Exocrine Pancreas

Question 1

the etiology of acute pancreatitis in dogs is most often

Answer 1

idiopathic

Question 2

list some risk factors for acute pancreatitis in dogas

Answer 2

breed, females, high TG, obesity, trauma or surgery, neoplasia, toxins or drugs, middle or older aged dogs

Question 3

what is thought to be the cause of acute pancreatitis in cats and what are some risk factors for disease?

Answer 3

we dont know what causes it

no association with breed, gender, diet, obesity, or drugs

being middle aged to older, bacterial infection more common but can be secondary, IBD, cholangitis, hepatic lipidosis secondary

Question 4

briefly explain the pathophys of acute pancreatitis

Answer 4

pancreatic enzymes like trypsinogen inside the acinar cells become activated INSIDE the pancreas. Net result is intracellular digestive enzyme activation

Question 5

the clinical signs of acute pancreatitis in dogs are highly variable and depend on the ___

Answer 5

degree of inflammation and whether it is local, systemic, or both

Question 6

list some common C/S of acute pancreatitis in dogs and cats

Answer 6

dogs: lethargy, anorexia, vomiting, nausea, painful abdomen, diarrhea, fever, tachycardia, icterus

cats: lethargy, anorexia, weight loss, vomiting, icterus

Question 7

A dog named Duchess Snugglepaws McFlooferton comes to see you because they are vomiting, very lethargic, and not interested in eating for the past few days. Besides pancreatitis, what other ddx are you going to have on your list?

Answer 7

Gi foreign body, gastric or duodenal ulcers, gall bladder disease, toxin ingestion, infectious gastroenteritis, neoplasia, metabolic disease

Question 8

you do a CBC/chem on Duchess Snugglepaws McFlooferton who you think could have pancreatitis. What results do you expect?

Answer 8

neutrophilia +/- left shift, hemoconcentration, thrombocytopenia (can cause DIC so make sure you investigate this!!)

increased liver enzymes, hyper or hypo albuminemia, azotemia, hypocholesterolemia, hypocalcemia

Question 9

true or false: serum lipase and amylase can be used to reliably diagnose pancreatitis in dogs.

Answer 9

false! they are not sensitive enough! lipase is normal in 60% of cases and amylase is normal in 50% of cases! they are also not specific enough! both can increase with hepatic or GI disease OR increased due to decreased renal clearance

Question 10

what does the pancreatitis snap test actually test for

Answer 10

pancreatic lipase, using specific antibodies

can also do a spec test

Question 11

the SNAP cPL test is the MOST useful for…

Answer 11

ruling OUT pancreatitis. if its negative, they are unlikely to have it

Question 12

the Spec cPL test is the MOST useful for…

Answer 12

ruling IN pancreatitis, false positives are rare, but the test does work better in more severe cases

Question 13

for the spec cPL test, the diagnostic cut off for pancreatitis is ____, and for thespec fPL test, the number consistent with pancreatitis is ____

Answer 13

400 mcg/L

more than 5.4 ug/L

Question 14

you decide to do abdominal radiographs on Duchess Snugglepaws McFlooferton, who you suspect has pancreatitis. what are some things you suspect to see? if you see nothing on radiographs, then what?

Answer 14

decreased abdominal contrast/abdominal effusion, “signal loop” of duodenum.

if we see nothing this is still helpful because we can rule out other diseases!

Question 15

you decide to do an abdominal ultrasound on Duchess Snugglepaws McFlooferton, who you think has pancreatitis. what do you expect to see?

Answer 15

hypoechoic pancreas

BUT this is HIGHLY dependent on operator skill and experience, can miss it!

Question 16

Duchess Snugglepaws McFlooferton’s owner is a human nurse and is well versed in medical terminology, and she asks you if you could do an aspirate of the pancreas. What do you say to her?

Answer 16

there are some risks, you’re poking an already angry pancreas, and even if it comes back negative/no inflammation, this doesn’t mean there is no pancreatitis present because the inflammation can be localized

Question 17

what is technically the gold standard for diagnosing acute pancreatitis but is almost never done?

Answer 17

a pancreatic biopsy usually via ex lap (incisional)

Question 18

Duchess Snugglepaws McFlooferton’s radiographs and cPL test comes back suggestive for acute pancreatitis. What treatment options will you offer?

Answer 18

first tier: fluids, antiemetics, analgesia, nutrition

second tier: antibiotics, plasma

third tier: surgery

Question 19

why are fluids indicated for pancreatitis?

Answer 19

a perfused pancreas is a happy pancreas! fluids keeps the microcirculation open and helps limit progression of disease. You can also supplement electrolytes like potassium.

Question 20

what antiemetic options are there for Duchess Snugglepaws McFlooferton? (pancreatitis)

Answer 20

maropitant, metoclopramide, ondansetron

Question 21

what is the proper way to provide nutrition for Duchess Snugglepaws McFlooferton? (panreatitis)

Answer 21

early feeding is beneficial (historically it was thought that fasting was the way to go)

ideally voluntary intake, but dont hesitate to place a feeding tube

use a low fat diet like royal canin GN or purina OM

Question 22

what is specific about giving cats with pancreatitis nutrition?

Answer 22

palatability is more important than fat content, and make sure to consider other concurrent disease like IBD, cholangiohepatitis, hepatic lipidosis, when choosing a diet

Question 23

why is plasma indicated for treatment of acute pancreatitis?

Answer 23

it provides alpha 2 macroglobulin, coagulation factors, and albumin

it is controversial and studies have mixed results, but you should consider it minaly in cases of DIC

Question 24

the brand new drug, Fuzapladib, has become recently available and could potentially help treat pancreatitis. how does it work?

Answer 24

it blocks neutrophil activation, adhesion, and migration, and may limit progression of pancreatitis and associated systemic inflammation in dogs

Question 25

chronic pancreatitis in dogs shows concurrent evidence of _____

Answer 25

endocrine and/or exocrine pancreatis function, like diabetes or EPI

Question 26

with chronic pancreatitis in cats, what concurrent diseases can they have because of this?

Answer 26

hepatic lipidosis, cholangitis/cholangiohepatitis, diabetes mellitus, IBD, CKD

Question 27

what is the cause of EPI in dogs and cats?

Answer 27

in dogs, it can be from chronic pancreatitis, or it can be from pancreatic acinar atrophy (like in GSD)

in cats, it is ALWAYS from chronic pancreatitis

Question 28

a dog named Fido Fluffernutter comes to you with chronic diarrhea paired with polyphagia. when you ask what his diarrhea looks like, the owner describes it as yellow and “fluffy”, like a slushie. what is your number 1ddx?

Answer 28

EPI

Question 29

how will you confirm EPI in Fido Fluffernutter?

Answer 29

a TLI test: highly sensitive and specific

if the result is low, you have EPI

Question 30

Fido Fluffernutter’s TLI comes back really low and you diagnose him with EPI. What treatment will you offer?

Answer 30

dried porcine pancreatic extract as a replacement therapy for the digestive enzymes, it’s a powder that you can sprinkle on your food

recommend a high quality diet

consider cobalamin supplementation