Pancreas Clinical Pathology Flashcards
reasons for increased analyte
increased production, absorption, or leakage into blood
decrease elimination or utilization
reasons for decreased analyte
increased elimination or utilization
decreased production or absorption
EPI mechanism
inadequate pancreatic digestive enzyme secretions cause incomplete digestion of food (maldigestion) leading to malabsorption and clinical signs
EPI clinical signs
- low body condition score
- ravenous appetite w/ failure to gain weight
- voluminous foul smelling feces
causes of EPI
- pancreatic acinar atrophy (dogs) - immune mediated destruction of pancreatic cells
- chronic pancreatitis
- obstruction of pancreatic duct
- neoplasia
diagnosing EPI
decreased TLI
loss of acinar cells –> decreased trypsinogen released –> less detected in the blood
concurrent factors that may increase TLI
- pancreatitis
- decreased GFR (dehydration/kidney disease)
- dexamethasone
pancreatitis
inflammation of the pancreas
can be primary (idiopathic) or secondary (infection, toxin, etc)
histopathologic diagnosis of pancreatitis
inflammation visible on histology but the animal often lacks clinical signs or lab changes
histology diagnosis can be missed if inflammation is focal
clinical diagnosis of pancreatitis
based on clinical signs and lab changes
more clinically relevant
no pathognomonic findings
pancreatitis clinical signs in dogs
GI signs
(vomiting, anorexia, diarrhea)
pancreatitis clinical signs in cats
lethargy and anorexia
pancreatitis CBC
signs of inflammation and dehydration
- leukocytosis with neutrophilia w/ left shift
- hypo or hyperproteinemia (inflamm. vs dehydration)
- inc. or dec. platelets
- relative erythrocytosis
pancreatitis chemistry
- prerenal azotemia (from dec. clearance of nitrogenous waste or dehydration)
- electrolyte and acid/base changes
- hypocalcemia
- increased liver enzymes (mixed cholestatic and hepatocellular)
- hyperbilirubinemia
- hyperlipidemia
sensitivity
probability that a test will be positive in a diseased animal
high sensitivity = few false negatives
used as a rule out test
specificity
probability that a test will be negative in a healthy animal
high specificity = few false positives
used as a rule in test
amylase + lipase values
- produced by the pancreas
- increased leakage with pancreatitis
- also produced by other tissues
low sensitivity/specificity
DGGR lipase
- enzymatic lipase assay
- DGGR is a substrate that gets broken down by lipase
- other disease processes can cause increase lipase activity
higher sensitivity/lower specificity
pancreatic lipase (PL)
specCPL or specFPL
SNAP cPL or fPL
specCPL/FPL
quantitative ELISA - gives the number amount of pancreatic lipases present
highest sensitivity and specificity
SNAP cPL/fpL
qualitative ELISA - gives normal/elevated/consistent with pancreatitis results
high sensitivity/lower specificity
used as a point of care test to rule out
TLI
trypsin like immunoreactivity
injury to pancreas causes leakage of trypsinogen causing increased TLI
more sensitive and specific than amylase and lipase but not best
can be caused by other disease processes
effusions with pancreatitis
peritoneal effusion: non septic exudate
pleural effusion: (rare) effusion around lungs; lymphatic blockage or pancreatopleural fistula
steps to diagnosing pancreatitis
- clinical signs
- CBC
- chemistry
- specPL
- imaging
- effusions
