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tv4001 > Pancreatitis and maldigestion/malabsorption > Flashcards

Pancreatitis and maldigestion/malabsorption Flashcards

1
Q

how much of the mass does the exocrine pancreas make up

A

90%

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2
Q

what is the role of the exocrine pancreas

A

synthesis of digestive enzymes into the duodenum that break down proteins, carbs and fat
also secrete bicarbonate

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3
Q

what causes pancreatitis

A

premature activation of digestive enzymes within the pancreas

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4
Q

systemic signs of pancreatitis caused by the release of inflammatory cytokines

A 
generalized inflammation
liver disease 
DIC 
hypotension 
renal failure or pulmonary failure
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5
Q

what prevents pancreatic autodigestion

A

pancreatic enzymes sequestered in acinar cells are in inactive form. they only become activated after reaching the duodenum
acinar cells also make pancreatic secretory trypsin inhibitors which inactivates any trypsin that is prematurely activated with granules

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6
Q

is it normal for small amounts of pancreatic enzymes to leak from pancreas into circulation?

A

yes, usually circulating protease inhibitors neutralize activated enzymes

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7
Q

causes for pancreatitis

A
  • dietary fat
  • non diet related hyperlipidemia (DM, cushings, hypothyrpodism etc)
  • drugs
  • pancreatic ischaemia
  • pancreatic duct obstruction
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8
Q

clinical signs of pancreatitis

A 
vomiting 
weakness 
abdominal pain 
dehydration 
diarrhea 
fever
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9
Q

CBC findings for pancreatitis

A

non specific
thrombocytopenia
neutrophilia and left shift
anemia

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10
Q

what is the best test for canine pancreatitis

A

cPLI

binds specifically to pancreatic lipase

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11
Q

what is the reference range of cPLI for pancreatitis

A

0-200 normal
>400 consistent with pancreatitis
retest in 2-3 weeks if between 200 and 400

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12
Q

pancreatitis complications

A 
DIC 
systemic inflammatory disease 
organ dysfunction 
recurrence or death 
pancreatic abscessation
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13
Q

treatment

A 
nutrition 
fluid therapy 
pain control 
correction of electrolyte abnormalities 
antiemetics
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14
Q

pancreatits in cats

A

most common disorder of exocrine pancreas in cats

cats usually have chronic pancreatitis where as dogs have acute

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15
Q

clinical signs of pancreatits in cats

A

lethargy
anorexia
dehydration

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16
Q

diagnosis of pancreatitis in cats

A

histopathology
specific fPLI
ultrasound

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17
Q

interpretation of fPLI

A

<3.5 normal range
3.6-5.3 = may have pancreatitis, retest in 2 weeks
>5.4 = pancreatitis

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18
Q

what does mild erythrocytosis indicate

A

dehydration

increased RBC, Hgb and Hct

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19
Q

what does moderate leukocytosis, moderate neutrophilia, with left shift, monocytosis and lymphopenia indicate

A

inflammation and stress

leukopenia = stress

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20
Q

what does low chloride indicate

A

vomiting

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21
Q

what indicates azotemia

A

BUN and creatine increase

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22
Q

what does increased amylase and lipase suggest

A

pancreatitis

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23
Q

what does increased cholesterol, total bilirubin and ALP indicate

A

choleostasis

24
Q

what does increased ALT indicate

A

hepatocellular damage

25
Q

what is hyperglycaemia likely due to

A

stress

26
Q

post mucosal malabsorption

A

lymphatic obstruction

27
Q

maldigestion

A

failure to adequately digest food

usually due to inadequate secretion of pancreatic digestive enzymes

28
Q

protein losing enteropathy clinical signs

A

vomiting, diarrhea, weight loss
oedema and ascites
thromboembolism
albumin and globulin lose at same degree

29
Q

what is EPI

A

inadequate pancreatic secretions causing incomplete digestion of food which subsequently causes inadequate absorption of nutrients

30
Q

causes of EPI

A

pancreatice acinar atrophy (PAA)
chronic pancreatitis
pancreatinc hypoplasia
pancreatic neoplasia

31
Q

pancreatic acinar atrophy (PAA)

A

immune mediated, begins with lymphocytic pancreatitis and gradually leads to destruction of pancreatic acinar tissue

32
Q

clinical signs of EPI

A 
diarrhoea
weight loss 
increased faecal volume 
raveouns appetite 
steatorrhea 
poor hair coat
33
Q

test of choice for EPI

A

TLI (trypsin like immunoreactivity)
detects both trypsinogen and trypsin
index of pancreatic function

34
Q

TLI interpretation dogs

A

<2.5 are diagnostic for EPI

35
Q

TLI interpretation cats

A

< 8 are diagnostic for EPI

36
Q

additional tests to run for EPI

A

folate and cobalamin (B12)

37
Q

how does EPI cause cobalamin deficiency

A

failure to secrete HCO3 rich fluid and protease into duodenum results in decreased production of intrinsic factor from the pancreas which then leads to intestinal bacterial overgrowth. The bacteria bind to cobalamin which decreases the amount available for absorption

38
Q

how does EPI affect folate levels?

A

folate can be normal to increased in EPI. enteric bacteria can produce folate. lower intestinal pH enhances folate absorption through the jejunum

39
Q

SIBO (small intestinal bacterial overgrowth)

A

substantial numbers of bacteria in the upper small intestine and the host responds to them in such a manner as to cause intestinal dysfunction

40
Q

diagnosis of SIBO

A

hard to definitively diagnose

  • low serum cobalamin
  • increased serum folate
41
Q

malabsorption

A

failure of intestinal tract to absorb adequately digested nutrients

42
Q

mechanisms of malabsorption

A

premucosal

mucosal

43
Q

premucosal malabsoprtion

A

rapid intestinal transit - hyperhtyoidism
lack of pancreatic enzymes - EPI
SIBO

44
Q

mucosal malabsorption

A

inflammation
infection
parasites
neoplasia

45
Q

explain IBD

A

inflammation leads to alterations in intestinal contents and disruptions of normal microflora, potentially causing bacterial overgrowth, which affects the intestines ability to absorb nutrients

46
Q

post mucosal malabsorption

A

lympahtic obstruction

47
Q

what are malabsorptive disorders of the small intestine commonly associated with?

A

concurrent protein losing enteropathy

48
Q

protein losing enteropathy clinical signs

A

vomiting, diarrhea, weight loss
oedema and ascites
thromboembolism
albumin and globulin lose at same degree

49
Q

what are the three lipids in the body

A

triglyceride
cholesterol
phospholipids

50
Q

what do triglycerides do

A

provide energy source and primary lipid in adipose tissue

51
Q

what do cholesterol and phospholipids form

A

cell membranes

52
Q

hyperlipidemia

A

increase in levels of any or all lipids in plasma

53
Q

what hyperlipdemia cause is most common

A

post prandial

pathological hyperlipidemia is usually secondary to underlying disease

54
Q

when is hyperlipidemia most likely seen

A

in patients with hypothyroidism or diabetes mellitus

55
Q

when is hypertriglyceridemia usually seen

A

in diabetes mellitus
hyperadrenocorticism
excessive negative energy balance

tv4001 (4 decks)

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