Pancreatic dz Flashcards
Different categories of pancreatitis
Acute, chr., rapid onset and recurrent
Initiation of pancreatitis
Pancreatic duct obstruction
Intraductal bile or enzyme injection
Duodenal reflux
Pancreatic ischemia
Diet induced
Hyperstimulation induced
Etiology of pancreatitis
Idiopathic, obesity, high fat diets, trauma, ischemia, hypercalcemia
Hyperlipidemia/ hyperlipoproteinemia (hereditary and endocrine dz)
Drugs that cause pancreatitis
Thiazide diuretics, furosemide, azathioprine, L-asparginase, sulfonamides, tetracyclines, glucos
Dz associations of pancreatitis
Feline inflammatory hepatic dz
Hepatic lipidosis
IBD
Complications of pancreatitis
DB, diabetes ketoacidosis, pancreatic abscesses or pseudocysts, cardiac arrhythmias, abdominal distention and DIC
Septicemia, bile duct obstruction, resp. distress, renal failure, exocrine pancreatic insufficiency
CS of pancreatitis for K9s
V/D, abdominal pain, fever, pyrexia, lethargy, anorexia, shock, collapse
CS of pancreatitis for cats
Anorexia, lethargy, dehydration, hypothermia, V/D, abdominal pain, dyspnea and ataxia
CBC on pancreatitis
Hemoconcentration, non-regen anemia, leukocytosis, neutrophilia, left shift, stress and inflammation
Serum chemistry on pancreatitis
↑ ALT, AST (hepatocellular injury, inflamm. mediators, ischemia, extension of enzymes)
↑ALP and BR (cholestasis)
↑ BUN, creatinine (dehydration, renal failure)
↓ Ca (saphonificaiton of fat)
↓ albumin
Imaging of pancreatitis
↑ opacity right cranial abdomen
Displacement of desc. duodenum / stomach
Gas filled desc. duodenum
↓ abdominal detail
Widening of gastric duodenal angle
US of pancreatitis
Hypoechoic pancreatic parenchyma (acute)
Hyperechoic pancreatic parenchyma (chr)
Hyperechoic mesentery
Enlargement of the pancreas
Peritoneal effusion
Present of cysts or masses
What is the gold standard for pancreatitis?
Pancreatic bx
Cytokine tests for pancreatitis
↑ phospholipase A2, C-reactive protein, PMNE
↑ IL-6, 8 and 10
↓ a2- macroglobulins
Tx of pancreatitis
Fluid therapy: hypovolemia, deydration, hypotension
NPO (initially in dogs, not cats)
Enteral feeding: nasoesoph.
Low fat diet
Plasma transfusion
Medical tx of pancreatitis
Broad spectrum abx
Antiemetics: maropitant, meoclopramide, odansetron
Analgesia (bupren, ketamine, lidocaine, fent)
Exocrine Pancreatic insufficiency
Inadequate production of pancreatic digestive enzymes
CS when 90% of pancreas destroyed
Exocrine pancreas involved, endocrine with extensive dz
Histopath of EPI
Acine cell apoptosis, zymogen granule loss, cytosplasmic clearing/ vaculolization
Lobular atrophy, islet cell loss, lymphocytic and plasmacytic pancreatitis
Genetic predisposition of EPI
Shepherds, rough coated collie
Autosomal recessive inheritance, pancreatic atrophy with infiltrates of lymphos
Etiology of dogs with EPI
Autoimmune pancreatic atrophy
Congential
Pancreatic neoplasia
Breed disposition
Clinical dz 1-5yr
Etiology of cats with EPI
Congenital from with DM
Pancreatic fluke
Clinical dz
CS of EPI in dogs
↑ fecal vol and frequency
WL, flatulence, polyphagia, pica, coprophagia, yellow-grey fecal color
CS of EPI in cats
Steatorrhea, intermittent watery diarrhea
Greasy/ unkempt haircoat
Nervousness and aggressive behavior
Vomiting, coagulopathy
Differentials for EPI
Hyperthyroidism, DM, IBD, pythiosis, giardia, GI lymphoma
Testing pancreatic function
TLI, Fecal proteolytic activity, PLI, serum lipase, fat absorption, microscopic examination of feces
Tx of EPI
Pancreatic enzyme extract
CS resolve 2-3 d
