SA Pancreas Flashcards
How does acute pancreatitis differ from other types of inflammation?
It is sterile
Describe the pathogenesis of acute pancreatitis
Trypsin is activated in the pancreas
It is normally only activated in the intestines as it damages the pancreas (normally present as trypsinogen in the pancreas-inactive form of trypsin)
-> direct tissue damage to pancreas
-> cascade initiation (coagulation, fibrinolysis, complement, kallikrein-kinin)
Can result in fatty ‘soap’ (fat is digested by trypsin -> calcium binds to it, looks like white soap)
Necrosis and inflammation
Why do most cases of acute pancreatitis occur?
Idiopathic
Give some predisposing factors for acute pancreatitis
Breed (spaniels and terriers) Gender (female > male) Obesity Drugs (eg cytotoxic) Concurrent disease Dietary factors (high fat diets, dietary indiscretion)
Feline pancreatitis is associated with which other diseases?
Cholangitis
IBD
Hepatic lipidosis
Diabetes mellitus
Give some clinical signs of pancreatitis in dogs
Dehydration
Anorexia
Vomiting
Weakness
Abdominal pain ('prayer position')
Diarrhoea
JaundiceGive some clinical signs of pancreatitis in cats
Lethargy Anorexia Vomiting Abdominal pain Diarrhoea
How do you diagnose acute pancreatitis?
Lab tests (haem/biochem, total amylase and lipase, specific pancreatic lipase (PLI))
Imaging (radiographs to rule out other disease, US best)
Biopsy
Which haem and biochem results may you see in a dog with acute pancreatitis?
Increased WBCC Increased glucose Decreased calcium Increased liver enzymes Jaundice (increased bilirubin)
How do you treat acute pancreatitis?
All supportive:
Nutritional support (may need feeding tube)
Pancreatic enzymes
Fluid therapy
Analgesia
Anti-emetics
ABs? (pancreatitis usually sterile but intestinal walls may be leaky -> bacteraemia)
Steroids? (cats that aren’t responding to any other treatment)
Sx?
What kind of diet is recommended long-term for pets with pancreatitis?
Normal/highly digestible diet
Importance to maintain consistency of diet to reduce risk of recurrence
What analgesia can you give with pancreatitis?
AVOID NSAIDs Buprenorphine Paracetamol Tramadol Gabapentin
Exocrine pancreatic insufficiency is heritable in which breeds?
German Shepherds, Rough Collies
Give the 3 aetiologies of exocrine pancreatic insufficiency
1) Pancreatic acinar atrophy (lymphocytic infiltration -> immune-mediated?)
2) Pancreatic hypoplasia (rare, congenital)
3) Chronic pancreatitis (more common in cats, but still rare)
Give the clinical signs of exocrine pancreatic insufficiency in dogs
Faecal changes (large volumes, foul-smelling, greasy, ‘large cow pats’; due to malabsorption)
Appetite changes (polyphagia, coprophagia, pica)
Vomiting
Poor coat condition
Give the clinical signs of feline exocrine pancreatic insufficiency
Weight loss Diarrhoea Polyphagia Vomiting Often have concurrent disease and cobalamin deficiency
How do you diagnose exocrine pancreatic insufficiency?
TLI (trypsin-like immunoreactivity)
Normal dog: >5ug/L
Dog with EPI: <2.5ug/L
Cat with EPI: <8ug/L
How do you treat exocrine pancreatic insufficiency?
Pancreatic enzymes Highly-digestible diet Cobalamin supplementation Antibacterials for bacterial overgrowth Treat any concurrent disease
What % of the pancreas is exocrine and what is endocrine?
98% exocrine (exocrine acinar cells; food digestion enzymes)
2% endocrine (Islets of Langerhans; insulin, glucagon)
How would acute pancreatitis appear on US?
Pancreas would be enlarged and swollen
Mesenteric changes -> hyperechoic (more white)
Which enzymes do pancreatic acinar cells secrete?
Proteases (trypsin, chymotrypsin, elastase)
Lipases
Amylase
Also secrete bicarbonate
What are the functions of the exocrine pancreas?
Enzyme and bicarbonate secretion
Aids B12 and zinc absorption
Antibacterial activity
Intestinal mucosal modulation
What are the cut-offs for DGGR lipase when testing for pancreatitis?
Cats: >34 U/L
Dogs: >216 U/L
How can you test exocrine pancreas integrity?
Amylase, lipase
DGGR lipase (measures total serum lipase activity)
cPL (specific canine pancreatic lipase; most specific and sensitive)
TLI (trypsin-like immunoreactivity)
In cats, exocrine pancreatic insufficiency may lead to a decrease in what?
Vitamin B12
Why are cats more prone to triaditis than dogs?
Cats completely depend on one pancreatic duct that enters the bile duct
Dogs also have an accessory pancreatic duct
