Pancreas Flashcards
what causes acute pancreatitis (the chemical pathway, not the patient factors)
premature activation of proenzymes in pancreatic parenchyma: likely secondary to fusion of zymogen and lysosome vacuoles that cause pH to drop, activating trypsinogen and the enzyme activation cascade
pancreatic secretory trypsin inhibitor (meant to prevent premature activation of proteases) overwhelmed
end result of acute pancreatitis
pancreatic inflammation, edema, hemorrhage, necrosis
peripancreatic fat necrosis and saponification
name at least 3 ethologies for dog acute pancreatitis
idiopathic, obesity, toxins or drugs (L-asparaginase, azathioprine…), dietary factors (indiscretion, high fat), hypertriglyceridemia, hypo perfusion, hereditary, trauma, hypercalcemia, hypothyroidism, DM, herperadrenocorticism
name a least 3 ethologies for cat acute pancreatitis
idiopathic, hypo perfusion, trauma, neoplasia, hypercalcemia, toxins or drugs (L-asparaginase, azathioprine)
infectious diseseases, eg. flukes or toxoplasmosis
drug associations are less clear in cats
what are 2 common comorbid conditions in cats with acute pancreatitis? what could this indicate about underlying disease?
IBD, neutrophilic cholangitis
underlying disease in hepatic llipodosis?
what are most common C/S of acute pancreatitis in dogs?
vomit, abdominal pain (this is rarely seen in cats), anorexia
less common: icterus (obstruction of CBD?), tachycardia (pain, decreased perfusion), fever, diarrhea
note that the C/S depend on the severity of local and systemic inflammation
what are most common C/S of acute pancreatitis in cats
weight loss, lethargy, anorexia, hypothermia (rather than fever), vomiting <50%
less common: tachycardia, icterus
note that the C/S depend on the severity of local and systemic inflammation
signalment acute pancreatitis dog
Boxers, Yorkies, Mini Schnauzers, Collies, Cocker Spaniels, CKCS
maybe more females
middle aged (5 years) and above (if younger think acute gastroenteritis or FB)
signalment acute pancreatitis cat
no breed sex or significant age predisp
most >7 years
what are some bloodwork findings with acute pancreatitis? note various disorders would have similar signs, need more specific than bloodwork alone
leukocytosis, +- left shift, and hemoconcentration (inflammatory leukogram and dehydration)
elevated liver values, esp. cholestatic parameters (ALT, GGT, bili, cholesterol)
hyperalbuminemia
elevated BUN and creatinine
hypocalcemia, bc Ca going into saponified fat (more common in cats and a poor px indicator)
do amylase and lipase correlate with severity of acute pancreatitis in DOGS?
NO. compatible with but not diagnostic or pathognomic in dogs! lacks Se and Sp
(dogs: serum amylase normal in up to 47%, serum lipase normal in up to 61% (rather than increased))
do amylase and lipase correlate with severity of acute pancreatitis in CATS?
NO. no diff in mean values for cats with extra pancreatic disease, pancreatitis, or normal.
NO diagnostic benefit for pancreatitis dx in cats
what is a specific diagnostic test for acute pancreatitis?
pancreas specific lipase (this is not influenced by renal elimination)
what are the two forms of pancreas specific lipase tests? which is bedside and which is lab test
SNAP is bedside test, gives + or - result
- good to rule out pancreatitis if negative, but if positive could either be questionable or actually pancreatitis
SPEC test is lab test, gives 3 ranges of concentrations
- there is a normal level, cut off for pancreatitis, but also a questionable range
AUS: see hypo echoic pancreas, hyper echoic surrounding tissue, and free abdominal fluid. what is likely issue?
acute pancreatitis. not that enlarged pancreas alone is not sufficient to dx
are rads good for diagnosing acute pancreatitis
no, not sensitive, and subjective.
however they help RULE out DDX, eg. FB and obstruction
what is gold standard for diagnosing acute pancreatitis? is this often done
biopsy. no, unless in sx for some reason.
