Pancreatic disease Flashcards
How can you interpret a test with high Sensitivity but low specificity?
- Few false negatives but many false positives
- Negative results can be believed
- Good screening test
How can you interpret a test with high Specificity but low Sensitivity?
- Few false positives but many false negatives
- Positive results can be believed
- Will not detect some some infected animals (false neg)
- Good confirmatory test
What occurs to pancreatic enzymes during pancreatitis?
- Zymogen granules and lysosomes fuse leading to early activation of Trypsin and proteases which destroy lipids and proteins
What type of inflammation can be seen on biopsy in acute vs chronic pancreatitis
Acute - neutrophilic inflammation
Chronic - lymphocytic inflammation
What dog breeds are overrepresented with acute pancreatitis?
- Mini Schnauzer
- Yorkies
List risk factors for canine pancreatitis
- Diet (high fat, getting into the garbage, rapid diet change)
- Diabetes mellitus
- HAC/Cushings
- HypoT
- Duct blockage
- Ischemia (hypotension, hypoxia, hypovolemia, under GA)
- IMHA / hemolysis (Babesia, Leishmania)
What can be seen on an Ab tap from a patient with ascites from acute pancreatitis?
Sterile neutrophilic peritonitis with NO evidence of bacteria
What are systemic complications of acute pancreatitis?
- Kidney injury
- Pulmonary failure
- Pancreatic encephalopathy
- DIC
- MODS, death
What diagnostic test is the gold standard for pancreatitis in cats and dogs?
- Spec cPL/fPL or Snap cPL/fPL has best sensitivity and specificity
What can cause a false positive CPLi test?
- Can be positive with intestinal FB obstructions, septic peritonitis, and hepatic disease
- Always look for underlying cause when cpL is positive
What is a disadvantage to using ultrasound for diagnosis of pancreatitis?
- Poor indicator of severity
- Must be used in conjugation with other diagnostics and CS
What is the treatment protocol for acute pancreatitis in dogs?
- Early nutrition associated with better prognosis!!
- Low fat diet
- Esophagostomy or NG tube if needed
- Fluids
- Opioids (avoid NSAIDs)
- Correct electrolyte imbalances
How do cats with pancreatitis present?
- Anorexia and lethargy most common (vague CS, difficult to diagnose)
- +/- V/D, weight loss
- less frequently have ABD pain
- Pallor or icterus
- Hypothermia (shock) or fever
- Resp distress
- Often have triaditis
What is the treatment protocol for acute pancreatitis in cats?
-Early nutrition associated with better prognosis!!
- Normal fat, high protein diet, esophagostomy or NG tube if needed
- Novel protein or HA diet if concurrent IBD
- Fluids
- Opioids (avoid NSAIDs)
- Correct electrolyte imbalances
List causes of EPI
- Chronic pancreatitis
- Pancreatic acinar atrophy (GSDs, Rough coated collies)
- Obstruction of the pancreatic duct (will have normal TLI)
CS of EPI in dogs?
- Weight loss / Poor BCS
- Loose stools, steatorrhea
- Increased appetite
CS of EPI in cats?
- Lethargy and anorexia most common
- Less commonly stinky greasy diarrhea unlike dogs
What is the gold standard diagnostic test for diagnosis of EPI?
TLI is the most sensitive and specific
What is the treatment protocol for patients with EPI?
- Lifelong Pancreatic & Cobalamin supplements
- Raw pancreas only if won’t take powder or refractory to powder
(Don’t restrict fat in EPI patients)
Risk of raw pancreas for medical management of EPI?
- Bovine spongiform encephalopathy
- Pseudorabies
- Echinococcus
List differentials for a palpable abdominal mass linked to the pancreas
- Acute pancreatitis
- Benign pancreatic tumor
- Neoplastic pancreatic tumor
make sure to differentiate
What endocrine diseases are associated with risk of acute pancreatitis in dogs?
- Diabetes mellitus
- HAC/Cushings
- HypoT
