Pancreatitis Flashcards
What are the 2 major forms of pancreatitis?
- ACUTE - dogs
- CHRONIC - cats, more mild
What causes acute pancreatitis?
acinar cell injury activates zymogens while still in the pancreas resulting in
- interstitial inflammation and edema
- proteolysis (trypsin!)
- fat necrosis
- hemorrhage
PANCREATIC AUTODIGESTION
What signalment is associated with acute pancreatitis?
> 5 y/o Miniature Schnauzers and Yorkies
What are 6 risk factors associated with acute pancreatitis?
- dietary indiscretion
- high fat diet
- severe hypertriglyceridemia
- breed - Miniature Schnauzers
- blunt external or surgical trauma
- drugs - potassium bromide, phenobarbital, azathioprine, L-asparaginase, sulfas
What are the classic signs of acute pancreatitis? What 4 other body systems are affected?
vomiting, hyporexia, abdominal pain, lethargy, dehydration, fever
- acute kidney injury due to vasculitis and ischemia - oliguria, anuria, polyuria
- respiratory distress - ARDs, SIRs
- encephalopathy
- bleeding tendencies - DIC
What are the 3 stages of pancreatitis?
STAGE 1 = local inflammation of the pancreas with edema
STAGE 2 = inflammatory response in the retroperitoneum, resulting in ileus
STAGE 3 = multiorgan dysfunction - hypotension, shock, metabolic disturbances, sepsis, organ failure
What is the major sequalae to acute pancreatitis? What 8 things can this lead to?
systemic inflammatory response (SIRs)
- DIC
- thromboembolic disease (PTE)
- pancreatic encephalopathy
- arrhythmias
- metabolic acidosis
- respiratory distress
- hypovolemic/cardiovascular shock
- multiple organ dysfunction syndrome (MODS)
What are 3 clinical pathology changes can be used to diagnose pancreatitis?
- CBC/CHEM - indicates systemic complications rather than direct pancreatic inflammation, r/o other disease
- amylase, lipase - NOT specific to the pancreas, elevated with any abdominal inflammation
- pancreatic lipase immunoreactivity (PLI) - helpful to r/o pancreatitis, can be elevated with biliary, liver, and gastric disease
What is the most useful imaging used for diagnosing acute pancreatitis? What else can be done?
AUS - hypoechoic pancreas and hyperechoic mesentery due to inflammation of the surrounding fat +/- peritoneal fluid, enlarged duodenal papilla, dilated pancreatic duct
abdominal radiographs - decreased contrast in cranial abdomen with widened pyloric-duodenal angle
What are 5 parts of the treatment plan for pancreatitis?
- fluids - essential
- antiemetics
- analgesia
- colloids
- antibiotics - controversial
How is dehydration with pancreatitis treated? What needs to be monitored for?
hypovolemic = 1/4 shock dose of fluids (90 mL/kg), then recheck
monitor electrolytes every 12-24 hours for hypokalemia and hypocalcemia
Why are colloids sometimes used when treating pancreatitis? What are 2 options?
vasculitis –> endothelial dysfunction –> decreased plasma oncotic pressure –> ascites
- fresh frozen plasma (10-15 mL/kg) - replace clotting factors, anti-thrombin III, albumin, and other proteins
- synthetic colloids (Hetastarch/Vetstarch 10-20 mL/kg) - associated with coagulopathies and acute renal injury
What is the first choice of analgesia for acute pancreatitis? What is avoided?
opioids - Buprenorphine, Fentanyl, Methadone, Hydromorphone, Lidocaine, Codeine (CRIs) - combine with other methods if severe pain
NSAIDs - worsens dehydration to cause kidney disease and causes gastritis
What new drug has been developed to directly treat pancreatitis?
Panoquell - inhibits inflammation by blocking neutrophil movement from vasculature to the pancreas –> leukocyte function-associated antigen 1 (LFA-1) inhibitor
What 3 antiemetics are recommended for cases of acute pancreatitis?
- Cerenia - NK-1 receptor antagonist
- Ondansetron - serotonin receptor antagonist
- Metoclopramide - dopamine and serotonin receptor antagonist, also treats ileus
may need a multimodal approach!
What treatment for acute pancreatitis is considered controversial? In what 3 situations are they recommended?
antibiotics - pancreatitis is considered a sterile process (no bacteria cause the inflammation, however severity can cause bacterial translocation from the GIT)
- sepsis
- necrotizing pancreatitis
- abscesses
What should be done once a patient with acute pancreatitis is stabilized and vomiting is under control? What is specifically used?
early enteral nutrition with NE/NG tubes ASAP
low fat diets –> RC LF, Purina EN, Hills I/D
When are corticosteroids recommended in cases of acute pancreatiits? How can they help?
case by case –> patient not responding to conventional therapy
- helps with inflammation
- helps treat critical illness-related cortisol insufficiency (CIRCI), where the patient is unable to produce enough corticosteroids to respond to illness
What are the 5 major complications associated with acute pancreatitis? How are they treated?
- DKA - start with fluids and monitor glucose/insulin
- electrolyte abnormalities - hypokalemia, hypocalcemia, hypophosphatemia
- hematemesis - GI protectants
- DIC/hypoproteinemia - FFP, albumin
- acute renal injury - fluids (monitor urine output)
What are poor prognostic indicators in cases of acute pancreatitis?
- multiorgan dysfunction
- DIC
(overall prognosis ranges from 27-58%)
What is the most common pancreatitis seen in cats? What are the most common clinical signs? How is it diagnosed?
chronic, idiopathic
anorexia and lethargy
AUS (mild to moderate changes can flood normal) + fPLI (other diseases can cause increase!)
What biochemical changes are seen with acute necrotizing pancreatitis in cats? What is prognosis like?
hypoglycemia and hypocalcemia - digesting fat uses up calcium and glucose
guarded –> requires more aggressive support
What comorbidities are seen with chronic pancreatitis in cats?
- cholangiohepatitis
- IBD
- AKA TRIADITIS due to common bile duct and pancreatic duct meeting before they reach the duodenum
How is chronic pancreatitis treated? What treatment are considered controversial?
- fluids
- analgesia
- nutrition - hydrolyzed or novel protein due to concurrent IBD
antibiotics and corticosteroids
Acute pancreatitis, abdominal radiograph:
poor detail + inflammation
- r/o FB with vomiting associated with pancreatitis, where they are nauseous due to ileus and abdominal pain
Acute pancreatitis, abdominal fluid:
non-degenerative neutrophils lacking bacteria supports pancreatitis
Acute pancreatitis, AUS:
fat around enlarged pancreas is hyperechoic
