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Smal animal GI > Small animal GI Learning objectives (10: pancreatitis dog/cat; 11/12/13: liver dz) > Flashcards

Small animal GI Learning objectives (10: pancreatitis dog/cat; 11/12/13: liver dz) Flashcards

1
Q

pancreatic protection

A
  • intracellular compartmentalization
    • enzymes are separate from lysosomes
  • proteases made in inactive form
    • zymogens
  • PSTI secreted in parallel with trypsinogen
  • acinar cells around acinus with duct that carries enzymes from acinar cells
  • duct cells release bicard to neutralize acid -Na-Cl fluid from acinar cells
  • pancreatic cells release trypsin inhibitor with pancreatic enzymes
  • lysosomal hydrolases packaged separately, kept separate from zymogen granules
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2
Q

zymogens + lysosomes

A

activated, digesting enzymes

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3
Q

Critical element in activating zymogens

A

Calcium

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4
Q

brush border enzyme

A
  • enterokinase
    • converts trypsinogen to trypsin
    • trypsin activates zymogens by cleaving amino acids off polypeptide chain
    • enterokinase is an enzyme located outside of pancreas (safety)
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5
Q

process of pancreatitis

A
  • pancreas digests itself
  • lysosomal granules and trypsinogen and zymogens all released through apical side of pancreatic cell into the duct
  • apical block of cell
    • build up of zymogens and lysosomes => activation of pancreatic enzymes by hydrolases in lysosomes
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6
Q

Risk factors for pancreatitis

A
  • possibly high fat diet - makes pancreatitis worse
  • indescretion of diet
  • pancreatic ischemia
  • reflux of duodenal contents - bile
    • moreso cats
  • duct obstruction: tumors, stones
  • genetic factors: yorkies, poodles, schnauzers
  • idiopathic
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7
Q

DDX of pancreatitis

A
  1. acute gastroenteritis
  2. hemorrhagic gastroenteritis
  3. intestinal obstruction
  4. acute peritonitis
  5. IBD
  6. renal failure
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8
Q

Clinical signs of pancreatitis

Dogs

A
  • vomiting
  • weakness
  • abdominal pain
  • large bowel diarrhea
    • transverse colon runs underneath pancreas
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9
Q

Clinical signs pancreatitis

Cats

A
  1. hypothermic
  2. lethargic
  3. anorexic
  4. dehydration
  5. abdominal pain

*could be triaditis

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10
Q

Lab findings for pancreatitis

dogs

A
  • neutrophilia and left shift
  • thrombocytopenia
  • anemia
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11
Q

lab findings pancreatitis

cats

A
  • bloodwork can be normal
    • possible hemoconcentration if dehydrated
    • anemia
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12
Q

Diagnostic studies for pancreatitis

A

canine pancreatic lipase (cPLI) and feline pancreatic lipase (fPLI)

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13
Q

DX pancreatitis

A
  • high serum cPLI, fPLI

*avoid bx and irritating pancreas more (unless being performed for other reasons)

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14
Q

TX: pancreatitis

A
  • analgesic
    • fentanyl patch
    • buprenorphine
    • epidural
  • antiemetics
    • metoclopramide
    • maropitant
    • ondansetron
  • Plasma or plasma expander

*antibiotics if pancreatitis turns into enteritis

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15
Q

Pancreatitis nutrition

A
  • fast 3-5 days until vomiting stops for 1 day
    • reintroduce food (low fat)
      • if vomits, refast for another 24 hours
  • Parenteral nutrition possible
  • enteral nutrition probably better
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16
Q

Pancreatitis diet cats

A
  • no idea
  • make sure to treat any underlying dz
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17
Q

Functions of liver

A
  • Drains blood from digestive organs
    • metabolic filter
    • removes translocated intestinal bacteria
    • carb metabolisim
    • vitamin metabolism
    • immunologic function
    • detoxification and excretion
  • Makes and releases bile acids
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18
Q

Liver bile ducts

A
  • flow parallel / opposite direction of artery and vein
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19
Q

hepatic lobule

A
  • has a hepatic vein in center
    • surrounded by sinusoids
  • portal trials on edges of lobules
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20
Q

The triad

A
  • made up of
    • bile duct
    • hepatic arteriole
    • portal venule
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21
Q

Sinusoids

A
  • framed by hepatocytes
    • make a weblike structure between central vein and portal triad
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22
Q

Kupferr cells

A
  • in the sinusoid lumen
  • specialized macrophages
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23
Q

Stellate cells

A
  • in perisinusoidal space
  • role is unclear
  • involved in formation of liber fibrosis
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24
Q

Signs of liver disease

A
  • inappetance
  • lethargy
  • vomiting
  • jaundice
  • change in liver size, contour, margins

