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Small Animal > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Anatomy

A
  • Central body with two limbs

- Exocrine (98%) & endocrine (2%) cells

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2
Q

Excocrine Pancreatic Function (4)

A 
Enzymes:
- amylase
- phospholipase
- chymotrypsin
- trypsin
- lipase
these initiate protein, CHO and lipid dgestion
  • bicarbonate chloride and water: neutralises duodenum
  • intrinsic factor: facilitates cobalamine (vit B12 absorption)
  • antibacterial proteins: regulates SI bacterial flora
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3
Q

Acute pacreatitis CS in dogs(8)

A
  • Vomiting
  • Anorexia
  • Depression
  • Abdominal pain
  • Diarrhoea
  • Shock
  • Jaundice
  • Dehydration
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4
Q

Normal defence against autodigestion

  • locally (7)
  • systemically (1)
A

Locally:

  • Proteolytic enzymes are synthesised as inactive zymogens (eg trypsinogen)
  • These are Zymogens packaged in granules
  • Granules also contain pancreatic secretory trypsin inhibitor (PSTI)
  • Granules lie far away from enzymes
  • When required, zymogen granules are released by exocytosis
  • trypsinogen is activated to trypsin in SI by enterkinase
  • trypsin then activates other granules

Systemically:
Plasma contains molecules that will scavenge free enzymes (eg. α-1 antitrypsin, α-2 macroglobulin)

so MANY processes are required to activate and fast deactivation to prevent autodigestion

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5
Q

Acute Pacreatitis pathogenesis (6)

A
  • Initiating event thought to be premature activation of digestive zymogens within the pancreatic cell
  • Lysosomes & zymogen granules fuse to form vacuoles
    Lysosomal enzymes activate trypsinogen –> trypsin
  • Vacuoles rupture releasing active enzymes into cell
  • Other zymogens then activated
  • Causes cell necrosis & pancreatic autodigestion
  • Inflammatory mediators & cytokines etc cause cell necrosis & inflammation
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6
Q

Acute pancreatitis

  • results (3)
  • histologically (3)
A

Result is:

  • Local inflammation & necrosis
  • Systemic dissemination of activated enzymes
  • Systemic inflammatory response

histologically:

  • necrosis
  • oedema
  • neutrophilic infiltrate
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7
Q

Acute pancreatitis

  • aetiology
A
  • Dietary factors: hyperlipideaemia, scavenging from bin
  • Drugs/Toxins
  • Trauma
  • Reduced pancreatic perfusion: shock, addisons
  • Genetics
  • Hypercalcaemia
  • Duodenal/biliary reflux
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8
Q

Acute pacreatitis clin path

  • haematology (2)
  • biochem (70
  • additional (2)
A

Non-specific changes due to inflammation & hypovolaemia

Haematology:

  • Leucocytosis
  • (Thrombocytopenia)

Biochemistry:

  • Increased liver enzymes
  • Azotaemia – pre-renal (renal)
  • Hypokalaemia
  • Hypocalcaemia
  • Hyperlipaemia (cause or effect ?)
  • (Hyperbilirubinaemia)
  • (Hyperglycaemia)

Additional tests:

  • increase in amylase
  • increase in lipase
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9
Q

Trypsin-Like Immunoreactivity (TLI)

A
  • measures trypsin and trypsinogen in blood
  • quite specific: if high likely to be due to pancratitis
  • not very sensitive: short t1/2, increase early in decrease but rapidly decreases
  • delayed results
  • meh
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10
Q

Canine Pancreatic Lipase

A

SNAP© cPLTM

  • In house test
  • Negative, intermediate, positive
  • Sensitivity 91% ; specificity 77% so positive should be confirmed
  • If negative, unlikely to have acute pancreatitis
  • If positive, should send away for quantitative test
Spec PLI
- Needs to be sent away
- Quantitative test
       -->  >400 ug/L – positive
- ~85% sensitive, ~95% specific (dogs)
- Potential false +ve if renal disease or steroid administration
Expensive
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11
Q

Acute pancreatitis Rx

  • radiographs (4)
  • US (5)
A

Radiographs:

  • need to rule out other causes
  • Signs - peritonitis
    - -> Loss of contrast
    - -> Gastric-duodenal angle widening
    - -> Gastric displacement

US

  • Subjective
  • Hypoechoic pancreas
  • Enlarged pancreas
  • Hyperechoic peri-pancreatic fat
  • Pain in cranial abdomen?
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12
Q

Acute pancreatitis Tx (5)

A
  • IVFT: Improve & maintain pancreatic perfusion
  • Analgesia
    - -> Buprenorphine/methadone 1st choice
    - -> Morphine/ketamine/lidocaine (MLK) or butorphanol CRI
    - -> opioids are fine with pancreatic duct but not NSAIDs

Anti-emetics

  • Maropitant
    - -> Blocks NK-1 receptor
    - -> Peripheral & centrally acting
  • Metoclopramide
    - -> Dopamine antagonist
    - -> Centrally acting & pro-kinetic action
  • Ondansetron
    - -> 5-HT3 antagonist
    - -> Peripherally & centrally acting

Gastric protectants

  • Acute pancreatitis predisposes to gastric ulceration
  • Cimetidine, Ranitidine, Famotidine, Omeprazole

