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9- SA- Gastrointestinal and Hepatic Disease > Pancreatic disease > Flashcards

Pancreatic disease Flashcards

1
Q

how many lobes of the pancreas are there

A

2

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2
Q

what is the pancreas closely associated with

A

the duodenum and the stomach

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3
Q

how many pancreatic ducts do dogs have and where do they open

A

2 - one opens next to the common bile duct on the major duodenal papilla and the other opens on the minor duodenal papilla

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4
Q

how many pancreatic ducts do cats have and where do they open

A

1 - fuses with the bile duct before opening on the major duodenal papilla

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5
Q

why do we see pancreatitis more regularly in cats

A

due to the design flaw of the opening of the pancreatic duct

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6
Q

what is the role of the pancreas

A

exocrine tissue secretes digestive enzymes, endocrine tissue secretes hormones

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7
Q

why do the enzymes in the exocrine pancreas not digest the pancreas itself

A

enzyme inhibitors prevent enzymatic digestion in the pancreas

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8
Q

Define acute pancreatitis

A

inflammation of the pancreas, sudden onset, little or no permanent changes after recovery

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9
Q

Define chronic pancreatitis

A

continuing inflammatory disease, irreversible morphological changes (fibrosis and atrophy), can lead to permanent impairment

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10
Q

What is EPI

A

exocrine pancreatic insufficiency

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11
Q

What is DM

A

diabetes mellitus

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12
Q

List 7 risk factors for pancreatitis in dogs

A

genetics
hyperlipidaemia
high fat meals
obesity
pancreatic ischaemia or hypoxia
trauma

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13
Q

List 5 risk factors for pancreatitis in cats

A

GI disease causing bile reflux can irritate the pancreas
genetics
hyperlipidaemia
pancreatic ischaemia or hypoxia
trauma

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14
Q

Describe triaditis in cats

A

pancreatitis, Inflammatory bowel disease and cholangitis
seen together

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15
Q

List the clinical signs of acute pancreatitis

A

Lethargy
weakness
anorexia
vomiting
diarrhoea

Severe acute:
shock
collapse

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16
Q

List 6 clinical findings that suggest pancreatitis

A

Abdominal pain - only 20% of cats
cranial abdominal mass
mild ascites
dehydration
fever- not all cases
jaundice (uncommon)

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17
Q

List 3 changes seen on haematology that suggest pancreatitis

A

anaemia
haemoconcentration
leukocytosis

Non-specific

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18
Q

List 7 things that can be seen on biochemistry that suggests pancreatitis

A

Azotaemia (pre renal)
Increased liver enzymes (ALP)
Hyperbilirubinaemia
Hyper or hypoglycaemia
Hypoalbuminaemia
Hypertriglyceridaemia
Hypercholesterolaemia

Non- specific

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19
Q

List 4 electrolyte changes that can be seen with pancreatitis

A

Hypokalaemia
Hypochloraemia
Hyponatraemia
Hypocalcaemia

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20
Q

What immunoassays are available in diagnostics of pancreatitis?

A

Spec PL
Snap PL

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21
Q

Is radiography useful to diagnose pancreatitis

A

no but it is useful to rule out other differentials

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22
Q

What can you see on abdominal ultrasound in pancreatitis case

A

enlarged pancreas
localised peritoneal effusion
changes to echogenicity
pancreatic duct dilation

23
Q

what does decreased echogenicity of the pancreas indicate

A

pancreatic necrosis

24
Q

what does hyperechogenicity of the pancreas indicate

A

pancreatic fibrosis

25
Q

Describe how to treat pancreatitis

A

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

26
Q

what analgesia do we provide to pancreatic patients

A

opiods first line
buprenorphine in cats
methadone first then buprenorphine when pain decreasing in dogs

Avoid NSAIDs

27
Q

What anti-emetics to give to a pancreatitic patient

A

Maropitant
Metoclopramide- but as CRI

28
Q

What antibiotics should we use if infectious cause of pancreatitis idenitified

A

trimethoprim/sulphonamide
marbofloxacin
metronidazole
clindamycin

29
Q

what should we feed dogs after pancreatitis

A

high carbs (rice/potato/pasta) and a low fat commercial diet

30
Q

what should we feed cats after pancreatitis

A

base the diet on any concurrent disease they may have

31
Q

how should we feed anorexic cats

A

NGT or oesophagostomy tube

32
Q

why do we want to get cats home as soon as possible

A

we have a better chance of getting them to eat at home

33
Q

Describe long-term management for pancreatic patients

A

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

34
Q

Describe the prognosis with pancreatitis

A

mild/moderate- good
Acute pancreatitis can be life-threatening
Poor prognosis if continue to refuse food

35
Q

T/F pancreatic neoplasia is common

A

False Rare

36
Q

List 3 types of pancreatic neoplasia

A

pancreatic adenomas
pancreatic adenocarcinoma
sarcomas

37
Q

List the clinical signs of pancreatic neoplasia

A

similar to chronic pancreatitis
vomiting
anorexia
diarrhoea
weight loss
signs associated with metastatic lesions
paraneoplastic alopecia- cats

38
Q

describe paraneoplastic alopecia

A

shiny skin disease in cats - alopecia of the ventrum, limbs and face

39
Q

what can you see on radiography of pancreatic neoplasia

A

decreased contrast in the cranial abdomen, may see a mass, spleen may be caudally displaced

40
Q

what can you see on ultrasound of pancreatic neoplasia

A

soft tissue mass in pancreatic region, +/- peritoneal effusion

41
Q

how do we get a definitive diagnosis of pancreatic neoplasia

A

biopsy or histology

42
Q

Describe how to treat pancreatic adenomas

A

benign - only treat if cause clin signs
If find mass during ex-lap- partial pancreatectomy to establish diagnosis

43
Q

Deacribe how to treat pancreatic Adenocarcinomas

A

Often metastatic disease present by time of diagnosis.
surgical resection- clean margins rarely acheived
prognosis grave

44
Q

Describe Exocrine Pancreatic Insufficiency

A

Loss of pancreatic acinar cells.
Causes malabsorption
Signs don’t occur until most of exocrine tissue has been lost.

45
Q

what is the most common cause of EPI on dogs

A

Pancreatic acinar atrophy- most commonly occurs in young dogs

46
Q

What is the most common cause of EPI in cats

A

Chronic pancreatitis
Rare in dogs

47
Q

Describe the history seen in dogs with EPI

A

weight loss but increased appetite
Diarrhoea - large volume, yellow, fatty, frequent
Flatulence
borborygmi
water intake may be increased

48
Q

List 4 clinical signs seen with EPI

A

Weight loss- can be severe
Muscle wastage
Minimal body fat
Poor hair coat

49
Q

Describe how to diagnose EPI

A

TLI (Low serum trypsin-like immunoreactivity)- diagnostic

50
Q

Describe how to treat EPI

A

Pancreatic enzyme replacement- with each meal
Dietary modification
Vitamin supplementation- cobalamin
antimicrobial therapy- if not responding to enzyme supplementation

51
Q

Describe the dietary modifications for EPI treatment

A

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

52
Q

Describe the prognosis associated with EPI

A

Underlying processes normally irreversible
Lifelong treatment required
Prognosis good with treatment

53
Q

What are the differences between a Spec PL and a Snap PL test?

A

Spec PL= Laboratory test, Quantitative and More specific
SNAP PL= In practice test, Normal or abnormal result and More sensitive

9- SA- Gastrointestinal and Hepatic Disease (14 decks)

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