*signs can be extremely variable

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25
Q

ALT

(cell damage)

A
  • liver specific
  • in cytoplasm
  • increases with necrosis
  • higher multiple fold inc over ALP when hepatocellular dz
  • poor correlation between magnitude of inc and severity of dz
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26
Q

AST

(cell damage)

A
  • not liver specific (muscle trauma also)
  • from cytoplasm to mitochondria
  • inc with necrosis
  • poor correlation between magnitude and severity of dz
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27
Q

ALP

(cholestatic)

A
  • from bone, liver, or steroid induced
    • except cats
  • in cats ALP has 6 hr half life - if it’s there, be worried
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28
Q

GGT

A

cholestatic

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29
Q

signs of high bilirubin

A

icterus/jaundice

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30
Q

Bilirubinuria

A
  • dogs: low renal threshold ok in dogs
  • cats: high renal threshold, not ok in cats
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31
Q

albumin

A
  • made in liver
  • will decrease in liver disease
  • will not decrease from anorexia/fasting
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32
Q

glucose

A
  • liver is responsible for gluconeogenesis
    • stores enough for about a month of fasting
    • will dec in liver disease
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33
Q

cholesterol

A
  • will dec in liver dz
    • liver responsible for uptake, and synthesis
  • will inc in choestatic dz
34
Q

blood ammonia

A
  • high blood ammonia is a sign of liver disease
    • liver converts ammonia to urea
  • fasting values
    • inc in ammonia may be normal
    • normal amonia in fasting animal may be liver disease
35
Q

Serum bile acids

A
  • not needed if patient is icteric
  • does not conribute to encephalopathy
  • can confirm liver function, but doesn’t indicate type of liver dz
  • in shunts
    • bile acids get re-routed around liver so post-prandial bile acids are very high
36
Q

what percent of liver can be removed before dysfunction

A

75%

37
Q

Additional dx tests for liver dz

A
  • CBC
  • clotting function
  • fecal exam to check for GI bleeding
  • rads to eval liver size
    • microhepatica: cranial shift of gastric axis
    • ascites
  • abdominocentesis: check for bile
  • ultrasound
    • many limitations
    • only use if you are good at finding a focal lesion or obstruction
  • liver aspiration
    • cancer check, hepatic lipidosis check
  • liver bx: for specific dx
38
Q

Dog has ALT of 780 (10-100) and ALKP 220 (10-100)

A

more consistent with HEPATOCELLULAR DZ not choestatic b/c ALT is so increased

39
Q

Causes of acute hepatitis

A
  • hepatotoxins (carbon tetrachloride, mycotoxins, xylitol)
  • drugs: acetaminophen (cats), azathioprine, trimethoprim-sulpha abx
  • mushrooms: amanita
  • viruses
  • sage palm ingestions (FLORIDA)

*varied causes, can be hard to find

40
Q

DX of acute hepatitis

A
  • inc in ALT and AST
  • ALP usually normal or only mildly inc
  • inc in serum bilirubin if many hepatocytes affected
  • liver bx
    • neither helpful nor essential
    • done in chronic hepatitis
41
Q

Causes chronic hepatitis

A
  • leptospirosis
  • drugs: phenobarb
  • copper metabolism
  • idiopathic
42
Q

breed related chronic hepatitis

A
  • dobie
  • cocker spaniel
  • labrador retreiver
43
Q

Copper associated hepatopathy

A
  • dalmation
  • bedlington terrier
  • west highland white terrier
  • labradors
44
Q

management of chronic hepatitis

A
  • remove cause: drugs, copper
  • anti-inflammatories
    • glucocorticoids - may also reduce fibrosis
  • anti-oxidants
  • supportive therapy
  • copper chelaters for 6+ months if copper related
  • UCDA
45
Q

UCDA

A
  • ursodeoxycholic acid
    • hydrophilic bile acid
    • possibly prevents apoptosis and prevent mitochondrial damage
    • inc flow of bile
    • immunomodulating effects
46
Q

Types of cholangitis in cats

A
  • neutrophilic
  • lymphocytic

*based on type of infiltrate in bile duct lumen/biliary epithelium. Ultimately need bx and bile culture to dx

47
Q

Neutrophilic cholangitis in the cat

A
  • can be acute or chronic
  • thought to be from ascending bacterial infection from intestine
  • signs:
    • fever
    • lethargy
    • vomiting
    • jaundice
48
Q

Lymphocytic cholangitis

A
  • may be from some initiating factor that triggers immune-mediated mechanisms that perpetuate liver path
  • signs
    • ascites
    • jaundice
49
Q

