pancreatitis

Question 1

Dog layout of ducts

Answer 1

Minor duodenal papilla- acessary pancreatic duct

major duodenal papilla- pancreatic duct and common bile duct

Question 2

cat pancreatic duct layout

Answer 2

Bile duct and pancreatic duct combine before exit into intestine- major only

Question 3

Much of parenchyma

Answer 3

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

Question 4

Trypsin, chymotrypsin, carboxypeptidase do what?

Answer 4

Trypsin, chymotrypsin, carboxypeptidase  Proteases to digest protein

Question 5

What does Amylase do?

Answer 5

Digest carbohydrates

Question 6

What does Lipases, cholesterol lipase, phospholipase  do?

Answer 6

Lipases, cholesterol lipase, phospholipase 

Digest fats

Question 7

Where is B12 absorbed?

Answer 7

ileum

Question 8

ZYMOGENS

Answer 8

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 pancautohydrolizes to prevent damage

Question 9

LITTLE RELEASE OF ENZYMES between

Answer 9

LITTLE RELEASE OF ENZYMES between DIGESTIVE PERIODS

Question 10

Vagus Nerve

Answer 10

Neural Control – stimulated by anticipation of meal

 Vagus Nerve

Question 11

PANCREATITIS

Answer 11

Disease of the EXOCRINE pancreas

Variable disease presentation from mild to FATAL

Acute or Chronic disease
 Acute more associated with fatal consequences

Question 12

What’s the pathology behind pancreatitis?

Answer 12

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

Question 13

MOA for pancreatitis?

Answer 13

 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

Question 14

PATHOLOGY RESULT of pancreatitis?

Answer 14

AUTO DIGESTION OF THE PANCREAS  Pancreatic edema

 Pancreatic hemorrhage
 Pancreatic necrosis
 Parapancreatic fat necrosis
 Profound local +/- systemic inflammation  DISEASE PROCESS we call PANCREATITIS

Question 15

Is INFLAMMATORY INFILTRATES reversible?

Answer 15

NOPE!

Question 16

ACUTE PANCREATITIS SIGNS

Answer 16

• ‘ADR’- Ain’t Doing Right • Vomiting
• Diarrhea
• Abdominal Pain
• Fever
• Lethargy
• Inappetence  Anorexia

• ‘Prayer Position’

Question 17

When Should you consider Pancreatitis ?

Answer 17

VOMITING

ABDOMINAL PAIN

Differential Diagnosis: gastroenteritis, foreign body, septic abdomen, etc.

Question 18

Amphimerus pseudofelineus

Answer 18

Amphimerus pseudofelineus
Infects Bile Ducts and can migrate to Pancreas North & South America TREATMENT: Praziquantel

Question 19

PANCREATIC LIPASE IMMUNOREACTIVITY (PLI)

Answer 19

Quantitative  Spec cPL of fPL

 Send out test on FASTED SERUM

_ * Gold Standard Blood Test_

Question 20

What is one of the best ways to dx pancreatitis?

Answer 20

abdominal u/s

Hypoechoic pancreas with hyperechoic surrounding mesentery

Question 21

Is there any specific treatment for pancreatitis?

Answer 21

NO!

supportive and symptomatic!

Question 22

What drugs do you NOT give for pancreatitis?

Answer 22

NSAIDs or steroids

Question 23

Do you give antibiotics for pancreatitis?

Answer 23

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

Question 24

Is paraenteral commonly used?

Answer 24

No, but enteral via GIT is!

Question 25

CHRONIC PANCREATITIS

Answer 25

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