pancreatic and intestinal Flashcards
what digestion happens in the stomach
physical digstion: muscular walls churn and the mix food with gastric juice to form chyme
chemical digestion: glands secrete gastric juice made of enzymes (gastrin, pepsin) and HCL
function of small intestine
chemical digstion
amylase: starch digestion
protein proteolytic enzymes from stomach or pancreas gets activated in the intestinal lumen
bile emulsifies lipids
lipase hydrolyses lipids for absorption
absorbtion: movement of products of digetion across the intestinal mucosa and into the circulatory system (water, electrolytes)
function of the large intestine
-absorption of water and electrolyte
-digestion: bacteria prodcues enzymes that break down less digetable material
-forms and stores faeces
what are the two tissues found in the pancreas
exocrine: acinar cells secrete digestive enzymes and release into duodenum
endocrine: islets of langerhans secrete hormones into the bloodstream
what is the name of the cells that secrete digestive enzymes
acinar cells
what form are the digestive enzymes in when they are secreted from the pancreas
inactive form , so thag digestion does not occur while it travels down the pancreatic duct into the duodenum (gets activated here)
what enzymes does acinar cells secrete
lipase: breaks down triglycerides and oils in the gut lumen
amyalse: breaks down a1-4 linkage of amylase polysaccharides into maltose anf then glucose
trypsinogen: activated by enterokinase in duodenum to trypsin
chymotrypsinogen: activated by trypsin in the gut lumen to cleave amino acid chains
carboxypeptidases: activated by trypsin in the gut lumen to clave caroboxy end of peptide bonds
what is pancreatitis
inflammatory disease of the pancreas
can be acute or chronic
risk factors of pancreatitis (what type of animals are more likey to get it)
middle to older dogs
overweight
high fat diet
previous histry of pancreatitis
abdominal trauma, immunosepressive drugs and infections
diagnosis of pancreatitis
Clinical Signs:
Anorexia
Vomiting
Weakness
Abdominal pain- prayer position (classic sign)
Dehydration
Diarrhoea
Systemic signs (renal failure, cardiac arrhythmias, pleural effusion, DIC, death)
diagnsotic tests: haemotology (leukocytosis with left shift neutrophilia)
serum biochemistry ( hyperglycemia, hyperlipemea (less fat digestion) possible increase amylase and lipase
what test is used to diagnose pancreatitis
pancraetic lipase immunoreactivity
what is so good about pancreatic lipase immunoreactivity
measures serum lipase form exocrine lipase only (test only for lipase prodcued by the pancreas)
tests are species specific (cPLI or fPLI)
what is the principal behind the pancreatic lipase immunoreactivty test (PLI)
lipase is secreted when there is inflamation of the pancreas
lipase is specific to the pancreas
how to test for pancreatitis in dog
-canine pancreatic lipase (cPL) (qualitative)
cPIL
is a snap test made by IDEXX indicates positive or negative results
-spec cPL (quantitative) sent out to lab or run on newer idexx machine
what are the requirements of pancreatic lipase immunoreactivity test
serum sample using serum seperator and plain tube (blood needs to clot)
what is another test used to test for pancreatitis
tyrpsin-like immunoreactivity
detects trypsinogen and trysin in the serum, not very sensative
will increase when there is pancreatitis
what are all the test that can be used to diagnose pancreatitis
-pancreatic lipase immunoreativity (species specific, cPL, fPL also spec cPL snd spec fPL) increase
-trypsin like immunoreactivity (not the most senstivity, will increase with pancreatitis)
-serum amylase (will increase, not specific for dogs and not at all specific for cats) only for screeing
-serum lipase (not very specific) (high with pancreatitis)
-abdominal ultrasound( exp and difficult)
-biopsy ( definite for diagnosis, expensive, risk during anesthesia and surgery)
treatment of pancreatitis
Treatment is mostly symptomatic:
Pain relief
IV fluid therapy (dehydration)
Anti-emetic medications (vomitting)
Low fat prescription diet such as Hills I/D or Royal Canin digestive low fat (less fat, stimulate the pancreas less, help pancreas to heal)
If a cause is known, then treatment for the cause is required
what is exocrine pancreatic insufficiency
maldigestion disorder due to lack of digestive enzymes made by the pancreas
(oppomof pancreatitis)
What is the history and clinical signs
Weight loss
•Poor hair coat (dry and scurfy)
•Flatulence
•Increased appetite
•Polyphagia (increased hungry)
•Coprophagia (eat poop)
•Diarrhoea
•Steatorrhoea (yellow-grey feces with an oily texture).
How to diagnose EPI
CBC
Biochemistry panel
Pancreatic biopsy (for definitive diagnosis of pancreatic acids r atrophy) invasive and can cause pancreatitis
-serum TLI
Fecal elastase ELISA assay
What happens to TLI in endocrine pancreatic insufficiency
Lower levels (less trysinogen is produced by pancreas)
How to conduct trypsin like immunoreactivity for endocrine pancreatic insufficiency
Take a blood sample from the dog/cat that has fasted 12-18 hours.
▫Shipped to referral lab (TLI is stable and can be shipped at ambient temperature.)
What is the limitation of TLI
In dogs/ cats with pancreatitis: TLI can be normal or increased (up to 50ug/l).
▫Dogs with bacterial overgrowth have a normal TLI test - unless exocrine pancreatic insufficiency is present as well.
Treatment of epi
Oral pancreatic extract (Eg pancreas powder) ▫Enzyme supplementation
•Diet
▫highly digestible
▫Small, frequent meals
▫High protein, low fat (less work for pancreas)
Testing small intestinal function on dogs (not very often run)
Serum Folate and Cobalamine
•Absorption and Tolerance tests
•Plasma turbidity test – tests lipid absorption
•Oral D-xylose absorption test – tests carbohydrate absorption
•Oral glucose tolerance test – tests carbohydrate absorption
•Fecal a1 – proteinase inhibitor concentration
•C reactive protein
Causes of EPI
Pancreatic acinar atrophy
▫Common in dogs
▫6 mths to 5 yrs
▫May be preceded by a lymphocytic infiltration of the pancreas.
•Pancreatic hypoplasia
▫Rare, congenital condition (<6 mths)
▫May be assoc with juvenile diabetes mellitus
▫Poor growth
•Chronic pancreatitis
▫Repeated bouts of acute pancreatitis, eventually destroys enough functional reserve (acinar cells undergo fibrosis)
▫EPI is uncommon in cats, but if it occurs, its due to chronic pancreatitis.
