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GI/Nutritional Disorders > Pancreatitis and EPI > Flashcards

Pancreatitis and EPI Flashcards

1
Q

Are cats or dogs more likely to have chronic, subacute forms of pancreatitis?

A

Cats

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2
Q

What risk factors are assoc. w/pancreatitis?

A

Obesity, systemic inflammation, endocrine diseases

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3
Q

What drugs can be risk factors for pancreatitis in dogs?

A

Azathioprine, l-asparginase, tetracycline

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4
Q

What endocrine diseases can be risk factors for pancreatitis in dogs?

A

Hyperadrenocorticism, DM

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5
Q

What are clinical signs assoc. w/pancreatitis in dogs?

A

V+/D+, anorexia cranial abdominal pain

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6
Q

What type of posture will a pancreatitis dog stand in?

A

Haunches in a “praying posture”

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7
Q

What can occur from severe necrotizing pancreatitis in dogs?

A

SIRS

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8
Q

What are clinical signs assoc. w/pancreatitis in cats?

A

Non-specific lethargy and anorexia +/- GI signs

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9
Q

What diagnostic tests are available for pancreatitis?

A

Serum amylase and lipase, ultrasound, cPLI

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10
Q

What test is most sensitive for pancreatitis?

A

c/fPLI (pancreatic-specific lipase immunoreactivity)

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11
Q

How are serum amylase and lipase affected by pancreatitis?

A

Both markedly elevated

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12
Q

How do you treat a dog with acute pancreatitis?

A

IVFT, H2 blockers, analgesics, feeding tube

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13
Q

How do you treat chronic pancreatitis in a dog?

A

Low-fat, highly digestible diet

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14
Q

How do you treat cats with acute pancreatitis?

A

Supportive, similar to dogs, no specific treatment for cats

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15
Q

In which breeds is EPI most common?

A

GSD, collies, English setters

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16
Q

What are clinical signs of EPI?

A

Polyphagia, D+ and wt loss in a young animal

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17
Q

What age of dogs are more commonly affected by EPI?

A

Youn

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18
Q

What is EPI?

A

Syndrome of inadequate synthesis and secretion of digestive enzymes

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19
Q

What is the most common cause of EPI in dogs?

A

Pancreatic acinar atrophy

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20
Q

What is the most common cause of EPI in cats?

A

Chronic pancreatitis

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21
Q

What other syndrome can result as a sequela of EPI?

A

Malassimilation of nutrients and small intestinal bacterial overgrowth (SIBO)

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22
Q

What type of D+ is assoc. w/EPI?

A

Small bowel w/voluminous, yellowish gray feces

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23
Q

How will routine bloodwork appear with EPI?

A

Normal

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24
Q

What parameters will be low with EPI?

A

TLI and PLI (<5ug/L)

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25
Q

What is the cornerstone of treatment for EPI in both dogs and cats?

A

Exogenous pancreatic enzyme supplementation

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26
Q

What type of diet should be fed to an EPI animal?

A

Highly digestible, low-fiber

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27
Q

How much loss of pancreatic function is needed before signs of malabsorption/maldigestion occur?

A

85-90%

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28
Q

In the absence of pancreatic secretion how much ingested protein and fat can dogs still absorb?

A

63% protein, 84% fat

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29
Q

What causes spontaneous pancreatic acinar cell atrophy in dogs?

A

Unknown but thought to be autoimmune atrophic lymphocytic pancreatitis in GSD and collies

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30
Q

What is the typical age of onset for EPI in dogs?

A

1-5y

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31
Q

Which dog breeds are at increased risk of EPI?

A

GSD, collie, chow, King Charles Spaniel

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32
Q

What test is highly sensitive and specific for diagnosing EPI?

A

12h fasted serum TLI

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33
Q

What measures of TLI indicate EPI in dogs? In cats?

A

Dogs <2.5ug/L

Cats <8.5ug/L

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34
Q

How can an animal’s feces aid in EPI diagnosis?

A

Fecal elastase is produced exclusively in the pancreas (<10ug/g is diagnostic)

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35
Q

Do EPI animals usually have weight loss with a good or poor appetite ?

A

Usually good

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36
Q

What nutritional deficiency is seen in 82% of EPI cases?

A

Cobalamin deficiency

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37
Q

Why is cobalamin deficient in dogs with EPI?

A

Lack of pancreatic proteases to release cobalamin from transport proteins

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38
Q

What are fat soluble vitamins that may become deficient with EPI?

A

Vit A, D, E, K

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39
Q

Does fat absorption ever return to normal in EPI cases?

A

No

40
Q

What antibiotic therapy can treat SIBO if there is a poor response to enzyme treatment?

A

Metronidazole or tylosin

41
Q

Why are gastric blockers used concurrently to treat EPI/

A

Reduce stomach acidity (incr. pH) to prevent enzyme supps from being inactivated

42
Q

What is the prognosis of EPI?

A

20% euthanized d/t expense of treatment

60% show good response to initial treatment

43
Q

What cobalamin level is assoc. w/a shorter survival time of EPI?

A

<100ng/L

44
Q

Develops as a result of pancreatic auto-digestion

A

Pancreatitis

45
Q

What mechanisms are in place to prevent pancreatic autodigestion?

