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SMALL ANIMAL > 9.5.2: Pancreatic Disease > Flashcards

9.5.2: Pancreatic Disease Flashcards

1
Q

Zymogens

A

The inactive form of digestive enzymes secreted by pancreatic acinar cells.

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2
Q

What mechanisms exist to prevent pancreatic enzymes digesting the pancreas?

A

Digestive enzymes are secreted as zygmogens which are cleaved by enterokinase to activate them.
Enzyme inhibitors prevent enzymes digesting pancreatic tissue.

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3
Q

Acute pancreatitis

A

Sudden onset inflammation of the pancreas.
Little to no permanent changes after recovery.

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4
Q

Chronic pancreatitis

A

Continuous inflammatory disease resulting in irreversible morphological changes e.g. fibrosis and atrophy
Can lead to permanent impairment of function e.g. EPI, Diabetes

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5
Q

Risk factors for pancreatitis

A
  • Hereditary: certain breeds
  • Hyperlipidaemia
  • High fat meal (not in cats)
  • Obesity (not in cats)
  • In cats only: GI disease/ vomiting leading to bile reflex. Also triaditis (pancreatitis + IBD + cholangitis)
  • Pancreatic ischaemia and hypoxia (e.g. shock, hypotension, occlusion of venous outflow during abdo surgery)
  • Pancreatic trauma - RARE - surgical manipulation or biopsy
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6
Q

Which breeds are predisposed to pancreatitis?

A

Dogs:

  • Miniature schnauzers - can also get idiopathic hypertriglyceridaemia which predisposes them to pancreatitis as well
  • Yorkies
  • Boxers
  • Cocker Spaniels
  • Poodles
  • Dachshunds

Cats:
* Siamese
* Bengals

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7
Q

What common pathway occurs with pancreatitis, regardless of the cause?

A

Decreased secretion of pancreatic juices -> premature activation of digestive enzymes -> damages the exocrine pancreas so there is oedema, haemorrhage and necrosis of surrounding fat -> inflammation leads to recruitment of WBCs and cytokines

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8
Q

What complications can occur due to recruitment of WBCs and cytokines when pancreas becomes inflamed?

A
  • Renal failure
  • Multi-organ failure
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9
Q

Clinical signs of acute pancreatitis

A
  • Lethargy / weakness
  • Anorexia
  • Vomiting
  • Diarrhoea
  • (if severe) shock and collapse

Clinical signs of pancreatitis are often non-specific and O may not realise subtle changes in behaviour are important.

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10
Q

Clinical exam findings with pancreatic disease

A
  • Abdominal pain
  • Cranial abdominal mass
  • Mild ascites
  • Dehydration
  • Fever
  • Jaundice - uncommon - occurs if there is obstruction of the bile duct due to inflammation or mass
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11
Q

Lab abnormalities with pancreatitis
1

A
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12
Q

Lab abnormalities with pancreatitis
2

A
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13
Q

Lab abnormalities with pancreatitis
3

A
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14
Q

Why might you (uncommonly) see jaundice in the patient with pancreatitis?

A

Jaundice occurs if there is obstruction of the bile duct due to inflammation or mass

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15
Q

Why would ALP be elevated in the patient with pancreatitis?

A
  • Increased liver enzymes (e.g. ALP) are due hepatocellular injury from toxins draining from the pancreas
  • Not much in cats - ALP has very short half life and may be gone by the time you test
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16
Q

Why is important to treat hypokalaemia in cats especially?

A

Hypokalaemia can cause anorexia and ileus in cats

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17
Q

Which is more sensitive vs more specific out of Spec PL and Snap PL?

A
  • Snap PL is more sensitive; however, can give false positives
  • Spec PL is more specific; however, can give false negatives
18
Q

You have a dog with suspected pancreatitis. You run a Snap cPL. What will you do if the result is:
a) negative
b) positive

A

a) negative - you can be pretty confident the dog doesn’t have pancreatitis

b) positive - send the sample away for Spec cPL to confirm diagnosis

19
Q

Wht is the difference between cPLI and fPLI?

A

c = canine
f= feline

20
Q

True/false: you can test amylase and lipase to confirm a diagnosis of pancreatitis.

A

False - don’t do this.
* Amylase and lipase are non specific
* They are influenced by hepatic, renal, intestinal disease, and neoplasia
* Don’t use to confirm pancreatitis

21
Q

How is testing TLI (cTLI or fTLI) useful in diagnosing pancreatitis?

A

TLI = trypsin-like immunoreactivity
* Less sensitive and specific compared to PLI
* Increase rapidly in early stages of pancreatitis but decline quickly
* Limited diagnostic utility

22
Q

Which of the following imaging modalities would you use to confirm diagnosis of pancreatitis?
a) radiography
b) ultrasonography

A

b) ultrasonography
(But need an experienced vet!)
* In pancreatitis, see enlargemtn of the pancreas, localised peritoneal effusion
* May see decreased echogenicity indicating pancreatic necrosis
* Hyperechogenicity may indicate pancreatic fibrosis (see with chronic pancreatitis) but also seen in benign pancreatic hyperplasia
* Can also look for pancreatic duct dilation

23
Q

What might you see on abdominal radiographs when a patient has pancreatitis?

