Small Ani. Med 2- Pancreas

wilsbach's version from 2016-02-27 21:42

Pancreatitis, acute abdomen

Question Answer
panc is where/ where would you find pain in panc probpainful cr abd
Pancreatitis is a Mild to severe Inflammatory disease--- explain the pathogenesis of how this can quickly be reallllly bad newsInflammation of panc--> Activation of digestive enzymes within pancreas--> Maintained and exacerbated by inflammatory cytokines and free radical production---> Vascultitis and edema--> Multisystem involvement (SIRS, MODS, MOFS)
what is the typical signalment of a pancreatitis dog? Middle aged or older dog.
what dietary things can trigger pancreatitis? high fat meal or garbage ingestion
what are factors which can influence the development of pancreatitis?(1) Diet (high fat, garbage) (2) Hypoperfusion (3) trauma (4) Toxins (KBr, L-aspar, Imuran) (5) abnormal metabolism: Hyperlipidemia!
why might a Miniature Schnauzer be more prone to develop pancreatitis?bc they are prone to hyperlipidemia, which makes pancreatitis more likely
what are acute signs of pancreatitis?anorexia, vomiting, depression, fever, abdominal pain, diarrhea, ascites, liquidothorax, icterus, DIC
what are chronic signs of pancreatitis?recurrent lethargy, vomiting,reduced appetite, slow, diarrhea
what posturing would hint toward pancreatitis?"prayer position"
what are the clinical signs of pancreatitis in cats?Cats non-specific: anorexia, weight loss
instead of "pancreatitis" cats get___ (explain what it is)--TRIADITIS. get Pancreatitis+ Cholangiohepatitis+ IBD (some also concurrently get Hepatic Lipidosis, Diabetes mellitus, Thromboembolism)
why do cats get triaditis and dogs get pancreatitis?bc in cats their bile duct and pancreatic duct all go to the same papillae
what are the major signs of pancreatitis on blood chem? (and others)Elevated liver enzymes & Hyperbilirubinemia (bc might be bile duct obstruction), azotemia (first pre-renal and then renal), Lipase & specific Lipase elevated!!!! (might also see Hyper or Hypoglycemia, Hypocalcemia, Hypercholesterolemia/ Hypertriglyceridemia/Hyperlipidemia)
what might CBC look like with pancreatitis?Neutrophilia/left shift (inflammation), Hemoconcentration (dehydration-- vomiting/dairrhea), ( Anemia, Thrombocytopenia)
what might UA look like with pancreatitis? Bilirubinuria (blocked bile duct!), Hemoglobinuria (uhhh toxins in blood leading to lysis maybe?, maybe inflammation), Concentrated USG
why all these clotting issues with pancreatitis?there are inflammatory factors everywhere and also the liver is pissed off and liver makes coag proteins
Dx pancreatitis on Classic changes (dog)....which are? Clinical Signs, hx, blood work, D-dimer (to check for DIC), coag panel, thrombocyte count, Lipase levels inc
2 places you can take cytology from to try to dx pancreatitis?FNA, DPL
what is the dx test of choice for pancreatitis?PLI!!!!
Dx of pancreatitis---- Pancreatic Lipase immunoreactivity: PLI: who is this test better in? Species specific: 82% sensitive dogs, 100% sens and spec in cats. There is a Snap test available (test for pancrease-specific lipase in the serum-- Inflammation of the pancreas leads to an increased release of pancreatic lipase into the circulation, thus elevated concentrations of pancreatic lipase are consistent with a diagnosis of pancreatitis)
what is up with the TLI dx test for pancreatitis?Trypsin-like immunoreactivity-- May elevate prior to amylase and lipase (good to get a running start).... Trypsin is a pancreatic proteolytic enzyme; if it leaks from pancreatic cells it causes severe necrotizing pancreatitis. Immunoreactive trypsin (probably a trypsin precursor) is present in serum/plasma and will react with anti-trypsin antibodies but has no proteolytic activity. Decreased TLI indicates exocrine pancreatic insufficiency. Increased TLI may be seen with acute pancreatitis.
what will pancreatitis look like on imaging? Loss of cranial abdominal detail, Dilated ´stiff´ duodenum (pipe)
what will pancreatitis look like on ultrasound?Hyperechoic peripancreatic fat, Cranial abdominal mass, Free abdominal fluid
Treatment Acute Pancreatitis Infusion therapy (colloids & cristalloids), Iv antibiotics metronidazole (+ Enrofloxacin sc ?), Pain meds (opiates), Fenbendazole (if oral treatment possible), (Fresh frozen plasma ?), (Partial parenteral nutrition ? Microenteral nutrition?), Low fat / high fibre diet, Control examinations incl CBC/Chem/US
Exocrine pancreas-- what is the structure producing substances for exocrine activity, and what are some of the things it produces?has ACINI which produce things like... inactive enzymes, intrinsic factor (cats), bicarb, albumin, immunoglobulines, lacotferrin
so the exodrine panc does Digestive enzyme production... how does it not eat itself? (explain defense mechanisms)DEFENSE: Physical separation of the various enzymes (2) Distance between the site of enterokinase (enzyme that breaks down zymogens) release and zymogens (inactive enzymes). (3) Presence of enzyme inhibitors in pancreas + in circulation....... So, all these protective measures allow the normal thing to happen, which is the pancreas forms inactive pro-enzymes (zymogens) which are transported to the SI which are then cleaved into active enzymes via enterokinases
exocrine panc makes intrinsic who? for what?Cats, For Vitamin B12 re-uptake
exocrine panc does Bicarbonate production....what does this do (what does it facilitate/ inhibit?)Neutralizes gastric acid!!!! (1) FACILITATES: Nutrient absorption, Mucosal cell turnover, enzyme activation. (2) INHIBITS: Autodigestion via enzyme inhibitors, Bacterial proliferation
**how does duct anatomy vary between dogs and cats?????DOGS: 2 ducts: panc and bile duct. CATS: panc duct and bile duct combined (hence they get "triaditis" not just pancreatitis)
triaditis involves what 3 structures?panc, liver and intestines
what has a major impact on the outcome of panc probs?PERFUSION
what is mm, CRT, heart, and pulse like with shock?mm pale (brick red in sepsis), CRT short (<1 sec) or prolonged (>2 sec), HR tachycardia, pulse can be bounding (hyperdynamic) or weak (hypodynamic)
shock infusion for dog? cat?Shock infusion dog: 90 ml/kg/h, Shock infusion cat: 45 ml/kg/h
Signs of shock + hypothermia + painful abdomen= what condition?ACUTE ABD
lists of Sx vs internal medical management conditions (pic)
Acute abdomen-- what would be extraabd problems which might present as acute abd?backpain? discospondylitis? neurologic? Intervertebral disc protrusion? (thoracic) pleuritis, pneumonia?
where and how might you perform abdominocentesis?where is marked on pic. Do it ON THEIR SIDE and then NO SYRINGE just let it drip out (needle might suck omentum up against it and you wont get a good sample)
if you do a DPL, what might you wanna look for/ tests you would want to run on your sample?Cytology, Bacteriology, (PCV/TP, Creatinine/Urea, Bilirubin, Lipase) (things in paraenthsis you can compare to blood but keep in mind you just diluted it with the lavage you did)
what does cytology of bile peritonitis look like?
possible txs for Necrotizing pancreatitis?infusion therapy (colloids & cristalloids), surgery, open abdomen (drainage), fresh frozen plasma, partial parenteral nutrition, pain meds, Antibiotics (enroflox/amoxclav until bacterial overgrowth back)…


