Pancreatitis and EPI Flashcards
Are cats or dogs more likely to have chronic, subacute forms of pancreatitis?
Cats
What risk factors are assoc. w/pancreatitis?
Obesity, systemic inflammation, endocrine diseases
What drugs can be risk factors for pancreatitis in dogs?
Azathioprine, l-asparginase, tetracycline
What endocrine diseases can be risk factors for pancreatitis in dogs?
Hyperadrenocorticism, DM
What are clinical signs assoc. w/pancreatitis in dogs?
V+/D+, anorexia cranial abdominal pain
What type of posture will a pancreatitis dog stand in?
Haunches in a “praying posture”
What can occur from severe necrotizing pancreatitis in dogs?
SIRS
What are clinical signs assoc. w/pancreatitis in cats?
Non-specific lethargy and anorexia +/- GI signs
What diagnostic tests are available for pancreatitis?
Serum amylase and lipase, ultrasound, cPLI
What test is most sensitive for pancreatitis?
c/fPLI (pancreatic-specific lipase immunoreactivity)
How are serum amylase and lipase affected by pancreatitis?
Both markedly elevated
How do you treat a dog with acute pancreatitis?
IVFT, H2 blockers, analgesics, feeding tube
How do you treat chronic pancreatitis in a dog?
Low-fat, highly digestible diet
How do you treat cats with acute pancreatitis?
Supportive, similar to dogs, no specific treatment for cats
In which breeds is EPI most common?
GSD, collies, English setters
What are clinical signs of EPI?
Polyphagia, D+ and wt loss in a young animal
What age of dogs are more commonly affected by EPI?
Youn
What is EPI?
Syndrome of inadequate synthesis and secretion of digestive enzymes
What is the most common cause of EPI in dogs?
Pancreatic acinar atrophy
What is the most common cause of EPI in cats?
Chronic pancreatitis
What other syndrome can result as a sequela of EPI?
Malassimilation of nutrients and small intestinal bacterial overgrowth (SIBO)
What type of D+ is assoc. w/EPI?
Small bowel w/voluminous, yellowish gray feces
How will routine bloodwork appear with EPI?
Normal
What parameters will be low with EPI?
TLI and PLI (<5ug/L)
What is the cornerstone of treatment for EPI in both dogs and cats?
Exogenous pancreatic enzyme supplementation
What type of diet should be fed to an EPI animal?
Highly digestible, low-fiber
How much loss of pancreatic function is needed before signs of malabsorption/maldigestion occur?
85-90%
In the absence of pancreatic secretion how much ingested protein and fat can dogs still absorb?
63% protein, 84% fat
What causes spontaneous pancreatic acinar cell atrophy in dogs?
Unknown but thought to be autoimmune atrophic lymphocytic pancreatitis in GSD and collies
What is the typical age of onset for EPI in dogs?
1-5y
Which dog breeds are at increased risk of EPI?
GSD, collie, chow, King Charles Spaniel
What test is highly sensitive and specific for diagnosing EPI?
12h fasted serum TLI
What measures of TLI indicate EPI in dogs? In cats?
Dogs <2.5ug/L
Cats <8.5ug/L
How can an animal’s feces aid in EPI diagnosis?
Fecal elastase is produced exclusively in the pancreas (<10ug/g is diagnostic)
Do EPI animals usually have weight loss with a good or poor appetite ?
Usually good
What nutritional deficiency is seen in 82% of EPI cases?
Cobalamin deficiency
Why is cobalamin deficient in dogs with EPI?
Lack of pancreatic proteases to release cobalamin from transport proteins
What are fat soluble vitamins that may become deficient with EPI?
Vit A, D, E, K
Does fat absorption ever return to normal in EPI cases?
No
What antibiotic therapy can treat SIBO if there is a poor response to enzyme treatment?
Metronidazole or tylosin
Why are gastric blockers used concurrently to treat EPI/
Reduce stomach acidity (incr. pH) to prevent enzyme supps from being inactivated
What is the prognosis of EPI?
20% euthanized d/t expense of treatment
60% show good response to initial treatment
What cobalamin level is assoc. w/a shorter survival time of EPI?
<100ng/L
Develops as a result of pancreatic auto-digestion
Pancreatitis
What mechanisms are in place to prevent pancreatic autodigestion?
