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Year 1/2 > Digestion & Metabolism 2: SA Exocrine & Pancreatic Dz > Flashcards

Digestion & Metabolism 2: SA Exocrine & Pancreatic Dz Flashcards

1
Q

BILE DUCTS in the PANCREAS IN….

dogs?

cats?

A

in DOGS, have PANCREATIC and ACCESSORY DUCT
–> ACCESSORY size > PANCREATIC

in CATS, RARELY have ACCESSORY DUCT, usually just PANCREATIC

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2
Q

the LEFT lobe of the pancreas sits at the…..

the RIGHT lobe of the pancreas sits…

A

LEFT lobe = sits on GREATER CURVATURE OF THE STOMACH

RIGHT lobe = next to DUODENUM

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3
Q

the ACCESSORY pancreatic duct opens on the ____ duodenal papilla

the PANCREATIC duct opens on the ___ duodenal papilla

the COMMON bile duct opens on the ____ duodenal papilla

A

ACCESSORY = MINOR

PANCREATIC = MAJOR

COMMON = MAJOR

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4
Q

what 2 cells in the PANCREAS are responsible for SECRETION? what do they secrete? (2 things for second one)

A

2 cells for SECRETION?
1. ACINAR cells = store DIGESTIVE ENZYMES as ZYMOGENS (inactive)

  1. DUCTULAR EPITHELIAL CELLS along PANCREATIC DUCTS…
    –> make BICARBONATE to CARRY DIGESTIVE ENZYMES to DUODENUM
    –> make INTRINSIC FACTOR to fight pathogens
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5
Q

what is a LIKELY cause of PANCREATITIS? (pathophys)

A

PREMATURE activation of DIGESTIVE ENZYMES that sit as ZYMOGENS in ACINAR CELLS

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6
Q

how does the pancreas defend against AUTODIGESTION? (three)

A
  1. zymogens can ONLY be activated in the DUODENUM by ENTEROKINASE (brush border enzyme)
  2. PANCREATIC SECRETORY TRYPSIN INHIBITOR is a LOCAL factor that can TURN OFF PREMATURELY ACTIVATED TRYPSINS
  3. CIRCULATING PROTEASE INHIBITORS for REGULATION of RELEASE of the enzymes
    –> ALPHA-1 PROTEASE INHIBITOR
    –> ALPHA-MACROGLOBULINS
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7
Q

other name for enterokinase?

what is the FUNCTION of enterokinase?

A

ENTEROPEPTIDASE

FUNCTION?
1. CONVERT TRYPSINOGEN –> TRYPSIN
2. TRYPSIN can then ACTIVATE MORE TRYPSINOGEN and MORE ZYMOGENS CAN BE ACTIVATED

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8
Q

PANCREATIC SECRETORY TRYPSIN INHIBITOR binds to trypsin REVERSIBLY/IRREVERSIBLY

ALPHA-1 PROTEASE INHIBITOR binds to trypsin REVERSIBLY/IRREVERSIBLY

ALPHA MACROGLOBULINS bind to trypsin & ____ REVERSIBLY/IRREVERSIBLY

A

PANCREATIC SECRETORY TRYPSIN INHIBITOR = binds REVERSIBLY

ALPHA-1 PROTEASE INHIBITOR = binds REVERSIBLY

ALPHA MACROGLOBULINS bind to trypsin & OTHER PANCREATIC PROTEASES IRREVERSIBLY

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9
Q

is ACUTE or CHRONIC pancreatitis IRREVERSIBLY CHANGED?

CHRONIC pancreatitis is more common in ___ > ____

A

CHRONIC = IRREVERSIBLE

CHRONIC pancreatitis MORE COMMON IN CATS > DOGS

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10
Q

pathogenesis of PANCREATITIS…

what 2 things occur in NORMAL animals?

what four things occur in PANCREATITIS animals?

A

NORMAL animals?
1. in a NORMAL animal, animals have INACTIVE TRYPSINOGEN sitting in ZYMOGEN GRANULES

  1. LYSOSOMAL ENZYMES are normally SEPARATED from ZYMOGENS & within THEIR OWN GRANULES –> fuse with DUCT EPITHELIAL CELLS & release CONTENTS into duct

PANCREATITIS
1. NOXIOUS STIMULUS causes APICAL BLOCK so that VACUOLES & DUCT EPITHELIUM CANNOT bind to release ZYMOGENS or LYSOSOMAL ENZYMES

  1. this causes a BUILD-UP of GRANULES
  2. this then causes FUSION & PREMATURE activation of ZYMOGENS by LYSOSOMAL ENZYMES
  3. when PSTI tries to INHIBIT TRYPSIN, INFLAMMATORY CASCADE
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11
Q

what 4 adjacent structures can be affected by PANCREATITIS?

what 2 SYSTEMIC effects can occur?

A

4 structures?
1. LIVER
2. STOMACH
3. DUODENUM
4. COLON

2 systemic effects?
1. SIRS
2. MULTIORGAN DYSFUNCTION

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12
Q

what is a COMMON CAUSE of PANCREATITIS in DOGS?

what are 2 ways we can get this?

