Term
| What are the exocrine functions of the pancreas? |
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Definition
-digestive enzymes sotred in inactive forms
-released into GI lumen, THEN cleaved by enteropeptidase |
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Term
| What are the endocrine functions of the pancreas? |
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Definition
| -insulin, glucagon, somatostatin |
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Term
| What is the purpose of endopeptidase? |
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Definition
-cleave peptide bonds
-results in trypsin, chymotrypsin, elastase |
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Term
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Definition
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Term
| What dos phospholipase A2 do? |
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Definition
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Term
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Definition
| -hydrolyzes triglycerides |
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Term
| What are the enzyme inhibitors w/in the pancreas? |
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Definition
-pancreatic secretory trypsin inhibitor
-alpha 2 antitrypsin |
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Term
| What are enzyme inhibitors w/in the blood? |
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Definition
-alpha 1 antitrypsin
-alpha 2 macroglobulin |
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Term
| Activation of zymogens wihtin the pancreatic acinar cels results in pancreatic autodigestion. Describe this. |
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Definition
-zymogens fuse w/ lysosomes
-trypsinogen to trypsin to chymotrypsin
-self-perpetuating auto-digestive process |
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Term
| What effects does pancreatitis have on the body? |
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Definition
-initiation of vasoactive amine cascade
-inc capillary permeability
-direct pancreatic injury
-stomach, duodenum, colon, liver
-spill over into systemic circulation causing systemic CS |
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Term
| What are the possible systemic effects of pancreatitis? |
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Definition
0hypotension
-sepsis
-thromboembolism
-DIC
-hepatocellular necrosis
-pulmonary edema/pleural effusion
-acute tubular necrosis
-cardiac arrhythmia |
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Term
| What are some possible factors leading to pancreatitis? |
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Definition
-nutrition: obesity, igh-fat diet
-ischemia: hypovolemia, vasoactive amine-induced vasoconstriction, assoc w/ DIC
-hyperlipidemia: mii schnauzers
-drugs: NOT STEROIDS |
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Term
| What is the typical signalment of pancreatitis dogs? |
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Definition
-middle-aged to older
-small breed |
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Term
| What are the clinical signs of pancreatitis in dogs? |
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Definition
-mild cases may be subclinical
-vomiting
-anorexia
-lethargy/weakness
-abdominal pain
0diarrhea
-shock/dehydration |
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Term
| What is the typical signalment of feline pancreatitis? CS? |
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Definition
-middle aged to older cats
-mostly subclinical or mild
-tends to be chronic |
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Term
| What do we see histologically w/ chronic pancreatitis in cats? |
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Definition
| -mononuclear cell infiltration & variable amounts of fibrosis |
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Term
| What are the clinical signs of feline chronic pancreatitis? |
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Definition
-partial to complete anorexia
-wt loss
-lethargy
-intermittent vomiting
-hitopath |
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Term
| Cats tend to get triaditis, not just pancreatitis. What is it? |
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Definition
-pancreatitis + hepatitis + IBD
-can be w/ cholangitis |
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Term
| What is the anatomic reason for predisposition of cats to triaditis? |
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Definition
| -pancreatic duct & bile duct fuse = major duodenal papilla |
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Term
| What are some risk factors for pancreatitis in cats w/ pre-existing IBD? |
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Definition
-vomiting is common
-inc intraduodenal P
-predisposes to pancreaticobiliary reflux
-feline sphincter of Oddi is common channel for pancreatic & biliary outflow at duodenal papilla
-higher number ofbacteria in proximal duodenum than dogs |
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Term
| What do we see on CBC w/ pancreatitis? |
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Definition
-dehydration
-stress/inflamm leukogram |
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Term
| What do we see on chem w/ pancreatitis? |
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Definition
-prerenal or renal azotemia
-inc ALT, ALP
-hyperbilirubinemia
-hypocalcemia: poor px
-inc cholesterol/triglycerides |
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Term
| How useful is amylase for diagnosing pancreatitis in dogs? Cats? |
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Definition
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Term
| How useful is lipase for diagnosing pancreatitis in dogs? Cats? |
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Definition
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Term
