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Internal Medicine > Pancreas > Flashcards

Pancreas Flashcards

1
Q

What percentage of the pancreas parenchyma is made up of exocrine acini vs endocrine islets?

A

90% exocrine acini vs 10% endocrine islet - they are not good when they pop.

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2
Q

What is the common pathway for pancreatitis?

A

Conversion of trypsinogen to trypsin in the pancreatic acini

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3
Q

How is trypsinogen activated in the small intestine?

A

Brush border enzyme enterokinase cleaves it.

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4
Q

Steatorrhea (fatty feces) is a prominent sign for what?

A

Pancreatic insufficiency (EPI)

Because pancreas is the only source of lipase.

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5
Q

Why is bicarb release by the pancreas?

A

The pancreatic enzyme can only work in a alkaline environment.

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6
Q

Intrinsic factor is necessary for what?

Where is it secreted in a cat vs dog?

A

B12 absorption in the ileum.

Cat- Pancreas only

Dog - Pancreas and gastric mucosa.

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7
Q

What percentage of trysinogen in the pancreas activate naturally?

A

10%

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8
Q

What are the protective mechanisms for premature activation of trypsinogen?

A

Pancreatic secretory trypsin inhibito

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9
Q

What is the likely cause of premature activation of trypsinogen in the pancreas?

A

Mutations that make trysinogen resitant to inhibitory mechanims

Too much trypsin is activated leading to overwhelming the pancreas’s defense mechs.

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10
Q

What removes trypsin from the blood?

A

Blood proteases

alpha-antitrypsin

alpha-macroglobulin

The saturation of these is what leads to SIRs

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11
Q

What breed of cat is more predisposed?

A

DSH

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12
Q

What drugs trigger pancreatitis?

A

KBr

Azathioprine

Asparaginase

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13
Q

What increases the risk of severe fatal pancreatitis in dogs?

A

DM

Cushings disease

Hypothyroid

These diseases cause hypertriglyceridemia

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14
Q

Which animal has two pancreatic duct and where do they dump into the duodenum?

A

DOG

The right pancreas gives off the large accessory and ends in the minor papilla

The left limb gives off a small pancreatic duct that terminates in the major duodenal papilla (does not join with the Gallbladder)

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15
Q

Which animal has one pancreatic duct and where do they dump into the duodenum?

A

CATS

Single major pancreatic duct that joins the common bile duct and dumbs into the proximal duodenum. (making the sphincter of Oddi an important player)

20% of cats have a second accessory duct that remains separate

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16
Q

Causes for EPI?

A

Pancreatic acinar atrophy: GSD - not reported in dogs

End-stage chronic pancreatitis - Dogs and cats

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17
Q

Causes for pancreatits?

A

Idiopathic (90%)

Trauma

Hypertriglycerdemia

Diet

Ischemia/reperfusion - surgery, GDV, shock, IMHA

Hypercalcemia

Drugs

Infection (Toxoplasma)

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18
Q

What is the classic postion of a dog with panc?

A

Praying stance

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19
Q

Cats and dogs with pancreatitis and jaundice commonly have what type of pancreatitis?

A

Acute on chronic

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20
Q

Most specific and sensitive test for pancreatitis?

A

PLI

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21
Q

Whats a neg prrognostic indicator in cats?

A

Hypocalcemia

Leukopenia

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22
Q

radiographic changes for pancreatitis?

A

Local peritonitis

Dilated, fixed C-shaped and laterally displaced proximal duodenum

Caudal displacement of the transverse colon.

Occasional mass is seen in the region of the pancreas

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23
Q

What is the most common form of pancreatitis in a cat? Dog?

A

Cat - Chronic pancreatitis

Dog - Acute.

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24
Q

Signs of chronic pancreatitis?

A

GI signs

Epigastric pain.

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25
Q

Two forms of chronic panc?

A

Idiopathic - English Cocker - any age

Autoimmune - CKCS, toy or non-sporting breeds - older dogs - MALES

26
Q

What endocrine diseases are sequeales to autoimmune chronic panc?

A

DM

EPI

50% develop this.

27
Q

What other autoimmune diseases are associated with autoimmune chronic panc in dogs?

A

Keratoconjuncitivitis sicca

Glomerulonephritis

28
Q

Development of EPI in middle to old age dogs… what should you be suspicious of?

A

Underlying chronic pancreatitis.

29
Q

Chronic pancreatitis is commonly associated with what diseases.. hint diffferent from dogs?

A

IBD

Cholangiohep

Hepatic lipidosis

Renal disease

30
Q

What is the most common cause for extrahepatic biliary obstruction in dogs?

