Pancreatitis

Question 1

Which dog breeds are predisposed to chronic pancreatitis?

Answer 1

Cavalier King Charles Spaniel, English Spaniel, Boxer, and Collies

Question 2

What are some important risk factors considered for canine pancreatitis?

Answer 2

obesity, hypertriglyceridemia
- but a prospective study found an association with increased increased cPLI but not pancreatitis

Question 3

How reliable is high fat diet leading to acute pancreatitis?

Answer 3

This association has not been reliably documented

Question 4

What are some infectious causes of acute pancreatitis?

Answer 4

Babesiosis in dogs
- ehrlichiosis & leishmania –> case reports only –> likely individual susceptibility rather than norm
- overall no bacterial/ septic pancreatitis been reported
- possible to have bacterial translocation
- bile duct obstruction may exacerbate pancreatitis in cats (common opening for bile duct and pancreatic duct) due to impaired ability to clear bacteria

Question 5

What are some drug causes of pancreatitis?

Answer 5

Phenobarbital/KBr
- most drugs = idiosyncratic
- no evidence of Elspar or meglumine antimonite leading to pancreatitis in dogs in prospective studies

Question 6

What are some toxic causes of pancreatitis?

Answer 6

• zinc
• snake bites
• organophosphates in dogs
• easter lily in cats

Question 7

What endocrine disorders are linked to acute pancreatitis?

Answer 7

in dogs: hyperadrenocorticism, hypothyroidism, and diabetes mellitus
- DM is a consequence of chronic pancreatitis in both dogs and cats, rather than a cause

Question 8

Can trauma lead to pancreatitis?

Answer 8

Yes! ex. high rise syndrome in cats, surgery or other minimally invasive interventions
- could be due to subclinical inflammation

Question 9

What’s the key factor in initiation pancreatic inflammation?

Answer 9

key factor = premature activation of trypsin within the acinar cells, which could be due to:
1.blockage of the acinar cell apex in the pancreatic duct leading to co-localization of zymogen and and lysosomal granules
2. oxidative stress
3. hypotension

Question 10

How does trypsin initiate pancreatic inflammation?

Answer 10

it also activates other digestive enzymes prematurely within the pancreas
- local inflammation
- subsequent production of reactive oxygen species and nitric oxide
- neutrophils, endothelin-1, and phospholipase A 3 –> shifts from apoptosis to necrosis
- disturbed pancreatic microcirculation + increased vascular permeability = edema and necrosis –> eventually leading to necrotizing pancreatitis
- more local inflammation –> SIRS due to different inflammatory cytokines

Question 11

What are some sequalae of acute pancreatitis?

Answer 11

acute pancreatitis –> systemic inflammatory response –> multi-organ dysfunction syndrome
- MODs: acute lung injury, acute kidney injury, uremia, DIC, cardiac arrhythmia

Question 12

What the cause of chronic pancreatitis?

Answer 12

Thought to be a consequence of late complication of acute pancreatitis or chronic immume-mediated inflammation
- chronic pancreatitis is more common than acute pancreatitis in cats

Question 13

How is chronic pancreatitis characterized in dogs?

Answer 13

pancreatic fibrosis
- it can lead to exocrine pancreatic insufficiency and/ or diabetes mellitus
- EPI in dogs is mostly due to acinar atrophy due to other pathophysiological mechanism