Pancreas

Question 1

Draw and Label the Pancreas

Answer 1

1. Left Lobe of the Pancreas (Orange)
2. Body of Pancreas (Red)
3. Right Lobe of Pancreas (Blue)
4. Common Bile Duct (Green)

Question 2

What are som causes of Exocrine Pancreatic Insufficiency?

Answer 2

• Primary
  
  • Juvenilepancreatic atrophy
• Secondary
  
  • Pancreatic duct obstruction
  • Extensive pancreatic necrosis
  • Chronic pancreatitis
• Pancreatic Hypoplasia
  
  • Occasionally observed in calves
• Pancreatic agenesis

Question 3

Compare the Gross and Histo appearance of Acute and Chronic Pancreatitis

Answer 3

• Chronic pancreatitis
  
  • ​Pancreas is distorted, shrunken and irregular with pallor and enhanced lobulation
  • +/- fibrous adhesions
  • Histopath: Fibrosis and chronic inflammation
• Acute Pancreatitis
  
  • ​Variable distrubution often multifocal
  • Foci of fat necrosis
  • Swollen (oedematous) and nottles pancreas
    
    • Red-black (haemorrhage) and gray-white (necrosis)
    • May see peritonitis with fibrinous adhesions

Question 4

What is acute pancreatic autolysis, and what can it lead to?

Answer 4

• Consequence of premature release of activated pancreatic enzymes (Trypsin) into the parenchyma which digests the pancreatic tissue.
• this can lead to Acute pancreatic necrosis/pancreatitis

Question 5

What is the difference between the Bile ducts of a cat v’s a dog?

Answer 5

Question 6

This is a cat pancreas, what is wrong here?

Answer 6

Nothing, these are Pacinian Corpuscles and are completely normal in cats.

Question 7

What tests can you use to confirm Pancreatitis?

Answer 7

• Pancreas specific lipase (cPL/fPL)
  
  • Detects pancreatic lipase, cf total lipase activity
  • Least affected by GIT, renal disease, corticosteroids
  • Requires 12hour fasted sample (lipaemia)
• Other less utilised markers
• Trypsin activation peptide (TAP) in urine/serum
• C-reactive protein (CRP) in serum
• Trypsin like immunoreactivity TLI in serum

Question 8

Discuss why acute pancreatitis can cause extrahepatic cholestasis and secondary bile inducedhepatocellular injury

Answer 8

• Pancreatitis is an inflammatory process which can obstruct the bile ducts causing cholestasis

Question 9

How are Fats and Protiens in the Duodenal Lumen Digested, and what hormone triggers this?

Answer 9

Question 10

Describe the two parts of the pictured pancreas

Answer 10

• Left side is the Exocrine section, containing Pancreatic acinar cells (apical zymogen granules)
• Right side the Islets of Langerhans

Question 11

What are some Pancreatic defence mechanisms?

Answer 11

• Continuous flow prevents reflux
• Enzymes sequestered in zymogen granules
• Most enzymes (except amylase and lipase) secreted as inactive proenzymes
• Local secretion of protective trypsin inhibitors
• Acinar cells have innate resistance to several enzymes
• Degradation of prematurely active enzymes
• Lysosomal enzymes can degrade zymogen granules

Question 12

What does EPI lead to?

What are some clinical signs?

Answer 12

• EPI leads to
  
  • Maldigestion and Malabsorption
  • +/- diabetes mellitus
• Clinical Signs
  
  • Diarrhoaea and weight loss normal to increased appetite +/- poor haircoat, pica
  • Fatulence and marked borborygmus common
  • Pale, soft voluminour, greasy and malodourous faeces (steatorrhoea)
  • Concurrent SIBO

Question 13

• What are the endocrine portion of the Pancreas?
• In a Histo slide how do you reconise these?

Answer 13

• Islets of Langerhan
• Histologically its the sections with lots of dots

Question 14

What are the 3 major mechanisms of Acute pancreatic necrosis/pancreatitis?

Answer 14

• Obstructiom of the duct(s)
  
  • eg. Calculi, Parasites
• Direct Injury to acinar cells
  
  • Cassia occidentalis and T-2 mycotoxin toxicosis
  • Zinc toxicosis of dogs, veal calves and sheep
  • Ischaemia
  • Certain drugs eg. sulfonamides
  • Infectious agents eg. Bacteria, Viruses, Parasites
• Disturbances of enzyme trafficking within cytoplasm of acinar cells

Question 15

• What are the Pro Pancreatic Enzymes?
• Which ones are released in Active form and what are their cofactors?
• What is required to activate the other pro enzymes?

Answer 15

1. Pro-Pancreatic Enzymes
   
   • Pancreatic Amylase (Calcium as CoFactor)
   • Pancreatic Lipase (Calcium, Colipase and Bile Salts as cofactors_
   • Trypsinogen
   • Chymotrypsinogen
   • Procarboxypeptidase
2. Pancreatic Amylase and Pancreatic Lipase
3. Trypsin Activates the others

Question 16

How are acids in the duodenam neutralised?

What hormone/s is released to do this?

Answer 16