Pancreatic dz

Question 1

Different categories of pancreatitis

Answer 1

Acute, chr., rapid onset and recurrent

Question 2

Initiation of pancreatitis

Answer 2

Pancreatic duct obstruction
Intraductal bile or enzyme injection
Duodenal reflux
Pancreatic ischemia
Diet induced
Hyperstimulation induced

Question 3

Etiology of pancreatitis

Answer 3

Idiopathic, obesity, high fat diets, trauma, ischemia, hypercalcemia
Hyperlipidemia/ hyperlipoproteinemia (hereditary and endocrine dz)

Question 4

Drugs that cause pancreatitis

Answer 4

Thiazide diuretics, furosemide, azathioprine, L-asparginase, sulfonamides, tetracyclines, glucos

Question 5

Dz associations of pancreatitis

Answer 5

Feline inflammatory hepatic dz
Hepatic lipidosis
IBD

Question 6

Complications of pancreatitis

Answer 6

DB, diabetes ketoacidosis, pancreatic abscesses or pseudocysts, cardiac arrhythmias, abdominal distention and DIC
Septicemia, bile duct obstruction, resp. distress, renal failure, exocrine pancreatic insufficiency

Question 7

CS of pancreatitis for K9s

Answer 7

V/D, abdominal pain, fever, pyrexia, lethargy, anorexia, shock, collapse

Question 8

CS of pancreatitis for cats

Answer 8

Anorexia, lethargy, dehydration, hypothermia, V/D, abdominal pain, dyspnea and ataxia

Question 9

CBC on pancreatitis

Answer 9

Hemoconcentration, non-regen anemia, leukocytosis, neutrophilia, left shift, stress and inflammation

Question 10

Serum chemistry on pancreatitis

Answer 10

↑ ALT, AST (hepatocellular injury, inflamm. mediators, ischemia, extension of enzymes)
↑ALP and BR (cholestasis)
↑ BUN, creatinine (dehydration, renal failure)
↓ Ca (saphonificaiton of fat)
↓ albumin

Question 11

Imaging of pancreatitis

Answer 11

↑ opacity right cranial abdomen
Displacement of desc. duodenum / stomach
Gas filled desc. duodenum
↓ abdominal detail
Widening of gastric duodenal angle

Question 12

US of pancreatitis

Answer 12

Hypoechoic pancreatic parenchyma (acute)
Hyperechoic pancreatic parenchyma (chr)
Hyperechoic mesentery
Enlargement of the pancreas
Peritoneal effusion
Present of cysts or masses

Question 13

What is the gold standard for pancreatitis?

Answer 13

Pancreatic bx

Question 14

Cytokine tests for pancreatitis

Answer 14

↑ phospholipase A2, C-reactive protein, PMNE
↑ IL-6, 8 and 10
↓ a2- macroglobulins

Question 15

Tx of pancreatitis

Answer 15

Fluid therapy: hypovolemia, deydration, hypotension
NPO (initially in dogs, not cats)
Enteral feeding: nasoesoph.
Low fat diet
Plasma transfusion

Question 16

Medical tx of pancreatitis

Answer 16

Broad spectrum abx
Antiemetics: maropitant, meoclopramide, odansetron
Analgesia (bupren, ketamine, lidocaine, fent)

Question 17

Exocrine Pancreatic insufficiency

Answer 17

Inadequate production of pancreatic digestive enzymes
CS when 90% of pancreas destroyed
Exocrine pancreas involved, endocrine with extensive dz

Question 18

Histopath of EPI

Answer 18

Acine cell apoptosis, zymogen granule loss, cytosplasmic clearing/ vaculolization
Lobular atrophy, islet cell loss, lymphocytic and plasmacytic pancreatitis

Question 19

Genetic predisposition of EPI

Answer 19

Shepherds, rough coated collie
Autosomal recessive inheritance, pancreatic atrophy with infiltrates of lymphos

Question 20

Etiology of dogs with EPI

Answer 20

Autoimmune pancreatic atrophy
Congential
Pancreatic neoplasia
Breed disposition
Clinical dz 1-5yr

Question 21

Etiology of cats with EPI

Answer 21

Congenital from with DM
Pancreatic fluke
Clinical dz

Question 22

CS of EPI in dogs

Answer 22

↑ fecal vol and frequency
WL, flatulence, polyphagia, pica, coprophagia, yellow-grey fecal color

Question 23

CS of EPI in cats

Answer 23

Steatorrhea, intermittent watery diarrhea
Greasy/ unkempt haircoat
Nervousness and aggressive behavior
Vomiting, coagulopathy

Question 24

Differentials for EPI

Answer 24

Hyperthyroidism, DM, IBD, pythiosis, giardia, GI lymphoma

Question 25

Testing pancreatic function

Answer 25

TLI, Fecal proteolytic activity, PLI, serum lipase, fat absorption, microscopic examination of feces

Question 26

Tx of EPI

Answer 26

Pancreatic enzyme extract
CS resolve 2-3 d