A

= HIGH CIRCULATING FATS (hyperlipidemia)

can get this from…
1. OVERWEIGHT ANIMALS
2. AFTER EATING a BIG FATTY MEAL

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13
Q

2 common etiologies of PANCREATITIS in CATS?

pancreatitis tends to be ____ in cats & ___ to diagnose

A
  1. IDIOPATHIC
  2. TRIADITIS

tends to be CHRONIC in cats & HARDER to diagnose

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14
Q

TRADITIS…

includes WHAT 3 inflammations?

more common in __ > ___

A

3 inflammations?
1. CHOLANGITIS
2. PANCREATITIS
3. INFLAMMATORY BOWEL DZ

CATS > DOGS

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15
Q

CANINE PANCREATITIS…

common clinical signs? (4, one is +/-)

SEVERE clinical signs? (5, one is a disease)

A

common clinical signs?
1. V+
2. ANOREXIA
3. CRANIAL ABDOMINAL PAIN
4. +/- LARGE BOWEL D+

SEVERE clinical signs?
1. PULMONARY EDEMA
2. PLEURAL EFFUSION
3. HYPOTENSION
4. ICTERUS
5. MULTIORGAN FAILURE

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16
Q

DIAGNOSIS for PANCREATITIS in small animals….

single definitive test?

often have NON-SPECIFIC findings in these 3 diagnostics…

PLI vs. TLI

A

THERE IS NO SINGLE DEFINITIVE TEST

NON-SPECIFIC findings in…
1. CBC
2. CHEM
3. UA

PLI > PANCREATITIS than TLI

17
Q

PLI definition & best test for…

___ SENSITIVITY & ____ SENSITIVITY

A

PANCREATIC LIPASE IMMUNOREACTIVITY & best test for PANCREATITIS

HIGH SENSITIVITY & HIGH SPECIFICITY

18
Q

cPLI vs. Snap cPL & PARAMETERS

A

cPLI = QUANTITATIVE PLI
<200 ug/L = NORMAL
200-400 ug/L = EQUIVOCAL
>400 ug/L = PANCREATITIS

Snap cPL = NORMAL OR ABNORMAL BINARY TEST
NORMAL reading = <200 ug/L
ABNORMAL reading = >400 ug/L

19
Q

why do we usually NOT perform pancreatic biopsies?

if we did, this would probably give us the most ____ diagnosis

A

usually DON’T perform pancreatic biopsy because patients tend to be SICK and MANIPULATING PANCREAS THOUGH TO BE BAD

if we did, DEFINITIVE diagnosis likely

20
Q

RADIOGRAPHIC findings of PANCREATITIS…

often…

2 common findings?

A

often DIFFICULT TO SEE

2 findings?
1. GROUND-GLASS appearance/DECREASED DETAIL in RIGHT CRANIAL QUADRANT OF ABDOMEN

  1. WIDENING of GASTRODUODENAL ANGLE
21
Q

CIRCLE vs. ARROW?

what DISEASE is this?

A

CIRCLE = GROUND-GLASS/DECREASED DETAIL appearance of RIGHT CRANIAL QUADRANT of ABDOMEN

ARROW = WIDENED GASTRODUODENAL ANGLE

both from PANCREATITIS

22
Q

= what is the IMAGING MODALITY OF CHOICE for PANCREATITIS?

what do we usually see? (2)

can ALSO see REGIONAL ____

if INFLAMMATION present, we might be able to see… (2)

____ sensitivity

A

= ABDOMINAL ULTRASOUND

usually see…
1. ENLARGED, HYPOECHOIC PANCREAS due to FLUID PRESENT INSIDE
2. HYPERECHOIC MESENTERY

can ALSO see REGIONAL LYMPHADENOPATHY (near pancreas)

if INFLAMMATION…
1. PERITONEAL EFFUSION
2. CORRUGATED DUODENUM

23
Q

TOP circle?

BOTTOM line?

shows WHAT disease?

A

TOP circle = ENLARGED, HYPOECHOIC pancreas from FLUID

BOTTOM line = HYPERECHOIC SURROUNDING MESENTERY

shows PANCREATITIS

24
Q

TREATMENT for pancreatitis? (6)

A
  1. REMOVE any INCITING CAUSE
  2. NUTRITION CHANGE
  3. AVOID DRUGS that can AGGRAVATE pancreatitis
  4. provide adequate PERFUSION
  5. ANALGESIA
  6. ANTI-EMETICS
25
Q

2 nutritional directives for PANCREATITIS?

nutrition PREFERRED to be given via _____ via what 2 methods?

if ILEUS is present, what method should we use to deliver nutrition

A

2 nutritional directives?
1. NO NEED FOR NPO
2. LOW-FAT diet or at least NO HIGH-FAT FOODS

nutrition PREFERRED to be given ENTERALLY via…
1. FEEDING TUBE
2. ORALLY if tolerated

if ILEUS present, use NG tube for NUTRITION

26
Q

what 2 clinical signs could indicate ANTIBIOTIC USE in PANCREATITIS?

