GI2- SA Pancreatitis

  1. The larger duct from the pancreas in the dog is called the __________.
    accessory pancreatic duct
  2. Describe the pancreatic duct in cats. What is the potential clinical relevance of this?
    joins common bile duct prior to entering duodenum; cats are at risk for concurrent biliary, pancreatic, and intestinal inflammation ("triaditis"
  3. Purpose of the pancreatic acini. (4)
    secretion of pancreatic enzymes for dehydration, ductal cells secrete water and bicarbonate, production of intrinsic factor to increase B12 absorption in the ileum, produces trypsin inhibitor
  4. Describe regulation of pancreatic secretion.
    acid from stomach releases secretin from duodenum; fats and AAs cause release of cholecystokinin--> secretin and CCK absorbed into blood stream--> secretin causes copious secretion of pancreatic fluid and bicarb; CCK causes secretion of enzymes--> vagal stimulation releases enzymes into acini
  5. What are the 3 phases of pancreatic secretion?
    cephalic phase--> gastric phase--> intestinal phase
  6. Describe the cephalic phase of pancreatic secretion.
    sight and smell of food--> Ach release by vagal nerve endings in pancreas--> initiates enzyme secretion
  7. Describe the gastric phase of pancreatic secretion.
    gastric distention causes continues nervous stimulation of enzyme secretion
  8. Describe the intestinal phase of pancreatic secretion.
    chyme enters SI--> release of CCK and secretion maximizes pancreatic secretion
  9. Dogs have historically been associated with _____________; cats with _____________.
    acute pancreatitis; chronic pancreatitis
  10. What are the types of acute pancreatitis? (2)
    edematous (mild and self-limiting), hemorrhagic/necrotic (life threatening)
  11. Edematous acute pancreatitis may progress to necrotic/hemorrhagic pancreatitis if....
    there is vascular compromise.
  12. Chronic pancreatitis in cats is usually ____________ inflammation with __(2)__.
    lymphoplasmacytic; fibrosis and acinar atrophy
  13. What is the common denominator of pancreatitis?
    premature activation of enzymes within the pancreas, leading to autodigestion
  14. What are zymogens?
    proteolytic and phospholipolytic enzymes that are synthesized, store, and secreted in inactive form
  15. What are examples of specific zymogens? (5)
    trypsinogen, chymotrypsinogen, procarboxypolypeptidase, proelastase, prophospholipase A2
  16. How are zymogens activated?
    require proteolytic activation by cleavage of the propeptide
  17. Zymogens are packaged with _______________ in the pancreas.
    pancreatic secretory trypsin inhibitor
  18. What is the basic pathophysiology associated with acute pancreatitis?
    lysosomes are combined with zymogen granules within the pancreas, leading to premature zymogen activation and premature release of enzymes
  19. What are the multisystemic complications that can occur with acute pancreatitis? (5)
    fluid/electrolyte/acid-base imbalances [vomiting], chemical peritonitis, DIC, systemic inflammatory response syndrome (SIRS), multiple organ failure
  20. What is the "poster child" for acute pancreatitis?
    small breed dog, older in age, overweight, potentially with other endocrine diseases; presents with acute vomiting
  21. What are causes and risk factors for acute pancreatitis? (8)
    middle-aged to older dogs, terriers or non-sporting dogs, obesity, history of recent high fat diet, hyperlipidemia, endocrine disease (DIABETES, hypothyroidism, Cushing's), drugs/toxins, idiopathic (Esp. mini schnauzers)
  22. What are causes and associations with feline pancreatitis? (8)
    cholangitis, IBD, abdominal trauma, organophosphates, ischemia, diabetes mellitus, hepatic lipidosis, infectious (flukes, FIP, toxo, calicivirus, herpesvirus 1, parvovirus)
  23. Clinical findings associated with acute pancreatitis in dogs? (13)
    vomiting**, anorexia, diarrhea, abdominal pain, enlarged pancreas, icterus, fever, weakness, dehydration, [advanced cases] shock, hypothermia, arrhythmias, respiratory distress
  24. What are clinical signs of pancreatitis in cats? (3)
    anorexia, dehydration, and lethargy [very non-specific...vomiting occurs very sporadically]
  25. What is the diagnostic strategy for pancreatitis? (3)
    rule out other causes of clinical signs, clinical/lab/imaging findings consistent with pancreatitis, pretty much a diagnosis of exclusion
