Exocrine pancreas

Question 1

Which is more likely to measure normal despite EPI: cPL vs PSL

Answer 1

PSL – suggests a lack of specificity

JVIM 2021, Cridge

Question 2

Which causes an increase in serum pancreatic lipase and correlates with severity of the disease:
–Renal disease
–Heart disease

Answer 2

–Heart disease (MVD, CHF) – probably due to injury or edema (not inflamm)

–Renal disease probably impacts pancreatic lipase to some degree, but relationship appears complex, inconsistent, does not correlate with creat

JVIM 2021, Cridge

Question 3

Which tends to lag behind in pancreatitis – pancreatic lipase or AUS changes?

Answer 3

AUS changes lag – may explain discrepancy with PSL

JVIM 2021, Cridge

Question 4

You are evaluating a clinically well 7yr MN lab with chronically elevated ALT. AUS shows microhepatica, hypoechoic pancreas, and scant FF. What could explain all of these changes?

Answer 4

Cirrhosis –> portal hypertension –> FF, pancreatic edema
Pancreatitis is unlikely

JVIM 2021, Cridge

Question 5

Which performs better for pancreatitis monitoring – cPLi or CRP?

Answer 5

cPLi – follows clinical progress better. Can take longer for CRP to improve.

JVIM 2021, Keany

Question 6

Regarding Eurytrema procyonis:
–Type of organism?
–Definitive and intermediate hosts?
–Where does it live in the body?
–What might kill it?

Answer 6

–Fluke
–Definitive host = raccoons/foxes, intermediate = snails +/- arthropod; cats can be an incidental host
–Lives in pancreatic duct, bile duct, GB –> can result in EPI
–Praziquantel

JVIM 2021, Auger

Question 7

What fluke lives in the pancreatic/bile ducts, can result in EPI, and usually has foxes/raccoons as the definitive host (cats are incidental)?

Answer 7

Eutrema procyonis

JVIM 2021, Auger

Question 8

What is the most common sign of EPI in cats? What is the second most common, and how does this compare with dogs?

Answer 8

–Weight loss >90%
–Diarrhea 62% (vs dogs - 95%)

JVIM 2021, Auger

Question 9

Is EPI more common in male or female cats?

Answer 9

Male

JVIM 2021, Auger

Question 10

What is the most common concurrent disease in cats with EPI?

Answer 10

Chronic enteropathy 59%

JVIM 2021, Auger

Question 11

What is the frequency of hypocobalaminemia in EPI cats?

Answer 11

60-70%

JVIM 2021, Auger

Question 12

What are at least 3 AUS findings in feline EPI, and overall how helpful is it for diagnosis?

Answer 12

–Thin pancreatic parenchyma
–Wider pancreatic duct (but also seen with age)
–SI thickening 81%
–Ileus 36% – probably dilated with undigested food

Overall not a helpful screening tool for EPI

JVIM 2021, Auger

Question 13

Incidental enlargement/tortuosity in cats usually affects which duct – the cystic duct or common bile duct? Where is each located?

Answer 13

Cystic duct

CD immediately follows GB
CBD attaches CD to duodenum

JVIM 2021, Fujimoto

Question 14

Which is more freely filtered by the kidneys, why, and how does azotemia affect measured levels?
TLI vs PLI

Answer 14

TLI more freely filtered because small and positively charged –> accumulates with azotemia (false elevation)

PLI is larger and negatively charged –> relatively low GFR in normalcy, less affected by azotemia.

JVIM 2021, Xenoulis

Question 15

Which are the three most specific AUS findings for pancreatitis? Which two did not correlate with pancreatitis?
–Pancreatic enlargement
–Pancreatic echotexture
–Hypoechoic pancreas
–Hyperechoic mesentery
–Peripancreatic FF

Answer 15

Most specific:
–Pancreatic enlargement
–Hypoechoic pancreas
–Hyperechoic mesentery

No correlation:
–Pancreatic echotexture
–Peripancreatic FF

JVIM 2020, Cridge

Question 16

True or False:
AUS can be used to determine severity of pancreatitis and monitor clinical progression.

Answer 16

False – no correlation with APPLE, CAPS; weak correlation with cPL

JVIM 2020, Cridge

Question 17

True or False:
Pred can cause an increase in DGGR lipase within the range expected for pancreatitis.