A

usually NOT indicated, but could be if…
1. BLOODY D+
2. BLOODY V+

27
Q

FUZAPLADIB (PANOQUEL BRAND)

= what does this aim to do & in what species??

pathophys?

A

= aims to CONTROL CLINICAL SIGNS of PANCREATITIS in dogs

pathophys = BLOCKS NEUTROPHIL MIGRATION to PANCREAS

28
Q

PROGNOSIS of pancreatitis in dogs?

MOST will…

A

GUARDED, WIDE range of severity!

MOST will RECOVER

29
Q

FELINE pancreatitis…

often is these one of 3 descriptors?

often associated with WHAT 2 diseases?

often see ___-___ clinical signs, specifically… (2)

use ____ test and ____ ____ to diagnose, but compared to dogs…

A

often is one of 3….
1. CHRONIC
2. INSIDIOUS
3. and/or RECURRENT

often associated with…
1. CHOLANGITIS
2. IBD

often see NON-SPECIFIC clinical signs, specifically…
1. LETHARGY
2. ANOREXIA

use fPLI test and ABDOMINAL ULTRASOUND to diagnose, but compared to dogs US LESS SENSITIVE FOR FELINE PANCREATITIS

30
Q

after the INDUCTION of pancreatitis, fPLI remains ____ for ____ ____

fPLI quantitative parameters? (3)

PROGNOSIS of FELINE PANCREATITIS?

A

ELEVATED, 10 DAYS

fPLI
≤3.5 ug/L = NORMAL
3.6-5.3 ug/L = EQUIVOCAL
≥5.4 ug/L = PANCREATITIS

PROGNOSIS is VARIABLE/GUARDED

31
Q

what are the TWO differences in treatment for FELINE pancreatitis when compared to dogs?

A
  1. DO NOT WITHOLD FOOD bc DO NOT WANT TO CAUSE HEPATIC LIPIDOSIS
  2. more likely to give ANTIBIOTICS because HIGH POSSIBILITY of CONCURRENT CHOLANGITIS from ASCENDING BACTERIAL INFECTION
32
Q

2 NEGATIVE prognostic indicators for FELINE PANCREATITIS?

A
  1. HYPOCALCEMIA
  2. fPLI >20 ug/L at HOSPITAL ADMISSION
33
Q

EXOCRINE PANCREATIC INSUFFICIENCY…

what is the MOST COMMON cause in DOGS?
1. definition/pathophys
2. likely mediated by…

what is the MOST COMMON cause in CATS?
1. definition/pathophys

TREATMENT is often very…

A

DOGS = PANCREATIC ACINAR CELL ATROPHY
1. = CONGENITAL CONDITION where PANCREATIC ACINAR cells will ATROPHY over time
2. likely IMMUNE-MEDIATED

CATS = CHRONIC PANCREATITIS
1. = RECURRENT pancreatitis causes LOSS OF ACINAR CELL MASS, so if this happens enough they DON’T MAKE ENOUGH DIGESTIVE ENZYMES = EPI

TREATMENT often very EFFECTIVE

34
Q

EXOCRINE PANCREATIC INSUFFICIENCY…

likely in WHAT age dogs?

what BREED of dog is most affected? + give 3 other breeds

likely in WHAT age cats?

A

likely in YOUNG ADULT dogs 1-5 YEARS

most COMMON BREED for EPI = GERMAN SHEPHERD
1. ROUGH-COATED COLLIE
2. CHOW
3. CAVALIER KING CHARLES

like in MIDDLE AGED to OLDER cats

35
Q

EXOCRINE PANCREATIC INSUFFICIENCY…

3 clinical signs in DOGS?

1 clinical sign in CATS? what 2 things do we NOT see?

what is the CHOICE for DIAGNOSIS?

what is COMMONLY seen on CHEM & why?

A

in DOGS…
1. WEIGHT LOSS
2. D+ (not enough enzymes to absorb ingesta) –> VOLUMINOUS & STEATORRHEA
3. POLYPHAGIA (RAVENOUS hunger)

in CATS…
1. WEIGHT LOSS ONLY
2. NO APPETITE CHANGE or D+

do TLI!

can see COBALAMIN DEFICIENCY in dogs/cats from LACK OF INTRINSIC FACTOR

36
Q

TREATMENT for EPI…

1 common worry for OWNERS?

usually give WHAT medication? if that doesn’t work, can try..?

2 traits of DIET we can put EPI pet on?

A

OWNERS = can be EXPENSIVE, especially for large dogs & LIFELONG

usually PANCREATIC ENZYME SUPPLEMENTATION via POWDER, but if that doesn’t work, can try ANTIBIOTICS (dysbiosis)

DIET can be…
1. HIGHLY DIGESTIBLE
2. LOW FAT

Year 1/2 (139 decks)

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