Pancreatitis Flashcards
What does the exocrine pancreas do?
The exocrine pancreas creates molecules and delivers them to GI tract to aid in digestion
-they have a very specific system for packaging these digestive enzymes so they dont digest things they arent supposed to
What is pancreatitis?
Inflammation of pancreas
-can cause leakage of digestive enzymes leading to digestion of local tissues
-leads to significant pain and inflammation
-inflammation is usually not uniform (not diffuse and consistent)
What is the gold standard for diagnosing pancreatitis?
Biopsy is the closest you can get to being diagnostic
- however, if you don’t get a sample of the pancreas that is inflamed, it can easily be missed
Can also use history, clinical signs, bloodwork, imaging, cytology/biopsy, or PLI as clues
What is more important than getting a definitive diagnosis of pancreatitis?
That you rule out other diseases that are treated very differently
What are the main clinical signs associated with pancreatitis
Vomiting, maybe diarrhea, abdominal pain*, anorexia, dehydration
-all are not very specific other than abdominal pain (if pain is missing, hard to convince yourself that its pancreatitis)
What are some findings on bloodwork that may be supportive of pancreatitis?
-inflammation
-liver enzyme elevation (if liver is being digested)
-hyperbilirubinemia (in cats especially inflammation can cause obstruction to biliary flow)
-can secondarily lead to acute kidney injury (azotemia) and electrolyte abnormalities
*bloodwork is generally better for ruling other things out
What on imaging may point you towards a diagnosis of pancreatitis?
Radiographs
-loss of detail in the cranial abdomen
-seeing the right kidney on a VD projection on a dog is suggestive
Ultrasound may be more helpful- but is user dependent and there is still a lot of limitations
-low specificity (high probability of false negatives), decent sensitivity but not perfect
When is cytology of the pancreas helpful?
In cases of carcinoma or an infectious pancreatic abscess
-biopsy still is probably better (but still has its limitations)
What can a PLI tell you?
If negative, pancreatitis is unlikely
-however if positive, can still be many things other than pancreatitis
This is a good screening test!
T/F: a patient with waxing and waning clinical signs is less likely to have pancreatitis
True
What would be a good choice for pain management in suspected pancreatitis cases?
Ketamine due to limited GI effects
- could switch to dexmed, NSAIDs
What is the main treatment for pancreatitis?
Time: self-limiting and will get better on own
-supportive care (addressing pain and nausea)- create an environment more conducive to healing
If a pancreatitis dog is not eating, what could you try?
NG tube
-entyce (appetite stimulant)- but wont do much if very anorexic (must be interested in food)
-offer them what they normally eat, if still not eating give GI diet
When should you place an NG tube in a pancreatitis patient?
If you believe they are unlikely to eat soon
- client wishes
- it is always a tough call
*don’t be sad if they start eating right after the NG tube is placed- this is a win
Do you need gastroprotectants in the case of pancreatitis?
If vomiting is persistent, or patient is regurgitating these might be ok to use to prevent ulcers of the esophagus
-best to get control of the vomiting/regurg
-not a lot of evidence that these help that much in these cases