A

Chronic panc.

31
Q

Chronic pancreatitis can look like what on US which makes diagnosis difficult?

A

NORMAL

32
Q

What is considered the primary cause for EPI in dogs? Cats?

A

Pancreatic acinar atrophy - Dogs

Chronic pancreatitis - Cats

33
Q

EPI most common in what breed of dog?

A

GSD*** Likely autoimmune

English setters, chow chows

34
Q

Diffference between dogs with EPI as a result of pancreatic acini atrophy (PAA) and dogs with EPI from chronic pancreatitis?

A

Dogs with chronic pancreatitis commonly develop DM and dogs with PAA do not.

This is due to the destruction of islet cells from pancreatitis.

35
Q

Other reasons besides PAA and chronic panc for the development of EPI?

A

Tumors

Hyperacidity of the duodenum inactivating lipase

Enzyme deficiency (lipase)

36
Q

70% of EPI dogs also have this condition of the intestines?

A

Small intestinal bacterial overgrowth (SIBO)

37
Q

EPI dogs and cats can also have what skin condition?

A

Chronic seborrheci skin disease

Due to lack of essential fatty acids.

38
Q

Best tests for EPI?

A

TLI and cPLI.

39
Q

1 exocrine pancreatic neoplasia?

A

Adenocarcinomas - very aggressive

40
Q

What are some paraneoplastic syndromes of pancreatic tumors?

A

Sterile panniculitis in dogs

Alopecia with shiny skin in cats

Hypercalcemia

41
Q

What breed predominance is shown with pancreatic adenocarcinomas?

A

Cockers and CKCS… both with higher rates of chronic pancreatitis.

42
Q

What are pseudocysts?

A

Acinar cysts… ASSOCIATED WITH PANC AND INCIDENTAL.. drain these

Retention cyst are incidental.

43
Q

What is the hallmark clinical sign of hyperglycemia?

A

PU/PD due to osmotic diuresis.

44
Q

1 reason for hyperglycemia and glucosuria (has to be both)?

A

DM

45
Q

Reason for just mild hyperglycemia and no glucosuria?

A

Recent meal

IV glucose

Stress

46
Q

Reasons for hypoglycemia?

A

Insulin overdose

Toy breeds not eating

Xylitol ingestion

Insulinoma and other paraneoplastic

Impaired hepatic gluconeogenesis (PSS and hepatic cirhosis)

Deficiency in diabetogenic hormone (hypocortisolism)

Spesis

Addisons

CKD

47
Q

Common cause for hypoglycemia in a puppy?

A

Idiopathic

Starvation

PSS

Sepsis

48
Q

What type of diabetes mellitus do most dogs have?

A

Type 1 or insulin dependent. Meaning they are not making enough

THEY NEED INSULIN

49
Q

What is the honeymoon phase of insulin treatment in dogs?

A

Where the dog responds excellent to insulin once first diagnose but then after 3-6 months it becomes hard to control due to the die off of B- Cells.

50
Q

IS there a sex predilec for DM?

A

Yes females!

51
Q

What is the pathophys of cataract in dogs with DM?

A

Break down of excessive sugars in the lens into sorbitol and galctitol… these are osmotic leading to water being sucked into the lens…leading to swelling and rupture of the lens fibers and development of cataracts.

52
Q

Other pathology of the eye with dogs with DM?

A

Diabetic retinopathy.

Lens induced Uveitis - lens is not exposed to immune system but when cataracts are formed adn reabsorbed it is exposed and leads to inflammation and uveitis.

53
Q

Other sequeale of DM?

A

Diabetic neuropathy - cats

Diabetic Nephropathy. Microvascular damade to the base membrane of the capillarys and glomeruli

Systemic hypertension - 50% of patients

54
Q

What type of DM predominates in cats?

A

Type 2

55
Q

What are we trying to rule out with US on newly diagnosed DM in cats and dogs?

A

Chronic panc.

Concurrent cushings.

Cystitis

Pyometras

56
Q

Most common place for B-cell tumors to mets to?

A

Lymphatics, liver and mesentery.

57
Q

What dogs are predisposed to B-cell tumors?

A

Labs, GSB, Goldens

Siamese

58
Q

When should insulin:glucose concentrations be obtained?

A

<50mg/dL

59
Q

What are the common clinical signs in a dog with a gastrin-secreting neoplasia?

A

Chronic vomiting

Weight losss

Anorexia

Diarrhea

Ulcers

60
Q

Besides infiltrative tumors.. what tumors can cause gastric ulcers?

A

Gastrinoma

MCT

Internal Medicine (12 decks)

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