note, biopsies can miss lesions, bc patchy distribution, and that normal gross appearance doesn’t exclude historical changes
what is first tier treatment for acute pancreatitis
fluids (pancreas prefers PERFUSION; also supplement potassium), nutrition (early feeding beneficial), analgesics (buprenorphine or for dogs lidocaine CRI. NO NSAIDS due to dehydration and organ injury risk, antiemetics (maropitant, metoclopramide, ondansetron)
treat concurrent dz, discontinue meds that could provoke pancreatitis
what is second tier tx for acute pancreatitis?
second tier: Abx, plasma.
not commonly used
what is third tier tx for acute pancreatitis
surgical.
not commonly pursued.
when to consider Abx for tx acute pancreatitis?
consider Abx if: febrile, evidence ofGi compromise, dramatic leukocytosis, direct evidence of bacteria (culture)
this is a second tier tx
when to consider plasma for tx acute pancreatitis?
coagulopathy secondary to SIRS
(theory is that it contains protease inhibitors and scavenges to activated proteases/lipases. but there is no proven clin benefit)
what can prolonged anorexia cause? give 3 negative effects
villous atrophy
bacterial translocation
immunosuppression
hence why early feeding in acute pancreatitis is important
first tier tx acute pancreatitis: when to consider nutrition?
if can give PO, what food?
as soon as stabilized (old school wait 24 h, not anymore)
once hydrated, analgesics, antiemetics +- pro kinetics, consider: per os or NG tubes.
highly digestible low fat is most common
first tier tx acute pancreatitis for cats: when to consider nutrition?
what do we often start with, PO or NE tube?
as with dogs, once stabilized
often need more permanent feeding method; often have concurrent dz eg. hepatic lipidosis or cholangitis
often start w NE tubes
what is chronic pancreatitis
continuing inflammatory disease of pancreas with presence of IRREVERSIBLE FIBROSIS AND ATROPHY
hard to definitively dx w/o biopsy, and acute pressure of chronic dz can mimic acute pancreatitis
dog with intermittent anorexia, abdominal pain, vomiting, food aversions, who (not always but some cases) EPI and DM. suspicious of?
chronic pancreatitis
cat with insidious weight loss, intermittent GI signs, sisgns of cholangitis and IBD. what are you suspicious of?
triaditis IBD pancreatitis neutrophilic colangiti
for dx of chronic pancreatitis, are pancreatic specific lipase and US as sensitive as for acute pancreatitis
atrophic tissue present, so not as Se PSL
US not as Se bc inflammation not as present; may see hyperechogenicity of pancreatic parenchyma consistent w fibrosis
what are mainstays of tx for chronic pancreatitis
supportive therapy as per acute dz, if needed
analgesia as needed
low fat diets
address fxnl loss if needed: insulin, pancreatic enzymes
address concurrent dz in cats
progressive lymphocytic inflammation leads to pancreatic atrophy. this is inability to produce sufficient pancreatic enzymes to digest fats, carbohydrates and proteins. what is condition
EPI exocrine pancreatic insufficiency
young adults predisposed, before 4 years of age in most, but older animals if due to underlying pancreatic dz: G step, Rough Collies common.
symptoms show when >90% tissue loss: chronic diarrhea yellowy gray and fatty and frothy. weight loss with polyphasic, flatulence, coprophagia. what is condition
EPI exocrine pancreas insufficiency
how is exocrine pancreatic insufficiency diagnosed
TLI serum trypsin like immunoreactivty, a referral lab test, w clinical signs.
TLI LOW consistent w dx
this is Se and Sp
treatment for exocrine pancreatic insufficiency
pancreatic enzyme tabs: powder better, Viokase V, given w food
freeze fed pancreatic tissue, may be illegal idk
highly digestible high quality diet, not restricted, and do not restrict fat
cobalamin some cases
antibiotics some cases
hypocobalaminemia common in dogs and cats with EPI, so supplement if needed PO or parenteral. why does this occur?
cobalamin absorption (in the ileum) requires intrinsic factor IF which is produced from pancreas (cats and dogs) and gastric wall (dogs) so get hypocobalaminemia.
when can Abx be considered for exocrine pancreatic insufficiency
not responding to therapy (tylosin or metronidazole)
commonly used adjectively bc intestinal bacterial overgrowth presumed present in some patients
