Pancreas Flashcards
What percentage of the pancreas parenchyma is made up of exocrine acini vs endocrine islets?
90% exocrine acini vs 10% endocrine islet - they are not good when they pop.
What is the common pathway for pancreatitis?
Conversion of trypsinogen to trypsin in the pancreatic acini
How is trypsinogen activated in the small intestine?
Brush border enzyme enterokinase cleaves it.
Steatorrhea (fatty feces) is a prominent sign for what?
Pancreatic insufficiency (EPI)
Because pancreas is the only source of lipase.
Why is bicarb release by the pancreas?
The pancreatic enzyme can only work in a alkaline environment.
Intrinsic factor is necessary for what?
Where is it secreted in a cat vs dog?
B12 absorption in the ileum.
Cat- Pancreas only
Dog - Pancreas and gastric mucosa.
What percentage of trysinogen in the pancreas activate naturally?
10%
What are the protective mechanisms for premature activation of trypsinogen?
Pancreatic secretory trypsin inhibito
What is the likely cause of premature activation of trypsinogen in the pancreas?
Mutations that make trysinogen resitant to inhibitory mechanims
Too much trypsin is activated leading to overwhelming the pancreas’s defense mechs.
What removes trypsin from the blood?
Blood proteases
alpha-antitrypsin
alpha-macroglobulin
The saturation of these is what leads to SIRs
What breed of cat is more predisposed?
DSH
What drugs trigger pancreatitis?
KBr
Azathioprine
Asparaginase
What increases the risk of severe fatal pancreatitis in dogs?
DM
Cushings disease
Hypothyroid
These diseases cause hypertriglyceridemia
Which animal has two pancreatic duct and where do they dump into the duodenum?
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)
Which animal has one pancreatic duct and where do they dump into the duodenum?
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
Causes for EPI?
Pancreatic acinar atrophy: GSD - not reported in dogs
End-stage chronic pancreatitis - Dogs and cats
Causes for pancreatits?
Idiopathic (90%)
Trauma
Hypertriglycerdemia
Diet
Ischemia/reperfusion - surgery, GDV, shock, IMHA
Hypercalcemia
Drugs
Infection (Toxoplasma)
What is the classic postion of a dog with panc?
Praying stance
Cats and dogs with pancreatitis and jaundice commonly have what type of pancreatitis?
Acute on chronic
Most specific and sensitive test for pancreatitis?
PLI
Whats a neg prrognostic indicator in cats?
Hypocalcemia
Leukopenia
radiographic changes for pancreatitis?
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
What is the most common form of pancreatitis in a cat? Dog?
Cat - Chronic pancreatitis
Dog - Acute.
Signs of chronic pancreatitis?
GI signs
Epigastric pain.
Two forms of chronic panc?
Idiopathic - English Cocker - any age
Autoimmune - CKCS, toy or non-sporting breeds - older dogs - MALES
What endocrine diseases are sequeales to autoimmune chronic panc?
DM
EPI
50% develop this.
What other autoimmune diseases are associated with autoimmune chronic panc in dogs?
Keratoconjuncitivitis sicca
Glomerulonephritis
Development of EPI in middle to old age dogs… what should you be suspicious of?
Underlying chronic pancreatitis.
Chronic pancreatitis is commonly associated with what diseases.. hint diffferent from dogs?
IBD
Cholangiohep
Hepatic lipidosis
Renal disease
What is the most common cause for extrahepatic biliary obstruction in dogs?
Chronic panc.
Chronic pancreatitis can look like what on US which makes diagnosis difficult?
NORMAL
What is considered the primary cause for EPI in dogs? Cats?
Pancreatic acinar atrophy - Dogs
Chronic pancreatitis - Cats
EPI most common in what breed of dog?
GSD*** Likely autoimmune
English setters, chow chows
Diffference between dogs with EPI as a result of pancreatic acini atrophy (PAA) and dogs with EPI from chronic pancreatitis?
Dogs with chronic pancreatitis commonly develop DM and dogs with PAA do not.
This is due to the destruction of islet cells from pancreatitis.
Other reasons besides PAA and chronic panc for the development of EPI?
Tumors
Hyperacidity of the duodenum inactivating lipase
Enzyme deficiency (lipase)
70% of EPI dogs also have this condition of the intestines?
Small intestinal bacterial overgrowth (SIBO)
EPI dogs and cats can also have what skin condition?
Chronic seborrheci skin disease
Due to lack of essential fatty acids.
Best tests for EPI?
TLI and cPLI.
1 exocrine pancreatic neoplasia?
Adenocarcinomas - very aggressive
What are some paraneoplastic syndromes of pancreatic tumors?
Sterile panniculitis in dogs
Alopecia with shiny skin in cats
Hypercalcemia
What breed predominance is shown with pancreatic adenocarcinomas?
Cockers and CKCS… both with higher rates of chronic pancreatitis.
What are pseudocysts?
Acinar cysts… ASSOCIATED WITH PANC AND INCIDENTAL.. drain these
Retention cyst are incidental.
What is the hallmark clinical sign of hyperglycemia?
PU/PD due to osmotic diuresis.
1 reason for hyperglycemia and glucosuria (has to be both)?
DM
Reason for just mild hyperglycemia and no glucosuria?
Recent meal
IV glucose
Stress
Reasons for hypoglycemia?
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
Common cause for hypoglycemia in a puppy?
Idiopathic
Starvation
PSS
Sepsis
What type of diabetes mellitus do most dogs have?
Type 1 or insulin dependent. Meaning they are not making enough
THEY NEED INSULIN
What is the honeymoon phase of insulin treatment in dogs?
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.
IS there a sex predilec for DM?
Yes females!
What is the pathophys of cataract in dogs with DM?
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.
Other pathology of the eye with dogs with DM?
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.
Other sequeale of DM?
Diabetic neuropathy - cats
Diabetic Nephropathy. Microvascular damade to the base membrane of the capillarys and glomeruli
Systemic hypertension - 50% of patients
What type of DM predominates in cats?
Type 2
What are we trying to rule out with US on newly diagnosed DM in cats and dogs?
Chronic panc.
Concurrent cushings.
Cystitis
Pyometras
Most common place for B-cell tumors to mets to?
Lymphatics, liver and mesentery.
What dogs are predisposed to B-cell tumors?
Labs, GSB, Goldens
Siamese
When should insulin:glucose concentrations be obtained?
<50mg/dL
What are the common clinical signs in a dog with a gastrin-secreting neoplasia?
Chronic vomiting
Weight losss
Anorexia
Diarrhea
Ulcers
Besides infiltrative tumors.. what tumors can cause gastric ulcers?
Gastrinoma
MCT