  26. CBC findings consistent with a dog with pancreatitis. (2)
    neutrophilia, left shift
  27. What is the test of choice for pancreatitis in both dogs and cats?
    PLI- pancreatic lipase [spec and snap cPL from Idexx]
  28. What level on cPL is suggestive of pancreatitis in dogs and cats?
    • Dogs: >400μg/L
    • Cats: >5.4μg/L
    • There is a grey zone for both....
  29. Describe the snap cPL test.
    shows up positive if the cPL is over >200....that's in the grey zone; so you can have a positive snap cPL in an animal that has another cause of increased lipase; VERY SENSITIVE- negative result rules out pancreatitis
  30. What biochemical findings are consistent with acute pancreatitis? (9)
    increased pancreatic lipase, azotemia/hypokalemia/hypoproteinemia [secondary metabolic effects], increased tryglycerides/cholesterol, hypocalcemia/hyperglycemia [endocrine effects], increased bilirubin, increased liver enzymes (ALP/ALT)
  31. How does pancreatitis cause secondary hepatobiliary disease?
    common bile duct obstruction due to inflammation--> reactive hepatopathy due to inflammatory mediators, hepatic ischemia, DIC, and hepatic microthrombi; may present as concurrent cholangitis, esp in cats
  32. What radiographical changes are consistent with acute pancreatitis in dogs?
    mostly rads are used to rule out other causes of vomiting, but you may see widening and static gas in the duodenum, duodenum may be "pushed down"
  33. How useful is imaging in diagnosing pancreatitis? (3)
    normal imaging does NOT RULE OUT, but it can provide supporting evidence, can rule out other causes of vomiting
  34. In what cats should you suspect pancreatitis? (7)
    liver disease with hyperbili and increased liver enzymes, concurrent IBD/cholangitis, hepatic lipidosis, poorly controlled diabetes mellitus, sepsis, hypoglycemia, acute collapse
  35. Describe the general therapeutic approach to acute pancreatitis? (4)
    supportive care, antiemetics, pain control, control complications
  36. Describe fluid therapy for acute pancreatitis. (3)
    balances electrolyte solution, KCl supplement, Ca2+ only if symptomatic
  37. Describe food intake for patients with acute pancreatitis.
    [historically] NPO (no food) 2-4 days, slowly introduce water, no vomiting?--> low fat food in very small amounts, still no vomiting?--> slow reintroduce normal food
  38. What is the argument for enteral feeding during pancreatitis instead of NPO?
    maintains intestinal motility, mucosal integrity, and local immune defenses; +/- prevent bacterial translocation and sepsis, [if the guts works, use it]
  39. Describe nutritional support in cats with pancreatitis.
    [vomiting less likely] DO NOT NPO....risk for hepatic lipidosis with starvation, offer food/place an NG tube if no vomiting, total parenteral nutrition if vomiting
  40. What antiemetics are commonly used with acute pancreatitis? (4)
    Cerenia (also decreases visceral pain- double indication), Metoclopramide, Chlorpromazine, Ondansetron
  41. What are potential immediate complications with acute pancreatitis? (7)
    hypovolemia, shock, DIC, thrombosis, kidney failure, bile duct obstruction, diabetes mellitus (transient or permanent)
  42. What are indications for surgery with pancreatitis? (2)
    pancreatic abscess, pancreatic fibrosis and chronic biliary obstruction
  43. What are potential long-term complications with acute pancreatitis? (3)
    diabetes mellitus, pancreatic insufficiency, pancreatic fibrosis and biliary obstruction
  44. What are strategies for preventing future episodes of acute pancreatitis? (3)
    if underlying cause found address it, no table food, keep them on a highly digestible low fat diet
  45. What treatment is sometimes considered for cats with chronic pancreatitis that you would never use in a dog with pancreatitis?
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GI2- SA Pancreatitis
vetmed GI2