Pancreatic Disease

Question 1

How are pancreatic enzymes activated?

Answer 1

• They are biologically inactive zymogens that are activated by trypsin (which is activated from trypsinogen by enteropeptidase)
• calcium is critical in the process
• activation involves removal of a few amino acids

Question 2

How does the pancreas not digest itself?

Answer 2

• Intracellular compartmentalization (enzymes separate from lysosomes)
• proteases formed and secreted in an inactive form (zymogens)
• PSTI is secreted in parallel w/ trypsinogen
• enterokinase is extrapancreatic
• pancreatic cells have low intracellular Ca

Question 3

What are the risk factors of pancreatitis?

Answer 3

• Dietary (fat, indiscretion)
• pancreatic ischemia
• reflux of duodenal contents - bile
• drugs
• duct obstruction
• genetic factors
• idiopathic

Question 4

What are the clinical signs of pancreatitis?

Answer 4

Dogs: vomiting, weakness, abd pain, dehydration, diarrhea, anorexia, depression, fever, shock, cranial abd mass, cardiac arrhythmia; Cats: palpable mass, dyspnea, ataxia, diarrhea; can occur with IBD and cholangiohepatitis (“triaditis”)

Question 5

How do you diagnose pancreatitis?

Answer 5

Canine and feline pancreatic lipase (cPLI, fPLI), pancreatic specific lipase (PSL), rads: loss of serosal detail right cranial abd, duodenum displaced laterally, duodenum and colon gas-filled (sentinel loop), corrugated duodenal wall and/or pancreatic mass, U/S: hypoechoic and enlarged pancreas, peripancreatic fat hyperechoic, biopsy (uncommonly indicated)

Question 6

How do you treat pancreatitis?

Answer 6

Supportive care: anti-emetics (metoclopramide, maropitant, ondansetron), fluid therapy, analgesics (buprenorphine, oxymorphone, fentanyl), blood, plasma or plasma expander, parenteral antibiotics (usually not needed), gradually reintroduce low fat food with clinical improvement, sx exploration if: pancreatic abscess or prolonged bile duct obstruction

Question 7

What are some laboratory findings found with pancreatitis?

Answer 7

Azotemia, hypoalbuminemia, hyperglycemia, hypocalcemia, hyperlipidemia, hyperbilirubinemia, incr liver enzyme activity

Question 8

What animals are more prone to EPI, and what are the clinical signs, diagnostics, and treatment for this disease?

Answer 8

Dogs - degenerative atrophy (GSD, GSX), cats - chronic pancreatitis; C/S: polyphagia, wt loss, steatorrhea, diarrhea (voluminous), Dx: TLI (<2.5 in dogs, <8 in cats); Tx: powdered enzymes, oral abx, cobalamin