Question Answer
what does classic EPI poop look/act like?large fecal volumes, normal frequency, no mucous, no blood-- another slide said large volumes of light colored feces
large fecal volumes-- is this large or small bowel?small bowel tends to have larger quantities
does weight loss indicate large or small bowel localization?small
Malabsorption non-PLE vs PLE ddxsNON-PLE: parasites, diet, ARD. PLE: IBD, lymphoma, Lyphangiectasia, Fungal infection
does lymphoma cause a PLE?YES
what is the giveaway test that says you have exocrine pancreatic insufficiency?LOW TLI (panc isnt making enough trypsin-like molecules so low serum levels)
along with a low TLI, what other test might be low?low cobalamine
what are the CSs of EPI?large fecal volumes, not always diarrhea, polyphagia, weight loss. Some also get: lethargy, anorexia, vomiting
what breed is prone to EPI? (primary)german shepherd
2 causes of PRIMARY EPI?(1) juvenile atrophy (german shepherd) (2) chron. recurrent pancreatitis
what causes SECONDARY EPI? (4)duct obstruction, fast breakdown of enzymes (Bacterial overgrowth) abnormal mucosa, abnormal intestinal pH
what will the fecal contents be like in EPI poopfat +++, fatty acids – (cant digest fat so wont have fatty acids), starch +++ (can't break it down so stays as starch), muscle fibre ++, pH low, amylase, trypsin low
explain normal versus abnormal TLI measurementsNORMALLY panc is perfused--Inactive trypsine leaks into blood, you measure it. in EPI there is atrophy of panc--less perfusion, less leakage-- low levels of Inactive trypsine in blood (low TLI result)
EPI TX: if you wanna give them pancreatic enzymes in their diet, what other drug might you wanna give them too and why?H2 blocker--- so less acid in stomach to inactivate/digest the enzymes youre supplimenting
why might you wanna give cobalamine injections with EPI?panc makes IF to bind cobalamin so it can be taken up
if you have EPI why might you wanna give metronidazole?bc of lack of bicarb to inhibit bacterial overgrowth, there might be SIBO...give to tx that
why give a EPI cat a hypoallergenic diet?usually with concurrent IBD
how much fat do you want in an EPI dogs diet?normal amount, unless concurrent pancreatitis, then low
how much fiber do you want in an EPI animals diet?LOW fiber, because fibre inactivates digestive enzymes, soluble fibre absorbs digestive enzymes
prog of EPI?good...but enzymes are expensive