Pancreatic disease Flashcards
how many lobes of the pancreas are there
2
what is the pancreas closely associated with
the duodenum and the stomach
how many pancreatic ducts do dogs have and where do they open
2 - one opens next to the common bile duct on the major duodenal papilla and the other opens on the minor duodenal papilla
how many pancreatic ducts do cats have and where do they open
1 - fuses with the bile duct before opening on the major duodenal papilla
why do we see pancreatitis more regularly in cats
due to the design flaw of the opening of the pancreatic duct
what is the role of the pancreas
exocrine tissue secretes digestive enzymes, endocrine tissue secretes hormones
why do the enzymes in the exocrine pancreas not digest the pancreas itself
enzyme inhibitors prevent enzymatic digestion in the pancreas
Define acute pancreatitis
inflammation of the pancreas, sudden onset, little or no permanent changes after recovery
Define chronic pancreatitis
continuing inflammatory disease, irreversible morphological changes (fibrosis and atrophy), can lead to permanent impairment
What is EPI
exocrine pancreatic insufficiency
What is DM
diabetes mellitus
List 7 risk factors for pancreatitis in dogs
genetics
hyperlipidaemia
high fat meals
obesity
pancreatic ischaemia or hypoxia
trauma
List 5 risk factors for pancreatitis in cats
GI disease causing bile reflux can irritate the pancreas
genetics
hyperlipidaemia
pancreatic ischaemia or hypoxia
trauma
Describe triaditis in cats
pancreatitis, Inflammatory bowel disease and cholangitis
seen together
List the clinical signs of acute pancreatitis
Lethargy
weakness
anorexia
vomiting
diarrhoea
Severe acute:
shock
collapse
List 6 clinical findings that suggest pancreatitis
Abdominal pain - only 20% of cats
cranial abdominal mass
mild ascites
dehydration
fever- not all cases
jaundice (uncommon)
List 3 changes seen on haematology that suggest pancreatitis
anaemia
haemoconcentration
leukocytosis
Non-specific
List 7 things that can be seen on biochemistry that suggests pancreatitis
Azotaemia (pre renal)
Increased liver enzymes (ALP)
Hyperbilirubinaemia
Hyper or hypoglycaemia
Hypoalbuminaemia
Hypertriglyceridaemia
Hypercholesterolaemia
Non- specific
List 4 electrolyte changes that can be seen with pancreatitis
Hypokalaemia
Hypochloraemia
Hyponatraemia
Hypocalcaemia
What immunoassays are available in diagnostics of pancreatitis?
Spec PL
Snap PL
Is radiography useful to diagnose pancreatitis
no but it is useful to rule out other differentials
What can you see on abdominal ultrasound in pancreatitis case
enlarged pancreas
localised peritoneal effusion
changes to echogenicity
pancreatic duct dilation
what does decreased echogenicity of the pancreas indicate
pancreatic necrosis
what does hyperechogenicity of the pancreas indicate
pancreatic fibrosis
Describe how to treat pancreatitis
treat underlying cause
correct fluid deficits- to increase perfusion to pancreas
analgesia
antiemetics
antibiotics if infectious cause identified
steroid may be useful in some cats
change of diet
what analgesia do we provide to pancreatic patients
opiods first line
buprenorphine in cats
methadone first then buprenorphine when pain decreasing in dogs
Avoid NSAIDs
What anti-emetics to give to a pancreatitic patient
Maropitant
Metoclopramide- but as CRI
What antibiotics should we use if infectious cause of pancreatitis idenitified
trimethoprim/sulphonamide
marbofloxacin
metronidazole
clindamycin
what should we feed dogs after pancreatitis
high carbs (rice/potato/pasta) and a low fat commercial diet
what should we feed cats after pancreatitis
base the diet on any concurrent disease they may have
how should we feed anorexic cats
NGT or oesophagostomy tube
why do we want to get cats home as soon as possible
we have a better chance of getting them to eat at home
Describe long-term management for pancreatic patients
avoid high-fat meals (maybe even a fat restricted diet)
oral pancreatic enzyme application can help steroids may be worth a trial in some cats
Describe the prognosis with pancreatitis
mild/moderate- good
Acute pancreatitis can be life-threatening
Poor prognosis if continue to refuse food
T/F pancreatic neoplasia is common
False Rare
List 3 types of pancreatic neoplasia
pancreatic adenomas
pancreatic adenocarcinoma
sarcomas
List the clinical signs of pancreatic neoplasia
similar to chronic pancreatitis
vomiting
anorexia
diarrhoea
weight loss
signs associated with metastatic lesions
paraneoplastic alopecia- cats
describe paraneoplastic alopecia
shiny skin disease in cats - alopecia of the ventrum, limbs and face
what can you see on radiography of pancreatic neoplasia
decreased contrast in the cranial abdomen, may see a mass, spleen may be caudally displaced
what can you see on ultrasound of pancreatic neoplasia
soft tissue mass in pancreatic region, +/- peritoneal effusion
how do we get a definitive diagnosis of pancreatic neoplasia
biopsy or histology
Describe how to treat pancreatic adenomas
benign - only treat if cause clin signs
If find mass during ex-lap- partial pancreatectomy to establish diagnosis
Deacribe how to treat pancreatic Adenocarcinomas
Often metastatic disease present by time of diagnosis.
surgical resection- clean margins rarely acheived
prognosis grave
Describe Exocrine Pancreatic Insufficiency
Loss of pancreatic acinar cells.
Causes malabsorption
Signs don’t occur until most of exocrine tissue has been lost.
what is the most common cause of EPI on dogs
Pancreatic acinar atrophy- most commonly occurs in young dogs
What is the most common cause of EPI in cats
Chronic pancreatitis
Rare in dogs
Describe the history seen in dogs with EPI
weight loss but increased appetite
Diarrhoea - large volume, yellow, fatty, frequent
Flatulence
borborygmi
water intake may be increased
List 4 clinical signs seen with EPI
Weight loss- can be severe
Muscle wastage
Minimal body fat
Poor hair coat
Describe how to diagnose EPI
TLI (Low serum trypsin-like immunoreactivity)- diagnostic
Describe how to treat EPI
Pancreatic enzyme replacement- with each meal
Dietary modification
Vitamin supplementation- cobalamin
antimicrobial therapy- if not responding to enzyme supplementation
Describe the dietary modifications for EPI treatment
feed more then recommended initially to encourage weight gain
If not improving on normal diet, use highly digestible low fibre diet
Avoid low fat diets
Describe the prognosis associated with EPI
Underlying processes normally irreversible
Lifelong treatment required
Prognosis good with treatment
What are the differences between a Spec PL and a Snap PL test?
Spec PL= Laboratory test, Quantitative and More specific
SNAP PL= In practice test, Normal or abnormal result and More sensitive
