pancreatitis Flashcards
Dog layout of ducts
Minor duodenal papilla- acessary pancreatic duct
major duodenal papilla- pancreatic duct and common bile duct
cat pancreatic duct layout
Bile duct and pancreatic duct combine before exit into intestine- major only
Much of parenchyma
Much of parenchyma = exocrine acinar cells & ducts
Acini are grapes like clusters of exocrine cells
• Exocrine cells secrete digestive enzymes into intralobar ducts which eventually flow to major pancreatic duct and communicates with duodenum
Trypsin, chymotrypsin, carboxypeptidase do what?
Trypsin, chymotrypsin, carboxypeptidase Proteases to digest protein
What does Amylase do?
Digest carbohydrates
What does Lipases, cholesterol lipase, phospholipase do?
Lipases, cholesterol lipase, phospholipase
Digest fats
Where is B12 absorbed?
ileum
ZYMOGENS
Digestive enzymes are released in inactive forms called zymogens
Necessary to prevent enzymes from digesting origin cells
Enzyme activation mostly occurs in small intestine for pancreatic enzymes Trypsin can become active in pancautohydrolizes to prevent damage
LITTLE RELEASE OF ENZYMES between
LITTLE RELEASE OF ENZYMES between DIGESTIVE PERIODS
Vagus Nerve
Neural Control – stimulated by anticipation of meal
Vagus Nerve
PANCREATITIS
Disease of the EXOCRINE pancreas
Variable disease presentation from mild to FATAL
Acute or Chronic disease
Acute more associated with fatal consequences
What’s the pathology behind pancreatitis?
ZYMOGEN ACTIVATION IN PANCREATIC TISSUE
Inflammation and necrosis of pancreatic cells Clinical signs caused by cell death & inflammation Leukocyte migration to inflammation = cytokine release Severe systemic inflammatory affects
MOA for pancreatitis?
1. Decrease of secretion of enzymes
2. Development of giant vacuoles in cytoplasm of acinar cells
3. Zymogens of digestive enzymes & lysosomal enzymes (hydrolytic enzymes in cells) combine = BAD NEWS as digestive enzyme converted and released
4. Premature activation of zymogens and/or trypsin Trypsin also activates zymogens
5. Overwhelming of natural defenses
Trypsin & protease inhibitors & alpha-macroglobulins
PATHOLOGY RESULT of pancreatitis?
AUTO DIGESTION OF THE PANCREAS Pancreatic edema
Pancreatic hemorrhage
Pancreatic necrosis
Parapancreatic fat necrosis
Profound local +/- systemic inflammation DISEASE PROCESS we call PANCREATITIS
Is INFLAMMATORY INFILTRATES reversible?
NOPE!
ACUTE PANCREATITIS SIGNS
- ‘ADR’- Ain’t Doing Right • Vomiting
- Diarrhea
- Abdominal Pain
- Fever
- Lethargy
- Inappetence Anorexia
• ‘Prayer Position’
When Should you consider Pancreatitis ?
VOMITING
ABDOMINAL PAIN
Differential Diagnosis: gastroenteritis, foreign body, septic abdomen, etc.
Amphimerus pseudofelineus
Amphimerus pseudofelineus
Infects Bile Ducts and can migrate to Pancreas North & South America TREATMENT: Praziquantel
PANCREATIC LIPASE IMMUNOREACTIVITY (PLI)
Quantitative Spec cPL of fPL
Send out test on FASTED SERUM
_ * Gold Standard Blood Test_
What is one of the best ways to dx pancreatitis?
abdominal u/s
Hypoechoic pancreas with hyperechoic surrounding mesentery
Is there any specific treatment for pancreatitis?
NO!
supportive and symptomatic!
What drugs do you NOT give for pancreatitis?
NSAIDs or steroids
Do you give antibiotics for pancreatitis?
Most pancreatitis are sterile in the dog and less so in the cat.
BUT significant HOSPITALIZED CASES OF
PANCREATITIS IN THE DOG AND CAT OFTEN RECEIVE ANTIBIOTICS
Is paraenteral commonly used?
No, but enteral via GIT is!
CHRONIC PANCREATITIS
Breed specific predisposition in the Miniature Schnauzer Gene abnormality = SPINK1 (protease inhibitor)
Test via ELISA kit
In general, chronic panc remains largely under diagnosed
Biopsy diagnosis
Mild to moderate clinical signs
Biopsy = mononuclear infiltrate +/- neutrophils +/- fibrosis