| What do we see on abdominal rads w/ pancreatitis? |
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Definition
-ground glass appearance
-widens the pyloroduodenal angle
-trapped gas pockets in duodenum
-duodenum displaced laterally |
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Term
| What do we see on abdominal U/S w/ pancreatitis? |
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Definition
-nonhomogenous mass effect
-hypoechogenicity
-edema
-hemorrhage
0hyperechoic peripancreatic fat
-dialted bile ducts |
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Term
| How do we diagnose pancreatitis? |
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Definition
| -pancreatic lipase immunoreactivity: inc levels |
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Term
| How do we treat mild pancreatitis? |
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Definition
-brief NPO
-antiemetics
-IV fluids: crystalloids
-analgesics: opioids |
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Term
| How do we treat chronic pancreatitis? |
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Definition
| -strict nutritional management: highly digestivle, high fiber, low fat |
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Term
| How do we treat moderate to severe pancreatitis? |
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Definition
-IV fluids
-analgesics: no NSAIDs
-antiemetics
-maybe plasma
-NPO while vomiting but give food asap
-add Mirtazapine in cats
-maybe sx |
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Term
| What do we add in cats that probably have triaditis? |
|
Definition
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Term
| What do we see in pancreatitis cases w/ bile duct obstruction? |
|
Definition
-usually transient adjacent peripancreatic edema & inflammation
-progressive inc in ALT/A:{, bilirubin |
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Term
| Are pancreatic abscesses common? what do we see on labwork? |
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Definition
-uncommon
-sterile
-leukocytosis, inc lipase/amylase,bilirubin.ALP
-hemorrhagic, necrotic, & purulent tissue |
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Term
| What do we see on abdominal U/S w/ pancreatic abscess? |
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Definition
-cavitary mass
-sterile, mucopurulent material |
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Term
| How do we treat pancreatic abscesses? |
|
Definition
-medical = death
-sx: debride necrotic tissue, open ab drainage, supprotive tx |
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Term
| What are the potential sequela of pancreatic abscesses? |
|
Definition
-loss of >85% pancras may cause DM
-EPI but less common
-hepatic lipidosis in cats
-phlegmon |
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Term
| What are phlegmon? How do we treat them? |
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Definition
-solid masses on pancreas & adjacent tissue resulting from edema, inflamm cells, and tissue necrosis
-spontaneous regression |
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Term
| What is a pancreatic pseudocyst? How do we treat it? |
|
Definition
-fluctuant, fluid-filled abdominal mass
-tx: sx or U/S-guided centesis |
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Term
| When should we expect complications w/ pancreatitis? |
|
Definition
-apparent recovery w/ relapse of signs
-persistent fever: leukocytosis w/ left shift, toxic neutrophils |
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Term
|
Definition
| -dogs: GSD, rc collies, greyhounds |
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Term
| What are the two types of EPI? |
|
Definition
-idiopathic: adult of any breed
-autosomal recessive: young GSD |
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Term
|
Definition
-pancreatic duct obstruction
-ex: E. procyonis, A. pseudofelineus |
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Term
| What changes occur in the intestinal mucosa secondary to EPI? |
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Definition
-malassimilation
-villous atrophy
-inflamm cell infiltrates
-alterations in mucosal enzyme activity
-bacterial overgrowth |
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Term
| Which vit are non-existant w/ EPI? Why? |
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Definition
-K, A, E
-b/c fat-soluble & EPI=dec fat absorption |
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Term
| Are cobalamin levels inc or dec w/ EPI? |
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Definition
|
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Term
| What are the clinical signs of EPI? |
|
Definition
-ravenous appetite w/ wt loss
-coprophagia
-dull hair coat
-PICA
-feces: steatorrhea |
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Term
| How do we definitively diagnose EPI? |
|
Definition
-serum Trypsin-like immunoreactivity (TLI): dec levels w/ EPI
-can use pancreatic lipase immunoreactivity but less sensitive |
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Term
|
Definition
-Viokase or Pancrezyme: lipase, protease, amylase
-add highly digestible protein & carb sources to diet
-parenteral cobalamin
-vit E
-SI bacteral overgrowth: tylosin powder, metronidazole
-H-2 rc antagonists |
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Term
|
Definition
| -good but lifelong tx and expensive |
|
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Term
|
Definition
-malignant transformation of fetal and neonatal delta cells that stim paietal cells to secrete acid
-highly malignant |
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Term
|
Definition
-affects alpha-cells of pancreas
=causes SND, pan=hypoaminoacidemia, marked hyperglycemia |
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Term
| Who gets nodular pancreatic hyperplasia? What does it look like? |
|
Definition
-older animals
-disseminated small nodules
-incidental finding at necropsy |
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