Triaditis

A
  • cholangitis +
  • pancreatitis +
  • IBD
50
Q

Tx for neutrophilic cholangitis

A
  • abx based on culture: usually E. Coli
  • Glucocorticoids (pred) for inflammation
  • cholecystectomy
    • cases with inspissated bile and biliary duct obstruction
  • fluid therapy and nutritional support
51
Q

TX for lymphocytic cholangitis

A
  • Glucocorticoids at immunosuppressive doses
  • may breat with abx if suspect chronic neutrophilic cholangitis
  • fluids, nutritional, antioxidant support
  • if ascites: low Na+ diet and diuretics
52
Q

Most common liver disease in cats

A

hepatic lipidosis

53
Q

causes of hepatic lipidosis

A
  • no confirmed etiology
  • from formation of a metabolic disorder
  • possibly related to malnutrition
  • obesity inc risk
  • inc risk from sudden rapid weight loss or dec caloric intake
  • may be related to negative nitrogen balance
54
Q

DX hepatic lipidosis

A
  • lab
    • dram inc ALP, inc ALT, mod inc AST, normal/slightly elevated GGT
    • normocytic, normochromic, non-regenerative anemia
  • Hx of fat cat with anorexia
  • hepatomegaly on rads, rounded margins
  • hyperechogenic ultrasound of liver
  • tissue aspiration: don’t misinterpret normal fat vacuoles
55
Q

management Hepatic lipidosis

A
  • nutritional support (60-90 kcal/kg/day at min)
  • treat concurrent illness/underlying cause
  • place e-tube
  • metoclopramide/cisapride for delayed gastric emptying
  • antiemetics if vomiting
56
Q

extrahepatic biliary obstruction

A

impairment of bile flow in biliary system between liver and duodenum

57
Q

clinical signs of extrahepatic biliary obstruction

A
  • general
  • vomiting
  • lethargy
  • innapetance
58
Q

DX: extrahepatic biliary obstruction

A
  • marked inc in ALP (always higher than ALT
  • can only confirm by laparotomy
59
Q

Causes of extrahepatic biliary obstruction

A
  • dog: pancreatitis
  • cat: pancreatic and biliary neoplasia
60
Q

Management of extrahepatic biliary obstruction

A
  • medically managed
  • non-resolving, may surgerize
61
Q

congenital portal systemic shunt

A
  • abnormal development of hepatic portal circulation
    • usually in young dogs, small for their age
62
Q

portosystemic shunts breed disposition

A
  • yorkies
  • min schnauzers
  • maltese
  • irish wolf hound
63
Q

Intrahepatic shunts more common in

A

large breed dogs

64
Q

extrahepatic shunts more common in

A

cats and small breed dogs

65
Q

Clinical presentation of portosystemic shunts

A
  • small dogs: ADR
  • cats: small stature, ptyalism, copper irises
  • other signs
    • PU/PD
    • urate stones (not seen on rads)
66
Q

lab Dx portosystemic shunts

A
  • biochem profile may be normal
  • ALT, AST, ALP, and GGT can be normal or mildly inc
  • ammonium biurate crystals in urine
  • may see low
    • urea nitrogen
    • albumin
    • glucose
  • microcytic anemia from low iron
  • abnormal bile acids, ammonia
67
Q

imaging dx portosystemic shunt

A
  • ultrasound
    • aortic to portal vein ratio
    • renomegaly
    • visualization of shunt
  • CT angiogram
  • Transplenic scintigraphy: no longer done
68
Q

portosystemic shunt management

A
  • sx ligation
  • restricted protein
  • high quality diet with lactulose
69
Q

Cats have a common

A

bile and pancreatic duct that join before entering duodenal papilla

70
Q

Cats are deficient in

A
  • glucoronyltransferase
    • cats have dec ability to excrete some compounds: NSAIDS
    • cats are slower to secrete bilirubin
71
Q

In cats, the gluconeogenensis pathway never

A

shuts down when fasting

72
Q

Needed to conjugate bile acids in cats

A

taurine

73
Q

AST increases in cats

A

often less dramatic and associated with muscle dystrophy

74
Q

ALP in cats in produced in response to

A

epithelial stimulus

75
Q

ALP increase in cats strongly suggests

A

on-going hepatic dz

76
Q

Cats tend to develop jaundice earlier than dogs b/c

A
  • reduced glutathione concentrations and
  • dec secretory ability
77
Q

In cats bilirubin is a very reliable sign of

A
  • hepatopathy
    • due to high renal threshold
78
Q

In cats, bile acids are

A
  • a sensitive test of liver function
    • blood ammonia test is used same way as in dog
79
Q

Cats with liver disease rarely have

A

hypoalbuminemia

80
Q

Hyperglobulinemia in cats

A
  • seen in a variety of diseases
  • often concurrent with liver disease

Smal animal GI (5 decks)

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