Pancreatitis Flashcards
What clinical signs / syndromes might you see in an animal with pancreatitis?
Weight loss Melena +/- diarrhoea PU/PD Fat, muscle fibres in faeces Abdominal pain Dehydration Vomiting Depressed
What are two trypsin inhibitors? Where are they present?
Alpha-1 protease inhibitor
Pancreatic secretory trypsin inhibitor
Present in ductal and acinar secretions
How is trypsinogen activated to trypsin?
Enterokinase in GI lumen
What are three defenses of the pancreas to autodigestion other than trypsin inhibitors?
Confinement of enzymes in zymogen granules
Synthesis of some enzymes in inactive form
Degradation of zymogen granules if release is inhibited
Resistance of acinar cells to trypsin, chymotrypsin and PLA2
Which two cell types may undergo mitosis to replace lost acinar cells?
Remaining acinar cells
Ductal epithelium
What is the most clinically significant of the congenital pancreatic diseases?
Pancreatic hypoplasia.
Which trace element deficiencies can cause primary pancreatic atrophy?
Zinc, selenium, copper
What is the difference between primary and secondary pancreatic atrophy?
Secondary atrophy results from concurrent pancreatic disease, usually non-uniform distribution
Primary atrophy due to dietary deficiency or something, uniform distribution
What is the usual mechanism for secondary pancreatic atrophy?
Obstruction of ducts
What is juvenile pancreatic atrophy?
Inherited autosomal recessive premature atrophy of pancreatic parenchyma - GSD
What is the presumed mechanism for atrophy in JPA? Are the islets of langerhans affected?
Autoimmune attack on pancreatic tissue (lymphocytic)
Usually the islets are unaffected, though increased in prominence
What is believed to lead to the majority of EPI cases in dogs?
Juvenile pancreatic atrophy
What is believed to lead to the majority of EPI cases in cats?
Chronic subclinical pancreatitis
What are three clinical signs that might be seen in dog with EPI (4 things)?
Chronic weight loss despite large appetite
Pica
Coprophagia
Pale, voluminous faeces +/- diarrhoea
What are two rare but potential consequences of EPI if left untreated?
Mesenteric torsion due to distended, voluminous intestinal contents
Coagulopathy due to vitamin K not being absorbed
What is one major consequence of untreated EPI?
Small intestinal bacterial overgrowth due to presence of undigested substrate in the lumen > SI dysfunction
Other than dogs, which species may be afflicted by acute pancreatic necrosis?
Cats Horses Pigs Mice Primates
What is the term for undigested muscle fragments?
Creatorrhoea
What is the term for undigested starch fragments?
Amylorrhoea
How could elevated blood triglycerides play a role in triggering acute pancreatic necrosis?
Clog capillaries supplying the pancreatic parenchyma > hypoxia and degeneration
What nutrition risk factors predipose to pancreatitis?
Obesity
High fat meal/diet
Low protein diet
What iatrogenic risk factors predipose to pancreatitis?
Corticosteroids
What toxic risk factors predipose to pancreatitis?
Zinc poisoning
Cassida occidentalis in pigs
What other risk factors predipose to pancreatitis?
High rise syndrome in cats, pancreatic trauma generally
Hypercalcemia
Uraemia
Hyperadrenocorticism
What are some of the signs a dog with acute pancreatic necrosis may present with?
Anorexia Depression Abdo pain Vomiting Dehydration Haemorrhagic diarrhoea
What are some of the signs a cat with acute pancreatic necrosis may present with?
Anorexia, lethargy, depression, dehydration, tachypnoea, hypothermia
What are some gross lesions that may be seen in specimens of acute pancreatic necrosis?
Fat necrosis of peripancratic fat Oedema of pancreas and its mesentery Multifocal petechial haemorrhages Hyperaemic pancreas Fibrinous exudate
What is one potential consequence of fibrosis following an episode of acute pancreatic necrosis?
Obstruction of the common bile duct > jaundice
What are some potential consequences of acute pancreatic necrosis?
DIC Renal failure (acute) Paralytic ileus Secondary bacterial infection EPI Diabetes mellitus
What form of pancreatic necrosis is thought to be caused by reflux of duodenal contents up the pancreatic duct?
Acute haemorrhagic pancreatic necrosis
What are the three non-necrotising forms of pancreatitis?
Focal, multifocal and interstitial
What is one potential cause of focal pancreatitis?
Stephanurus dentatus (pigs) may encyst in pancreaas on way to/from liver to provoke intense local suppurative inflammation
Is haematogenous spread of infection to the pancreas common?
No
What can cause multifocal pancreatitis?
Epitheliotrophic viral infectious e.g canine distemper, foot and mouth disease, adenovirus
Systemic toxoplasmosis (esp. cats)
FIP infection (cats)
What can pancreatitis as a result of foot and mouth disease mean for the ruminant?
May develop diabetes mellitus
What is generally the trigger for chronic lymphocytic interstitial pancreatitis? Which species are most commonly affected?
Ascent of bacteria up the pancreatic duct from the intestine
Cats and horses
- as the pancreatic duct enters the duodenum with or close to the bile duct, common to also see cholangitis and cholangiohepatitis
Which species most commonly develop pancreatic calculi?
Cattle
What is an example of a pancreatic duct parasite?
Ascarid (roundworm nematode) in pigs and dogs
What is the cause for pancreatic nodular hyperplasia of exocrine cells?
Idiopathic - old cats, dogs, cattle
What is the most common neoplasm of the pancreas?
Exocrine pancreatic adenocarcinoma