Nutrition: do NOT rest pancreas! Feed the enterocytes, give low fat food in small ammounts

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13
Q

Acute Pancreatitis Prognosis and Outcome

A
  • complete recovery
  • recurring acute pancreatitis
  • chronic pancreatitis
  • death
  • complications (SIRS, abscess/psuedocyst, DIC, multi-organ failure, extra hepatic bile duct obstruction_
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14
Q

Acute Pancreatitis in Cats CS (7)

A
  • Often non-specific – anorexia, lethargy
  • Vomiting rare
  • Hypothermia more common than fever
  • Sometimes cranial abdominal mass
  • Dehydration
  • Pale mucous membranes
  • Dyspnea
  • (Diarrhoea)
  • (Icterus)
  • (PUPD)
  • (Polyphagia)
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15
Q

Acute Pancreatitis in Cats

  • investigation (4)
  • Tx
A

Haematology & biochemistry
- Highly variable, non-specific

Amylase & lipase

  • Often normal
  • Increased with intestinal disease & renal disease
  • Not useful

Feline TLI
- Not useful for pancreatitis

SNAP© fPLTM

  • In house
  • Normal/abnormal

Tx:

  • similar to dogs
  • more indication for ABs
  • consider corticosteroids
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16
Q

Chronic Pancreatitis pathogenesis (5)

A
  • may present acutely but progress to chronic or start as chronic
  • Permanent histological change
  • Non-suppurative
  • Mononuclear infiltrate with fibrosis
  • Progressive loss of exocrine & endocrine function
17
Q

Chronic Pancreatitis

  • CS (4)
  • Dx (3)
A

CS

  • Intermittent, low-grade clinical signs OR
  • Acute signs OR
  • Exocrine pancreatic insufficiency OR
    - -> Older, non-GSD
  • Diabetes mellitus (PUPD, weight loss, polyphagia)

Dx:

  • biopsy
  • US
  • PLI
18
Q

Chronic pancreatitis Tx (8)

A
  • Supportive
  • Analgesia
  • Low-fat diet
  • Vitamin B12 injections - if low
  • Consider appetite stimulants (cats)
  • Treat EPI if present or if chronic weight loss
  • Treat DM if present
  • Consider corticosteroid therapy (cats & Cocker spaniels)
19
Q

Exocrine Pancreatic Insufficiency (EPI)

  • what
  • CS (6)
  • Clin path (2)
A
  • decreased pancreatic secretory capacity

CS:

  • Weight loss
  • Diarrhoea
  • Flatulence
  • Increased appetite
  • Poor hair coat
  • Steatorrhoea

Clinical pathology

  • TLI is low
  • serum cobalamin is low
20
Q

EPI causes (4)

A

Can be caused by:

Pancreatic acinar atrophy

  • End stage autoimmune process
  • GSDs and Rough collies – autosomal recessive

Aplasia
- Young dogs

Chronic pancreatitis

  • main cause in cats
  • increasingly recognised in dogs
  • May have concurrent diabetes mellitus

Pancreatic neoplasia

21
Q

EPI management (3)

A

Enzyme supplementation

  • Powder or granules (not unopened capsules)
  • Give with every meal – mix with food
  • Can be unpalatable for cats

Diet

  • Individual variation
  • May be able to continue original diet
  • No single best diet
  • Highly digestible, low fiber, moderate fat diet may help?
  • Little & often?

cobalamin injections if it’s low

22
Q

EPI: poor response (5)

A

Enough enzyme in correct form?

Dysregulation of GI flora

  • Antibiotic responsive diarrhoea
  • Metronidazole, tylosin, tetracyclines
  • For 1-3 weeks

The effect of gastric pH
- Consider H2-antagonists or proton pump inhibitors

Diet change
- Fat restriction?

Concurrent SI disease

  • Food responsive diarrhoea, IBD
  • May need further investigations
23
Q

Pancreatic Neoplasia

  • Differentiation (3)
  • Most common: dogs (2), cats (1)
A
  • Exocrine or endocrine
  • Primary or secondary
  • Benign (adenomas) or malignant (adenocarcinomas
Dogs
- Pancreatic lymphoma, haemangiosarcoma etc
- Pancreatic adenocarcinoma
Cats	
- Pancreatic adenocarcinoma
24
Q

Pancreatic Neoplasia

  • CS (4)
  • Dx (3)
A

CS:

  • May be incidental finding
  • Can be non-specific (hyperglycaemia if beta cells destroyed)
  • Can obstruct duct leading to secondary atrophy & EPI
  • Can lead to pancreatitis (local inflammation secondary to tumour necrosis)

Dx:

  • Imaging: similar to pancreatitis + mass
  • Try FNA but do not exfoliate well
  • Often diagnosed at exploratory laparotomy or post-mortem
25
Q

Pancreatic Neoplasia

  • Metastasis
  • Tx (3)
  • Profnosis
A

Metastatic spread common
- liver, local lymph nodes, mesentery, intestines & lungs

Tx:

  • Surgical resection –> Margins rarely achieved
  • Chemotherapy –> Little effect
  • Radiation therapy –> Not used

Prognosis: grave

Small Animal (35 decks)

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