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Small Animal Medicine II > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

What are the 2 major forms of pancreatitis?

A
  1. ACUTE - dogs
  2. CHRONIC - cats, more mild
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2
Q

What causes acute pancreatitis?

A

acinar cell injury activates zymogens while still in the pancreas resulting in

  • interstitial inflammation and edema
  • proteolysis (trypsin!)
  • fat necrosis
  • hemorrhage

PANCREATIC AUTODIGESTION

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3
Q

What signalment is associated with acute pancreatitis?

A

> 5 y/o Miniature Schnauzers and Yorkies

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4
Q

What are 6 risk factors associated with acute pancreatitis?

A
  1. dietary indiscretion
  2. high fat diet
  3. severe hypertriglyceridemia
  4. breed - Miniature Schnauzers
  5. blunt external or surgical trauma
  6. drugs - potassium bromide, phenobarbital, azathioprine, L-asparaginase, sulfas
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5
Q

What are the classic signs of acute pancreatitis? What 4 other body systems are affected?

A

vomiting, hyporexia, abdominal pain, lethargy, dehydration, fever

  1. acute kidney injury due to vasculitis and ischemia - oliguria, anuria, polyuria
  2. respiratory distress - ARDs, SIRs
  3. encephalopathy
  4. bleeding tendencies - DIC
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6
Q

What are the 3 stages of pancreatitis?

A

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

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7
Q

What is the major sequalae to acute pancreatitis? What 8 things can this lead to?

A

systemic inflammatory response (SIRs)

  1. DIC
  2. thromboembolic disease (PTE)
  3. pancreatic encephalopathy
  4. arrhythmias
  5. metabolic acidosis
  6. respiratory distress
  7. hypovolemic/cardiovascular shock
  8. multiple organ dysfunction syndrome (MODS)
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8
Q

What are 3 clinical pathology changes can be used to diagnose pancreatitis?

A
  1. CBC/CHEM - indicates systemic complications rather than direct pancreatic inflammation, r/o other disease
  2. amylase, lipase - NOT specific to the pancreas, elevated with any abdominal inflammation
  3. pancreatic lipase immunoreactivity (PLI) - helpful to r/o pancreatitis, can be elevated with biliary, liver, and gastric disease
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9
Q

What is the most useful imaging used for diagnosing acute pancreatitis? What else can be done?

A

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

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10
Q

What are 5 parts of the treatment plan for pancreatitis?

A
  1. fluids - essential
  2. antiemetics
  3. analgesia
  4. colloids
  5. antibiotics - controversial
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11
Q

How is dehydration with pancreatitis treated? What needs to be monitored for?

A

hypovolemic = 1/4 shock dose of fluids (90 mL/kg), then recheck

monitor electrolytes every 12-24 hours for hypokalemia and hypocalcemia

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12
Q

Why are colloids sometimes used when treating pancreatitis? What are 2 options?

A

vasculitis –> endothelial dysfunction –> decreased plasma oncotic pressure –> ascites

  1. fresh frozen plasma (10-15 mL/kg) - replace clotting factors, anti-thrombin III, albumin, and other proteins
  2. synthetic colloids (Hetastarch/Vetstarch 10-20 mL/kg) - associated with coagulopathies and acute renal injury
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13
Q

What is the first choice of analgesia for acute pancreatitis? What is avoided?

A

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

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14
Q

What new drug has been developed to directly treat pancreatitis?

A

Panoquell - inhibits inflammation by blocking neutrophil movement from vasculature to the pancreas –> leukocyte function-associated antigen 1 (LFA-1) inhibitor

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15
Q

What 3 antiemetics are recommended for cases of acute pancreatitis?

A
  1. Cerenia - NK-1 receptor antagonist
  2. Ondansetron - serotonin receptor antagonist
  3. Metoclopramide - dopamine and serotonin receptor antagonist, also treats ileus

may need a multimodal approach!

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16
Q

What treatment for acute pancreatitis is considered controversial? In what 3 situations are they recommended?

A

antibiotics - pancreatitis is considered a sterile process (no bacteria cause the inflammation, however severity can cause bacterial translocation from the GIT)

  1. sepsis
  2. necrotizing pancreatitis
  3. abscesses
17
Q

What should be done once a patient with acute pancreatitis is stabilized and vomiting is under control? What is specifically used?

A

early enteral nutrition with NE/NG tubes ASAP

low fat diets –> RC LF, Purina EN, Hills I/D

18
Q

When are corticosteroids recommended in cases of acute pancreatiits? How can they help?

A

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
19
Q

What are the 5 major complications associated with acute pancreatitis? How are they treated?

A
  1. DKA - start with fluids and monitor glucose/insulin
  2. electrolyte abnormalities - hypokalemia, hypocalcemia, hypophosphatemia
  3. hematemesis - GI protectants
  4. DIC/hypoproteinemia - FFP, albumin
  5. acute renal injury - fluids (monitor urine output)
20
Q

What are poor prognostic indicators in cases of acute pancreatitis?

A
  • multiorgan dysfunction
  • DIC

(overall prognosis ranges from 27-58%)

21
Q

What is the most common pancreatitis seen in cats? What are the most common clinical signs? How is it diagnosed?

A

chronic, idiopathic

anorexia and lethargy

AUS (mild to moderate changes can flood normal) + fPLI (other diseases can cause increase!)

22
Q

What biochemical changes are seen with acute necrotizing pancreatitis in cats? What is prognosis like?

A

hypoglycemia and hypocalcemia - digesting fat uses up calcium and glucose

guarded –> requires more aggressive support

23
Q

What comorbidities are seen with chronic pancreatitis in cats?

A
  • cholangiohepatitis
  • IBD
  • AKA TRIADITIS due to common bile duct and pancreatic duct meeting before they reach the duodenum
24
Q

How is chronic pancreatitis treated? What treatment are considered controversial?

A
  • fluids
  • analgesia
  • nutrition - hydrolyzed or novel protein due to concurrent IBD

antibiotics and corticosteroids

25
Q

Acute pancreatitis, abdominal radiograph:

A

poor detail + inflammation

  • r/o FB with vomiting associated with pancreatitis, where they are nauseous due to ileus and abdominal pain
26
Q

Acute pancreatitis, abdominal fluid:

A

non-degenerative neutrophils lacking bacteria supports pancreatitis

27
Q

Acute pancreatitis, AUS:

A

fat around enlarged pancreas is hyperechoic

Small Animal Medicine II (57 decks)

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