Trypsin inhibitor, alpha macroglobulin, enzymes are stored as inactive
What breeds are most predisposed to pancreatitis?
Mini Schnauzers and mini poodles
What usually causes pancreatitis?
Dietary indiscretion
What endocrine disorders can predispose to pancreatitis?
DM, hyperadrenocorticism, hypothyroidism
Why might melena result from pancreatitis?
Duodenal inflammation 2* to pancreatitis can cause GI bleeding
Why might hematochezia result from pancreatitis?
Proximity of an inflamed pancreas to colon causes trauma to the colon
What is “prayer position”?
Rear end up, forelimbs extended in front (looks like stretching)
Why might pancreatitis produce a thrombocytopenia?
2* to PLT consumption d/t severe inflammation
What type of diet is indicated for canine pancreatitis?
Low fat diet
Do cats require a low-fat diet or a period of NPO for pancreatitis?
No
What other condition commonly accompanies a pancreatitis cats?
DKA
How long should a pancreatitis dog be NPO and why?
24h, fasting will rest the pancreas
How will an inflamed pancreas appear on ultrasound?
Hypoechoic pancreas w/hyperechoic surrounding
Why will an inflamed pancreas appear hypoechoic on ultrasound?
Edema
Why will an EPI dog lose weight despite having a ravenous appetite?
Lose ability to digest fat and protein
Where in the GIT is cobalamin absorbed?
Ileum
Where in the GIT is folate absorbed?
Jejunum
How are cobalamin and folate affected by EPI?
High folate, low cobalamin
In dogs, where does the pancreatic duct open?
Adjacent to bile duct on major duodenal papilla, accessory pancreatic duct opens on minor duodenal papilla
In cats where does the pancreatic duct open?
Fuses w/common bile duct and opens on major papilla
What are exocrine pancreatic cells?
Acinar cells and duct cells
What is the function of acinar cells?
Synthesize and store digestive enzymes
What is the function of duct cells?
Secrete bicarb and intrinsic factor
What structure is part of the endocrine pancreas?
Islets of Langerhans
What do alpha cells produce?
Glucagon
What do beta cells produce?
Insulin
What do delta cells produce?
Somatostatin
What do F-cells produce?
Pancreatic polypeptide
Which digestive enzymes split proteins into peptides?
Trypsin and chymotrypsin
Which digestive enzymes cleave amino acids from the carboxyl ends of polypeptides?
Carboxy(poly)peptidase
What digestive enzyme digest elastin fibers that partially hold meats together?
Elastase
What digestive enzyme digests carbs?
Pancreatic amylase
Which enzymes further digest carbs into glucose?
Brush border enzymes
Which digestive enzyme hydrolyzes triglycerides into monoglycerides and FFAs?
Pancreatic lipase
Which digestive enzyme hydrolyzes cholesterol esters into cholesterol and FFAs?
Cholesterol esterase
Which digestive enzyme splits fatty acids from phospholipids?
Phospholipase A2
What helps prevent activation of digestive enzymes until they have reached the duodenum?
Pancreatic secretory trypsin inhibitor
Acute inflammatory condition of the pancreas that is completely reversible
Acute pancreatitis
Long-standing inflammation of the pancreas w/irreversible histo changes (fibrosis)
Chronic pancreatitis
When does autodigestion occur?
When fusion of lysosomes and zymogen granules occurs
Trypsin activating zymogen causes what damage to the pancreas?
Free radical release, increased capillary permeability, pancreatic edema and ischemia
Which cat breed is most commonly affected by pancreatitis?
Siamese
What age of cats is typically affected by pancreatitis?
Over 7yo
What is the triaditis of GI disease in cats?
Pancreatitis, cholangitis, IBD
What are the most common presenting signs in a cat with pancreatitis?
Anorexia and lethargy
What are the most common presenting signs in a dog with pancreatitis?
V+/D+
What is the gold standard for dx of pancreatitis?
Pancreatic biopsy
Are amylase and lipase used for dx of pancreatitis in cats?
No, not sensitive or specific enough
What diet should you feed a pancreatitis cat?
High calorie diets
What is the most common analgesia used for pancreatitis in cats?
Buprenorphine
What is a negative px indicator assoc. w/pancreatitis in cats?
HypoCa
