Pancreatitis

Question 1

What is pancreatitis?

Answer 1

Inflammation of the pancreas

Sterile exocrine gland that is very active (digestive enzymes) - leak out then local digestion and inflammation

Heterogenous

Question 2

Is there one perfect test for pancreatitis?

Answer 2

No (need a combo)

Question 3

Are clinicians more likely to over or under diagnose pancreatitis?

Answer 3

Over - non-specific signs (vomit, anorexia, abdominal pain)

Question 4

What are some key things we need to know to diagnose pancreatitis?

Answer 4

History and clinical signs
Bloodwork
Imaging
Cytology and Biopsy
Pancreatic lipase immunoreactivity (PLI)

Question 5

What are some common differentials that should be used to rule out pancreatitis?

Answer 5

Foreign Body
Neoplasia
Gall Bladder Mucocele
Peritonitis
Trauma
Neoplasia
Poly nephritis

Question 6

Is pancreatitis a positive diagnosis?

Answer 6

No, presumptive

Question 7

What are supportive findings of pancreatitis on bloodwork?

Answer 7

Rule out other disease
Inflammation
Liver enzyme elevation (ALT and ALP increase)
Hyperbilirubinemia

Secondary complications
AKI
Electrolyte imbalances

Question 8

How can radiographs help rule in or out pancreatitis?

Answer 8

Find no FB
Reduced detail in cranial abdomen
See right kidney on VD in dog suggestive
Ultrasound may be helpful (still flawed) - look for mass

Question 9

How can ultrasound help rule in or out pancreatitis?

Answer 9

user dependent, low specificity even with skilled radiologist
More sensitive

Question 10

How can cytology be helpful in diagnosing pancreatitis?

Answer 10

Carcinoma or infectious abscess
Biopsy
FNA

Question 11

How can the PLI (pancreatic lipase immunoreactivity test help ID pancreatitis?

Answer 11

Negative then pancreatitis unlikely
Positive???

Question 12

How do you treat pancreatitis?

Answer 12

B12, maropitant (if vomiting), SQ fluids and maropitant at home

Very symptomatic/supportive
Fluids
Low Fat Diet
Nutritional Support
Antinausea drug
Sucralfate
Pain control

Question 13

T/F Pancreatitis should only be diagnosed after ruling all other disease out first!

Answer 13

True

Question 14

What kind of pain meds are available?
Which would you select for pancreatitis?

Answer 14

Opioid - constipation, resp depression, GI vomit and diarrhea - epidural best option for this

NSAID - ok if not dehydrated

Local Anesthesia

Alpha 2 - not ideal

Ketamine - Best to start with (no GI effect)

Question 15

Once you get the animal to stop vomiting, what should you focus on next?

Answer 15

Nutrition
-Nasogastric tube
-Helps gut heal

Liquid diet - commercially prepared best
25-30% RER slow bolus or CRI