pancreatic and intestinal

Question 1

what digestion happens in the stomach

Answer 1

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

Question 2

function of small intestine

Answer 2

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)

Question 3

function of the large intestine

Answer 3

-absorption of water and electrolyte
-digestion: bacteria prodcues enzymes that break down less digetable material
-forms and stores faeces

Question 4

what are the two tissues found in the pancreas

Answer 4

exocrine: acinar cells secrete digestive enzymes and release into duodenum
endocrine: islets of langerhans secrete hormones into the bloodstream

Question 5

what is the name of the cells that secrete digestive enzymes

Answer 5

acinar cells

Question 6

what form are the digestive enzymes in when they are secreted from the pancreas

Answer 6

inactive form , so thag digestion does not occur while it travels down the pancreatic duct into the duodenum (gets activated here)

Question 7

what enzymes does acinar cells secrete

Answer 7

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

Question 8

what is pancreatitis

Answer 8

inflammatory disease of the pancreas
can be acute or chronic

Question 9

risk factors of pancreatitis (what type of animals are more likey to get it)

Answer 9

middle to older dogs
overweight
high fat diet
previous histry of pancreatitis
abdominal trauma, immunosepressive drugs and infections

Question 10

diagnosis of pancreatitis

Answer 10

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

Question 11

what test is used to diagnose pancreatitis

Answer 11

pancraetic lipase immunoreactivity

Question 12

what is so good about pancreatic lipase immunoreactivity

Answer 12

measures serum lipase form exocrine lipase only (test only for lipase prodcued by the pancreas)
tests are species specific (cPLI or fPLI)

Question 13

what is the principal behind the pancreatic lipase immunoreactivty test (PLI)

Answer 13

lipase is secreted when there is inflamation of the pancreas
lipase is specific to the pancreas

Question 14

how to test for pancreatitis in dog

Answer 14

-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

Question 15

what are the requirements of pancreatic lipase immunoreactivity test

Answer 15

serum sample using serum seperator and plain tube (blood needs to clot)

Question 16

what is another test used to test for pancreatitis

Answer 16

tyrpsin-like immunoreactivity
detects trypsinogen and trysin in the serum, not very sensative
will increase when there is pancreatitis

Question 17

what are all the test that can be used to diagnose pancreatitis

Answer 17

-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)

Question 18

treatment of pancreatitis

Answer 18

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

Question 19

what is exocrine pancreatic insufficiency

Answer 19

maldigestion disorder due to lack of digestive enzymes made by the pancreas
(oppomof pancreatitis)

Question 20

What is the history and clinical signs

Answer 20

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).

Question 21

How to diagnose EPI

Answer 21

CBC
Biochemistry panel
Pancreatic biopsy (for definitive diagnosis of pancreatic acids r atrophy) invasive and can cause pancreatitis
-serum TLI
Fecal elastase ELISA assay

Question 22

What happens to TLI in endocrine pancreatic insufficiency

Answer 22

Lower levels (less trysinogen is produced by pancreas)

Question 23

How to conduct trypsin like immunoreactivity for endocrine pancreatic insufficiency

Answer 23

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.)

Question 24

What is the limitation of TLI

Answer 24

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.

Question 25

Treatment of epi

Answer 25

Oral pancreatic extract (Eg pancreas powder) ▫Enzyme supplementation

•Diet
▫highly digestible
▫Small, frequent meals
▫High protein, low fat (less work for pancreas)

Question 26

Testing small intestinal function on dogs (not very often run)

Answer 26

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

Question 27

Causes of EPI

Answer 27

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.