Pancreatitis Flashcards
Compare the histology of chronic and acute pancreatitis
Acute - suppurative inflammation (reversible). Neutrophilic. Varying amounts of pancreatic acinar cell and peripancreatic fat necrosis
Chronic - lymphocytic infiltrate - fibrosis/ atrophy
How does the pancreas protect itself from auto digestion?
Releases zymogens (pro-enzymes)
These are in lysosomes that combine in the duodenum
Trypsin inhibitors within pancreatic acinar cells
1 way pancreatic duct
Plasma protease inhibitors
What happens in acute pancreatitis?
Something leads to premature activation of the digestibe enzymes –> autodigestion –> h+ –> local thrombosis –> necrosis –> activation of the complement system –> leukocyte recruitment
What can cause pancreatitis in dogs/ cats?
Dogs only: dietary indiscretion/ genetics/ obesity/ hyperlipidaemia/ autoimmune
Both: Sx/ blunt trauma/ high Ca/ drug induced e.g. organophosphates/ pancreatic duct obstruction/ hypoxia/ neoplasia/ toxo
Cats - virulent calici
Why are cats more likely than dogs to get pancreatitis?
Fused pancreatic and bile ducts
They vomit more which can cause pancreatic duct reflux
High GI microbial load
What MAY be seen on bloods?
haemoconcentration electrolyte disturbances low alb azotaemia raised liver enzymes (normally more ALP than ALT but both) low Ca (associated with poorer prognosis) High cholesterol High bili
How useful is fPLI?
Most useful but even then doesn’t pick them all up, esp chronic cases
When may pancreatic pseudocyts appear?
After chronic pancreatitis
How useful is biopsy for the dx of pancreatitis?
Not great as can be patchy inflammation
may be useful in the dx of auto-immune pancreatitis, although this is not proven to be a syndrome in cats
What are the mainstays of treatment for pancreatitis?
IVFT to correct imbalances - esp Ca
Pain relief - mostly opiate, consider others, gabapentin can be good as it reduces substance P which is involved in inflammation (like maropitant), ketamine, NSAIDs are ok if hydrated and no GI disease obvious
Antinausea - maropitant, ondansetron, can use others
Feed - including mirtazapine.
Shouldn’t need ABs unless evidence of bacterial translocation
Antacids should only be needed if there is evidence of GI ulceration or oesophagitis
Why may metoclopramide not be the best choice for pancreatitis?
Can reduce splancnic circulation and therefore cause pancrea hypoxia (not really proven, best to steer clear as first line, but you may have to bite the bullet)
When may Sx be indicated for pancreatitis?
Extrahepatic biliary tract obstruction
Sometimes abscesses - may be possible to drain percutaneously, or manage medically, may need Sx
What are the cons of liver biopsy?
Possibility of haemorrhage
Disease is often heterogenous so may miss the problem (same in the pancreas)
Histopathological assessment if somewhat subjective
What actually happens in heptaic fibrosis?
Excess deposition of extracellular matrix
What are some emerging possible future tests of hepatic fibrosis?
Hyaluronic acid
Transforming groeth factor B-1 (a profibrotic cytokine)
AST: platelet ratio indexx
