bowl disease, or IBD?
Idiopathic intestinal inflammation which can occur in both dogs and cats and can affect any portion of the intestinal tract
What breeds are most common for suffering from IBD?
German shepherds and rottweilers
What is required for a definitive diagnosis of IBD?
Biopsy as it is speculated to be a intestinal response to bacterial and/or dietary antigens AKA food allergies
How can IBD be treated?
Hypoallergenic diets, antibiotics, high dose corticosteroids, and immune modulating drugs
What is gastritis?
Inflammation of the stomach due to the ingestion of spoiled or contaminated foods, foreign objects, toxic plants, chemicals, or irritating drugs
What are the clinical signs of gastritis?
Acute onset of vomiting, typically food and bile, but may also have small amounts of blood
How is gastritis typically treated?
Fluids, NPO for 24 hours, small amounts of cool water frequently, then small amounts of bland diet is vomiting stops, anti-emetics can be given parenterally if vomiting persists
What is HGE?
Hemorrhagic gastroenteritis which presents as profuse hematemesis and/or hematochezia
What animals typically are afflicted with HGE?
Small breed dogs with no access to garbage, therefore the cause is unknown
What are the typical findings for a patient with HGE?
High PCV with normal TP due to dehydration
How is HGE treated?
Aggressive fluid therapy to prevent secondary problem, antibiotics to prevent intestinal anaerobes from proliferating
What is bilious vomiting syndrome?
May be caused by gastroduodenal reflux that occurs when the dog’s stomach is empty for long periods of time
