Pancreatic Flashcards
list risk factors for pancreatitis
hypertriglyceridemia, obesity, infections? breed, genes? drug reactions, intoxications, endocrine disease, trauma/surgery, hypercalcemia?
in dogs with serum triglyceride levels >= xx mg/dL (xx mmol/L), a xx-fold higher likelihood of having serum cPLI values consistent with pancreatitis have been seen
> = 862mg/dL (9.7 mmol/L), 4.5-fold
what drugs have been associated with acute pancreatitis?
potentiated sulfonamides, azathioprine, L-asparaginase, meglumine antimonate, N-methyl-glucamine, clomipramine, phenobarbital/KBr; CCK-8 and cerulein can be used to induce AP in dogs
what intoxications have been reported as causes of AP?
zinc, vipera xanthina palestinae envenomation, organophosphate (dog only)
what endocrine disorders have been linked to canine AP?
hyperadrenocorticism, hypothyroidism, diabetes mellitus
previous surgery other than neutering has been associated with an increased odds ratio (OR = xx) for pancreatitis in dogs
OR = 21.1
the key factor initiating pancreatic inflammation is what?
activation of trypsin within the acinar cells
why would trypsin be activated within acinar cells? (3 reasons)
blockage of acinar cella pex in pancreatic duct leading to co-localization and fusion of zymogen and lysosomal granules; oxidative stress; hypotension
what is the self-defense mechanism against activated trypsin?
neutralization by pancreatic secretory trypsin inhibitor, which is overwhelmed when more than 10% of intracellular trypsin is activated
what causes the switch from inflammation to necrosis in AP?
neutrophils, endothelin-1, phospholipase A3. disturbed pancreatic microcirculation and increased vascular permeability -> edema and necrosis
what inflammatory mediators are involved with AP progressing to ANP?
TNFa, IL1b, IL6, IL10, PAF, ICAM-1, CD40L, complement component C5a, chemokine, substance P, hydrogen sulfide, kinin-kallikrein and RAAS
discuss NK-1 in AP
pancreatic substance P and NK-1 receptors are highly unregulated in mice with AP, and knockout mice deficient in NK1 receptors are protected against AP and associated lung injury
why isn’t serum amylase recommended for diagnosis of pancreatitis?
some dogs with pancreatitis do not show increase in amylase, and amylase increases can be seen with many conditions
1 treatment for pancreatitis?
aggressive fluid therapy
what % of dogs with severe pancreatitis are found to be painful in the abdomen?
58%
FFP and fresh whole blood contain what elements that may be beneficial to dogs with AP?
alpha2-macroglobulin, albumin, anticoagulant and coagulation factors
what drug has been shown to be useful in preventing progression of pancreatitis in cats with experimentally induced pancreatitis when administered within 12 hours of initiating the disease?
dopamine
what is the most common disorder of the exocrine pancreas in cats?
pancreatitis
most common c/s in cats with pancreatitis?
inappetence > lethargy > dehydration > vomiting
the presence of hypocalcemia in a pancreatitis case is associated with what?
presence of severe, necrotizing pancreatitis
XX has the highest currently reported sensitivity (xx%) and specificity (xx%) of any diagnostic modality for the detection of pancreatitis in the cat
spec fPL; 79% sensitivity, 82% specificity
what type of diet is recommended for canine & feline pancreatitis patients?
dog: ultra-low fat. cat: novel protein or hypoallergenic
why isn’t a low fat diet recommended for cats with pancreatitis?
they have a high constitutive requirement for arachidonic acid
what is the most common cause of EPI?
absolute lack of pancreatic acinar cells that is due to destruction of acinar cells due to chronic pancreatitis (dogs and cats) or depletion of acinar cells due to pancreatic acinar atrophy (dogs)
roughly what % of dogs with EPI are due to chronic pancreatitis versus pancreatic acinar atrophy?
50/50
what % of cats with EPI are due to chronic pancreatitis versus pancreatic acinar atrophy?
100/0
clinical signs of EPI ensure when more than xx% of exocrine pancreatic function has been lost
90%
explain the theory behind why EPI leads to malabsorption
due to a lack of trophic factors normally secreted by the exocrine pancreas that help maintain normal GI mucosa
what % of cats and dogs with EPI have hypocobalaminemia?
82% of dogs have hypocobalaminemia (36% marked hypocobal); 100% of cats
why do so many animals with EPI have low cobalamin?
intrinsic factor is mainly secreted from the exocrine pancreas
most common c/s in dogs and cats with EPI?
weight loss
describe the clinical presentation of an animal with EPI
weight loss, loose stools; watery diarrhea uncommon. poor hair coat, borborygmus, flatulence. increased appetite, coprophagia, pica. cats may have greasy soiling of hair coat in perineal region.
diagnostic test of choice for EPI?
TLI
TLI measures what?
concentration of cationic trypsinogen, cationic trypsin, and some cationic trypsin molecules bound to proteinase inhibitor molecules
list 2 scenarios in which TLI could be normal in a patient with EPI
isolated pancreatic lipase deficiency. patient with obstructed pancreatic duct.
what is a concern with a patient diagnosed with EPI based on fecal elastase?
high number of false positives (23%): confirm diagnosis with TLI
if you have a patient on pancreatic enzyme powder that develops oral bleeding, what should your first step be?
check a coagulation panel: vitamin K responsive coagulopathies have been reported in two cats with EPI
what diseases can potentially be transmitted using raw pancreas to treat EPI?
bovine and ovine pancreas: bovine spongiform encephalopathy. pork: pseudorabies (aujeszky’s dz) [dried pancreatic powder can also transmit these]. game and ovine: echinococcus
what type of diet should be avoided in dogs with EPI? why?
high fiber: dietary fiber may interfere with fat absorption
if a dog or cat is diagnosed with EPI, what else should you test for?
cobalamin levels
serum concentrations of what types of vitamins are decreased in dogs with EPI?
fat-soluble
list the prognostic factors for EPI
hypocobalaminemia
what things should you consider if your EPI patient isn’t responding to enzymes and cobalamin?
concurrent disease (IBD, DM, dysbiosis), enzyme replacement dose, consider tylosin trial, consider omeprazole trial (to decrease amount of lipase supplement is destroyed by gastric pH)
what breed & gender are predisposed to exocrine pancreatic tumors?
females, airedale terriers
what mutation has been identified in people and dogs with exocrine pancreatic cancer?
K-ras
what are the most common metastatic sites for exocrine pancreatic cancers?
duodenum, regional LNN, liver, lungs, carcinomatosis
what paraneoplastic syndrome has been seen in cats with exocrine pancreatic neoplasm?
alopecia, most prominent on ventral abdomen +/- limbs and paws. Other reported metastases/paraneoplastic things: bone mets, multifocal necrotizing steatitis, PU/PD d/t hypercalcemia
how does exocrine pancreatic neoplasia lead to icterus?
compression of extra hepatic bile duct; 10% of cases of EHBDO are d/t pancreatic exocrine carcinoma
discuss prognosis of exocrine pancreatic carcinoma
poor. cats - overal MST 97d; if sx or chemo - 165d. palliative tx or abdominal effusions- 26 and 38d, respectively
