Pancreatitis and maldigestion/malabsorption Flashcards
how much of the mass does the exocrine pancreas make up
90%
what is the role of the exocrine pancreas
synthesis of digestive enzymes into the duodenum that break down proteins, carbs and fat
also secrete bicarbonate
what causes pancreatitis
premature activation of digestive enzymes within the pancreas
systemic signs of pancreatitis caused by the release of inflammatory cytokines
generalized inflammation liver disease DIC hypotension renal failure or pulmonary failure
what prevents pancreatic autodigestion
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
is it normal for small amounts of pancreatic enzymes to leak from pancreas into circulation?
yes, usually circulating protease inhibitors neutralize activated enzymes
causes for pancreatitis
- dietary fat
- non diet related hyperlipidemia (DM, cushings, hypothyrpodism etc)
- drugs
- pancreatic ischaemia
- pancreatic duct obstruction
clinical signs of pancreatitis
vomiting weakness abdominal pain dehydration diarrhea fever
CBC findings for pancreatitis
non specific
thrombocytopenia
neutrophilia and left shift
anemia
what is the best test for canine pancreatitis
cPLI
binds specifically to pancreatic lipase
what is the reference range of cPLI for pancreatitis
0-200 normal
>400 consistent with pancreatitis
retest in 2-3 weeks if between 200 and 400
pancreatitis complications
DIC systemic inflammatory disease organ dysfunction recurrence or death pancreatic abscessation
treatment
nutrition fluid therapy pain control correction of electrolyte abnormalities antiemetics
pancreatits in cats
most common disorder of exocrine pancreas in cats
cats usually have chronic pancreatitis where as dogs have acute
clinical signs of pancreatits in cats
lethargy
anorexia
dehydration
diagnosis of pancreatitis in cats
histopathology
specific fPLI
ultrasound
interpretation of fPLI
<3.5 normal range
3.6-5.3 = may have pancreatitis, retest in 2 weeks
>5.4 = pancreatitis
what does mild erythrocytosis indicate
dehydration
increased RBC, Hgb and Hct
what does moderate leukocytosis, moderate neutrophilia, with left shift, monocytosis and lymphopenia indicate
inflammation and stress
leukopenia = stress
what does low chloride indicate
vomiting
what indicates azotemia
BUN and creatine increase
what does increased amylase and lipase suggest
pancreatitis
what does increased cholesterol, total bilirubin and ALP indicate
choleostasis
what does increased ALT indicate
hepatocellular damage
what is hyperglycaemia likely due to
stress
post mucosal malabsorption
lymphatic obstruction
maldigestion
failure to adequately digest food
usually due to inadequate secretion of pancreatic digestive enzymes
protein losing enteropathy clinical signs
vomiting, diarrhea, weight loss
oedema and ascites
thromboembolism
albumin and globulin lose at same degree
what is EPI
inadequate pancreatic secretions causing incomplete digestion of food which subsequently causes inadequate absorption of nutrients
causes of EPI
pancreatice acinar atrophy (PAA)
chronic pancreatitis
pancreatinc hypoplasia
pancreatic neoplasia
pancreatic acinar atrophy (PAA)
immune mediated, begins with lymphocytic pancreatitis and gradually leads to destruction of pancreatic acinar tissue
clinical signs of EPI
diarrhoea weight loss increased faecal volume raveouns appetite steatorrhea poor hair coat
test of choice for EPI
TLI (trypsin like immunoreactivity)
detects both trypsinogen and trypsin
index of pancreatic function
TLI interpretation dogs
<2.5 are diagnostic for EPI
TLI interpretation cats
< 8 are diagnostic for EPI
additional tests to run for EPI
folate and cobalamin (B12)
how does EPI cause cobalamin deficiency
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
how does EPI affect folate levels?
folate can be normal to increased in EPI. enteric bacteria can produce folate. lower intestinal pH enhances folate absorption through the jejunum
SIBO (small intestinal bacterial overgrowth)
substantial numbers of bacteria in the upper small intestine and the host responds to them in such a manner as to cause intestinal dysfunction
diagnosis of SIBO
hard to definitively diagnose
- low serum cobalamin
- increased serum folate
malabsorption
failure of intestinal tract to absorb adequately digested nutrients
mechanisms of malabsorption
premucosal
mucosal
premucosal malabsoprtion
rapid intestinal transit - hyperhtyoidism
lack of pancreatic enzymes - EPI
SIBO
mucosal malabsorption
inflammation
infection
parasites
neoplasia
explain IBD
inflammation leads to alterations in intestinal contents and disruptions of normal microflora, potentially causing bacterial overgrowth, which affects the intestines ability to absorb nutrients
post mucosal malabsorption
lympahtic obstruction
what are malabsorptive disorders of the small intestine commonly associated with?
concurrent protein losing enteropathy
protein losing enteropathy clinical signs
vomiting, diarrhea, weight loss
oedema and ascites
thromboembolism
albumin and globulin lose at same degree
what are the three lipids in the body
triglyceride
cholesterol
phospholipids
what do triglycerides do
provide energy source and primary lipid in adipose tissue
what do cholesterol and phospholipids form
cell membranes
hyperlipidemia
increase in levels of any or all lipids in plasma
what hyperlipdemia cause is most common
post prandial
pathological hyperlipidemia is usually secondary to underlying disease
when is hyperlipidemia most likely seen
in patients with hypothyroidism or diabetes mellitus
when is hypertriglyceridemia usually seen
in diabetes mellitus
hyperadrenocorticism
excessive negative energy balance
