Pancreatitis Flashcards
Why do cats typically have more obstructive disease associated with the pancrease than dogs?
Cats have a single pancreatic duct that feeds into the duodenum at the same place as the common bile duct
Dogs have two entrances into the duodenum that are both separate from the bile duct
What comprises most of the paranchyma of the pancreas?
Exocrine acinar cells and ducts arranced in clusters
What do exocrine pancreatic cells secrete?
Digestive enzymes
What is the flow from the exocrine cells to the duodenum?
Intralobar ducts–> major pancreatic duct–> duodenum
What are the Islets of Langerhans?
Contain the endocrine cells (insulin, glucagon, etc) and are between the acini of the pancreas
What do trypsin, chymotrypsin, and carboxypeptidase do?
Enzymes that digest proteins (proteases)
What does amylase do?
Digestion of carbohydrates
What do lipases, cholesterol lipase, and phospholipase do?
Digest fats
What else does the pancreas produce?
Ribonuclease, deoxyribonuclease, gelatinase, elastase, intrinsic factor, bicarbonate, water
What does intrinsic factor do?
Facilitates B12 absorption in the ileum
What are zymogens?
Digestive enzymes that are released in inactive forms
Why are zymogens important?
They are necessary to prevent enzymes from digesting origin cells
Where are zymogens activated?
Mostly in the small intestine for pancreatic enzyme
What happens if zymogens become active in the pancreas? Which enzyme is most commonly prematurely activated?
Autohydrolysis of the pancreatic tissues; Trypsin most often
T/F: Digestive enzymes are secreted and released constitutively so the gut is always ready to digest food.
False- there is little release of enzymes between digestive periods controlled by the Vagus nerve in response to cephalic phase of digestion
What are other things that control the secretion of digestive enzymes?
Mechanoreceptors in response to food distension
Endocrine in response to luminal contents of food (cholecytokinin, secretin, gastrin)
Is pancreatitis a disease of the exocrine or endocrine pancreas?
Exocrine
What is the usual severity of pancreatitis?
Can be anywhere from mild to fatal
Acute disease more associated with fatal disease than chronic but both ca be very serious
What are some other exocrine pancreatic diseases?
EPI and neoplasia
What is the pathology of pancreatitis?
Zymogen activation in pancreatic tissue leading to inflammation and necrosis of pancreatic cells
What are clinical signs caused by?
Death and inflammation of the pancreatic tissues and severe systemic inflammatory effects of cytokine release
What are the mechanisms of disease of pancreatitis?
- Decreased of secretion of enzymes
- Development of vacuoles in cytoplasm of acinar cells
- Zymogens combine and activate
- Premature activation of zymogens and trypsin
- Overwhelming of natural defenses
What is a result of the pathophysiology of pancreatitis on the pancreas?
Auto-digestion of the pancreas
- Edema
- Hemorrhage
- Necrosis/ fat necrosis
- Local and systemic inflammation
What is the usual infiltrate in acute pancreatitis?
Neutrophilic
What is the usual infiltrate in chronic pancreatitis?
Lymphocytic
What is the usual infiltrate in acute on chronic pancreatitis?
Neutrophil and lymphocyte
T/F: The damage caused by pancreatitis usually reversible.
True
What are the usual conical signs of pancreatitis?
Vomiting, diarrhea, abdominal pain, lethargy, inappetence
T/F: Systemic effects are seen with all animals with pancreatitis.
False- usually only severe cases
ARDS, SIRS, MODS, or PTE all possible
What are some other potential sequelae to pancreatitis?
Bile duct obstruction, hypotension, acute renal failure, pulmonary edema, DIC, hepatic dysfunction, diabetes mellitus, EPI, severe gastroenteritis, death
What are signs of acute pancreatitis?
ADR, vomiting, diarrhea, abdominal pain (prayer position), fever, lethargy, inappetence/anorexia
What will you find on the physical exam of a patient with pancreatitis?
Weakness, dehydration, abdominal pain, hypersalivation, hyper/hypothermia, hypovolemic shock, abdominal mass effect, icterus, petechia/ecchymosis
What is the usual cause of pancreatitis in the dog?
Eating “human” food
What are other causes of pancreatitis in the dog?
- High fat diet/hypertriglyceridemia
- Schnauzers predisposed to idiopathic
- Organophosphate toxicity
- Drugs
- Trauma or hypoperfusion
- Neoplasia
- Hypercalcemia
- Immune mediated disease
What are some causes of pancreatitis in the cat?
- Infectious disease (FIV, FIP, Toxo, parasites)
- Neoplasia
- Organophosphate toxicity
- Concurrent GI disease
- Concurrent liver disease
What is Amphimerus pseudofelineus?
Parasite of the bile ducts that can migrate to the pancreas
Tx: praziquantel