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Year 4 > SA Pancreas > Flashcards

SA Pancreas Flashcards

1
Q

How does acute pancreatitis differ from other types of inflammation?

A

It is sterile

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2
Q

Describe the pathogenesis of acute pancreatitis

A

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

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3
Q

Why do most cases of acute pancreatitis occur?

A

Idiopathic

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4
Q

Give some predisposing factors for acute pancreatitis

A 
Breed (spaniels and terriers)
Gender (female > male)
Obesity
Drugs (eg cytotoxic)
Concurrent disease
Dietary factors (high fat diets, dietary indiscretion)
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5
Q

Feline pancreatitis is associated with which other diseases?

A

Cholangitis
IBD
Hepatic lipidosis
Diabetes mellitus

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6
Q

Give some clinical signs of pancreatitis in dogs

A 
Dehydration
Anorexia
Vomiting
Weakness
Abdominal pain ('prayer position')
Diarrhoea 
Jaundice
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7
Q

Give some clinical signs of pancreatitis in cats

A 
Lethargy
Anorexia
Vomiting
Abdominal pain
Diarrhoea
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8
Q

How do you diagnose acute pancreatitis?

A

Lab tests (haem/biochem, total amylase and lipase, specific pancreatic lipase (PLI))
Imaging (radiographs to rule out other disease, US best)
Biopsy

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9
Q

Which haem and biochem results may you see in a dog with acute pancreatitis?

A 
Increased WBCC
Increased glucose
Decreased calcium
Increased liver enzymes
Jaundice (increased bilirubin)
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10
Q

How do you treat acute pancreatitis?

A

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?

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11
Q

What kind of diet is recommended long-term for pets with pancreatitis?

A

Normal/highly digestible diet

Importance to maintain consistency of diet to reduce risk of recurrence

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12
Q

What analgesia can you give with pancreatitis?

A 
AVOID NSAIDs
Buprenorphine
Paracetamol
Tramadol
Gabapentin
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13
Q

Exocrine pancreatic insufficiency is heritable in which breeds?

A

German Shepherds, Rough Collies

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14
Q

Give the 3 aetiologies of exocrine pancreatic insufficiency

A

1) Pancreatic acinar atrophy (lymphocytic infiltration -> immune-mediated?)
2) Pancreatic hypoplasia (rare, congenital)
3) Chronic pancreatitis (more common in cats, but still rare)

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15
Q

Give the clinical signs of exocrine pancreatic insufficiency in dogs

A

Faecal changes (large volumes, foul-smelling, greasy, ‘large cow pats’; due to malabsorption)
Appetite changes (polyphagia, coprophagia, pica)
Vomiting
Poor coat condition

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16
Q

Give the clinical signs of feline exocrine pancreatic insufficiency

A 
Weight loss
Diarrhoea
Polyphagia
Vomiting
Often have concurrent disease and cobalamin deficiency
17
Q

How do you diagnose exocrine pancreatic insufficiency?

A

TLI (trypsin-like immunoreactivity)
Normal dog: >5ug/L
Dog with EPI: <2.5ug/L
Cat with EPI: <8ug/L

18
Q

How do you treat exocrine pancreatic insufficiency?

A 
Pancreatic enzymes
Highly-digestible diet
Cobalamin supplementation
Antibacterials for bacterial overgrowth
Treat any concurrent disease
19
Q

What % of the pancreas is exocrine and what is endocrine?

A

98% exocrine (exocrine acinar cells; food digestion enzymes)

2% endocrine (Islets of Langerhans; insulin, glucagon)

20
Q

How would acute pancreatitis appear on US?

A

Pancreas would be enlarged and swollen

Mesenteric changes -> hyperechoic (more white)

21
Q

Which enzymes do pancreatic acinar cells secrete?

A

Proteases (trypsin, chymotrypsin, elastase)
Lipases
Amylase
Also secrete bicarbonate

22
Q

What are the functions of the exocrine pancreas?

A

Enzyme and bicarbonate secretion
Aids B12 and zinc absorption
Antibacterial activity
Intestinal mucosal modulation

23
Q

What are the cut-offs for DGGR lipase when testing for pancreatitis?

A

Cats: >34 U/L
Dogs: >216 U/L

24
Q

How can you test exocrine pancreas integrity?

A

Amylase, lipase
DGGR lipase (measures total serum lipase activity)
cPL (specific canine pancreatic lipase; most specific and sensitive)
TLI (trypsin-like immunoreactivity)

25
Q

In cats, exocrine pancreatic insufficiency may lead to a decrease in what?

A

Vitamin B12

26
Q

Why are cats more prone to triaditis than dogs?

A

Cats completely depend on one pancreatic duct that enters the bile duct
Dogs also have an accessory pancreatic duct

Year 4 (51 decks)

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