Answer 17

False. Pred can cause a modest increase but still <150.

JVIM 2020, Mendoza

Question 18

A study looked at protease inhibitors in dogs with acute pancreatitis (checked twice in the first 48hrs of hospitalization).
–Which one(s) was/were associated with nonsurvival?
–The study supported that _____ is a primary protease inhibitor, and ______ is secondary (because it declined later in the disease process).

α1-proteinase inhibitor (α1PI)
antithrombin
α2-antiplasmin (α2AP)

Answer 18

Antithrombin – lower in nonsurvivors suspect due to consumption as a protease inhibitor > clot inhibitor. It decreased first (so probably a primary protease inhibitor) and α1PI decreased later (so probably a secondary protease inhibitor).

JVIM 2020, Kuzi

Question 19

A study looked at inflammatory cytokines in dogs with acute pancreatitis (checked twice in the first 48hrs of hospitalization).

Which one(s) was/were associated with cPLI, CRP, and clinical score (CAPS)?

IL-2, IL-6, IL-8, TNF-α

Answer 19

IL-6 only

JVIM 2020, Kuzi

Question 20

What is the effect of pancreatitis on levels of lipids (Chol, TG) and lipoprotein profile? How could this impact a hyperlipidemia workup?

Answer 20

–Mild, occasional increase in TG +/- Chol – not clinically relevant
–Lipoprotein profile: higher LDL, lower HDL (can see a similar pattern with many inflamm conditions)
–Significant hyperlipidemia may be a cause, but not effect of pancreatitis. Need to find another reason for the hyperlipidemia.

JVIM 2020, Xenoulis

Question 21

True or False:
If a cat has a normal fPL, pancreatitis is highly unlikely.

Answer 21

False. fPL and AUS both have low sensitivity, so neither on their own can rule it out. Best to do both.

JVIM 2020, Lee

Question 22

Regarding dogs with pancreatitis and secondary EHBO:
–When does Tbili peak and start declining? How does this compare with clinical improvement?
–True or False: Some dogs can be icteric >1mo.
–How often is GB decompression (percutaneous or sx) needed to achieve a good outcome? (usually, sometimes, seldom)

Answer 22

–Peak 9 days post onset of CS (usually already feeling better by then), starts declining 15 days
–True, occasionally
–Seldom

JVIM 2020, Wilkinson

Question 23

Asymmetric dimethylarginine (ADMA) is a potential marker of oxidative stress. How does it perform in assessment of disease severity and mortality in dogs with acute pancreatitis?

Answer 23

Higher ADMA correlated with higher CAPS and mortality, BUT significant overlap with healthy dogs AND ADMA can be elevated from a number of other conditions.

JVIM 2020, Gori

Question 24

True or False:
Elevated cPL cannot differentiate pancreatitis vs neoplasia.

Answer 24

True – need bx

JVIM 2020, Aupperle-Lellbach

Question 25

True or False regarding ICU hospitalized dogs:
–Dogs commonly had elevated DGGR lipase in a range that could be consistent with pancreatitis, but no other support for panc.
–Progressive DGGR lipase was associated with longer hospital stay.

Answer 25

True, true

JVIM 2020, Prummer

Question 26

True or False: Some studies find that severe findings of pancreatitis on AUS correlated with incr risk of death. Others find no correlation, or only weak to moderate correlation with clinical diagnosis, cPL, and clinical progression.

Answer 26

True

JAVMA 2021 Gori
JVIM 2019 Cridge

Question 27

What DGGR lipase cutoff agrees with cPL cutoff >200?

Answer 27

DGGR >42

JSAP 2021 Hope

Question 28

What criteria to CAPS and sCAPS consider? (Three labwork, two PE)

What does a high CAPS or scAPS score indicate?

Answer 28

Creat, iCa, coagulopathy (plt, PT/PTT)
SIRS (CAPS) or RR (sCAPS)

High score –> incr risk of death within 30d

JVIM 2019 Fabres

Question 29

True or False: Risk of portal vein thrombosis is not associated with severity of pancreatitis.

Answer 29

False

JVIM 2018 French

Question 30

In a small study of EPI dogs, what effect did enteric coated vs uncoated pancreatic enzymes have on fat digestion?

Answer 30

None – but may have type II error

JVIM 2018 Parambeth