A

Trypsin inhibitor, alpha macroglobulin, enzymes are stored as inactive

46
Q

What breeds are most predisposed to pancreatitis?

A

Mini Schnauzers and mini poodles

47
Q

What usually causes pancreatitis?

A

Dietary indiscretion

48
Q

What endocrine disorders can predispose to pancreatitis?

A

DM, hyperadrenocorticism, hypothyroidism

49
Q

Why might melena result from pancreatitis?

A

Duodenal inflammation 2* to pancreatitis can cause GI bleeding

50
Q

Why might hematochezia result from pancreatitis?

A

Proximity of an inflamed pancreas to colon causes trauma to the colon

51
Q

What is “prayer position”?

A

Rear end up, forelimbs extended in front (looks like stretching)

52
Q

Why might pancreatitis produce a thrombocytopenia?

A

2* to PLT consumption d/t severe inflammation

53
Q

What type of diet is indicated for canine pancreatitis?

A

Low fat diet

54
Q

Do cats require a low-fat diet or a period of NPO for pancreatitis?

A

No

55
Q

What other condition commonly accompanies a pancreatitis cats?

A

DKA

56
Q

How long should a pancreatitis dog be NPO and why?

A

24h, fasting will rest the pancreas

57
Q

How will an inflamed pancreas appear on ultrasound?

A

Hypoechoic pancreas w/hyperechoic surrounding

58
Q

Why will an inflamed pancreas appear hypoechoic on ultrasound?

A

Edema

59
Q

Why will an EPI dog lose weight despite having a ravenous appetite?

A

Lose ability to digest fat and protein

60
Q

Where in the GIT is cobalamin absorbed?

A

Ileum

61
Q

Where in the GIT is folate absorbed?

A

Jejunum

62
Q

How are cobalamin and folate affected by EPI?

A

High folate, low cobalamin

63
Q

In dogs, where does the pancreatic duct open?

A

Adjacent to bile duct on major duodenal papilla, accessory pancreatic duct opens on minor duodenal papilla

64
Q

In cats where does the pancreatic duct open?

A

Fuses w/common bile duct and opens on major papilla

65
Q

What are exocrine pancreatic cells?

A

Acinar cells and duct cells

66
Q

What is the function of acinar cells?

A

Synthesize and store digestive enzymes

67
Q

What is the function of duct cells?

A

Secrete bicarb and intrinsic factor

68
Q

What structure is part of the endocrine pancreas?

A

Islets of Langerhans

69
Q

What do alpha cells produce?

A

Glucagon

70
Q

What do beta cells produce?

A

Insulin

71
Q

What do delta cells produce?

A

Somatostatin

72
Q

What do F-cells produce?

A

Pancreatic polypeptide

73
Q

Which digestive enzymes split proteins into peptides?

A

Trypsin and chymotrypsin

74
Q

Which digestive enzymes cleave amino acids from the carboxyl ends of polypeptides?

A

Carboxy(poly)peptidase

75
Q

What digestive enzyme digest elastin fibers that partially hold meats together?

A

Elastase

76
Q

What digestive enzyme digests carbs?

A

Pancreatic amylase

77
Q

Which enzymes further digest carbs into glucose?

A

Brush border enzymes

78
Q

Which digestive enzyme hydrolyzes triglycerides into monoglycerides and FFAs?

A

Pancreatic lipase

79
Q

Which digestive enzyme hydrolyzes cholesterol esters into cholesterol and FFAs?

A

Cholesterol esterase

80
Q

Which digestive enzyme splits fatty acids from phospholipids?

A

Phospholipase A2

81
Q

What helps prevent activation of digestive enzymes until they have reached the duodenum?

A

Pancreatic secretory trypsin inhibitor

82
Q

Acute inflammatory condition of the pancreas that is completely reversible

A

Acute pancreatitis

83
Q

Long-standing inflammation of the pancreas w/irreversible histo changes (fibrosis)

A

Chronic pancreatitis

84
Q

When does autodigestion occur?

A

When fusion of lysosomes and zymogen granules occurs

85
Q

Trypsin activating zymogen causes what damage to the pancreas?

A

Free radical release, increased capillary permeability, pancreatic edema and ischemia

86
Q

Which cat breed is most commonly affected by pancreatitis?

A

Siamese

87
Q

What age of cats is typically affected by pancreatitis?

A

Over 7yo

88
Q

What is the triaditis of GI disease in cats?

A

Pancreatitis, cholangitis, IBD

89
Q

What are the most common presenting signs in a cat with pancreatitis?

A

Anorexia and lethargy

90
Q

What are the most common presenting signs in a dog with pancreatitis?

A

V+/D+

91
Q

What is the gold standard for dx of pancreatitis?

A

Pancreatic biopsy

92
Q

Are amylase and lipase used for dx of pancreatitis in cats?

A

No, not sensitive or specific enough

93
Q

What diet should you feed a pancreatitis cat?

A

High calorie diets

94
Q

What is the most common analgesia used for pancreatitis in cats?

A

Buprenorphine

95
Q

What is a negative px indicator assoc. w/pancreatitis in cats?

A

HypoCa

GI/Nutritional Disorders (29 decks)

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