A
  • Evidence of pancreatitis rarely seen; may see decreased detail / ground glass appearance of cranial abdomen
  • Useful in ruling out other differentials, assessing displacement of abdo organs etc.
24
Q

Treatment plan for pancreatitis

A
  • Correct underlying fluid and electrolyte abnormalities
  • Treat underlying cause
  • Analgesia: in cats buprenorphine often works, in dogs start with methadone. May be very painful
  • Anti-emetics: maropitant, ondansetron, metoclopramide CRI. Most animals feel nauseous even if not vomiting.
  • Antibiotics if infectious cause identified: TMPS, metronidazole, clindamycin, enrofloxacin
  • Steroids are generally to be avoided except in cats with chronic pancreatitis
25
Q

When should you feed the patient with pancreatitis and what should you feed them?

A
  • Start feeding once vomiting has been controlled (old advice was to withhold food - not anymore)
  • Feed high carb, low fat commercial diet: roce, potato, pasta
  • Fat and protein stimulate pancreatic secretions so avoid these
  • Consider enteral feeding for anorexic cats e.g. NO tube, O tube
26
Q

Clinical signs and treatment of pancreatic pseudocyst

A
27
Q

Clinical signs and treatment of a pancreatic abscess

A
28
Q

Long term treatment and control of pancreatitis

A
  • Avoid high fat meals
  • Fat restricted diet if recurrent bouts of pancreatitis
  • Oral pancreatic enzyme supplements
  • In cats with recurrent episodes: trial prednisolone 1mg/kg q12-24hrs for 1 week, tapering to 0.5mg/kg EOD as needed
29
Q

Prognostic factors for pancreatitis

A
  • Unpredictable and varies in severity
  • Difficult to give accurate prognosis
  • Most cases given supportive care respond spontaneously and do well long-term
  • Acute pancreatitis can be life threatening
  • Poor prognosis if continues to refuse food / can’t tolerate food
  • In cats: hypocalcaemia with acute necrotising pancreatitis has a poor prognosis
30
Q

Characteristics of pancreatic adenomas
1

A
31
Q

Characteristics of pancreatic adenocarcinomas
2

A
32
Q

Clinical signs of pancreatic neoplasia

A
  • Similar to chronic pancreatitis: vomiting, diarrhoea, weight loss
  • May have signs associated with metastatic lesions e.g. lameness, dyspnoea, bone pain
  • Cats: paraneoplastic alopecia (shiny skin disease; alopecia of the ventrum, limbs and face)
33
Q

Lab abnormalities in pancreatic neoplasia

A
  • Lab results may be unremarkable
  • May have neutrophilia, anaemia, hypokalaemia, bilurubinaemia, azotaemia, hyperglycaemia, increased liver enzymes
  • Some dogs have very high serum lipase
  • Hypercalcaemia can occur
34
Q

Radiographic findings in pancreatic neoplasia

A
  • Decreased contrast in the cranial abdomen
  • May see mass
  • Spleen may be caudally displaced
35
Q

Ultrasonographic findings in pancreatic neoplasia

A
  • Soft tissue mass in region of the pancreas
  • If peritoneal effusion present, can sample it for cytology
  • FNA of mass can be attempted (only successful in 25% cases)
36
Q

Diagnosis of pancreatic neoplasia

A
  • Often made at ex-lap or at PM
  • Biopsy and histology required to establish definitive diagnosis
37
Q

Treatment of pancreatic adenomas

A
  • These are benign and often only found if causing clinical signs
  • Of you find mass during ex-lap -> can do a partial pancreatectomy to establish diagnosis (never remove the whole pancreas!!!)
38
Q

Treatment of pancreatic adenocarcinomas

A
  • Often metastatic disease present by time of diagnosis
  • Sites of metastatic disease: liver, abdo, thoracic LNs, mesentery, intestines, lung
  • If no gross metastatic lesions, surgical resection can be attempted, but clean surgical margins are rarely achieved
  • Overall prognosis is grave
39
Q

What is pancreatic nodular hyperplasia and when do you see it?

A
  • Occurs frequently in older cats and dogs
  • Small nodules are found throughout the exocrine pancreas; this does not lead to functional change or clinical signs
  • Usually an incidental finding
40
Q

What disease process is shown here and what gross findings are associated with it?

A

Pancreas from dog with pancreatitis
* Oedematous tissue
* Soft
* Swollen
* Fibrinous adhesions
* Serosanguinous free abdominal fluid
* Pseudocysts
* Haemorrhages (pancreas and omentum)
* Abdominal fat necrosis
* Histology: multifocal infiltration of neutrophils + haemorrhage, necrosis, oedema, and vessel thrombosis

41
Q

Describe the gross appearance of pancreatic neoplasia

A

Adenomas
* Solitary and contained with capsule

Adenocarcinomas
* Similar to adenomas
* May see evidence of metastatic spread to other organs

SMALL ANIMAL (90 decks)

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