Lecture 15/16 Gastrointestinal evaluation (test 2) Flashcards
what are your pancreatic serum tests?
Amylase
Lipase
TLI
PLI
what are your serum GI tests
Serum Folate
Serum Cobalamin
Serum Uncong. Bile Acids
GI “function” assay
what are the two major functions of the pancreas
Exocrine
Endocrine
what is the main function of the pancreas, and what are common disorders of the exocrine pancreas
Aids in digestion
production and secretion of digestive enzymes
regulated by hormonal and neuronal mechanisma
Many enzymses are preformed and stored as inactive zymogens
Exocrine pancreatic disorders
Pancreatitis/injury
EPI
Neoplasia
what are the 4 main enzymes that can help diagnosis pancreatitis
Amylase
lipase
PLI
TLI
what is the function of Amylase
slide 16
what is the function of lipase
slide 16
how is Amylase and Lipase cleared from the body
Excretion through urine
what can cause an ↑ in amylase and lipase?
Pancreatic injury Obstruction of pancreatic ducts Non-Pancreatic renal failure GI Dz Hepatobiliary Dz Some drugs (glucocorticoids and can ↑ lipase)
how much of an increase would you want to see in amylase to suspect pancreatitis?
at least 3-4 times
what other enzyme ifbe increased helps your R/O pancreatitis?
Azotemia
T or F
an Lipase value increased of 8X is diagnostic for pancreatitis
False
it is suggestive, Dogs with pancreatitis can have normal → 10X RI increase of Lipase
other factors should be addressed to confirm
what does PLI stand for and what is it used for?
Pancreatic Lipase Immunoreactvity
there is a specific pancreatic isoform that can be identified in the blood when pancreatic tissue is damaged
Is the PLI test species specific?
YES
what does TLI stand for, and what does it test
Tripsin Like Immunoreactivity
trypsin leaks from damaged pancreatic tissue
there is a small amount released into circulation in the healthy animal but is decreased in EPI
an increase “may” be seen with early acute pancreatitis (very low sensitivity)
Why might Azotemia R/O pancreatitis?
if your GFR is down, you will have an increased in proteins (azotemia), Amylase and lipase are cleared by the kidneys, so an increase of
more lipase ?
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What is the cause and consequences of API
Failure to produce pancreatic enzymes and bicarbonate
Clinical signs
- weight loss
- normal to increased appetite
- Steatorrhea
what is a DfDx, and/or often a sequelea of EPI
SIBO
small intestinal bacterial overgrowth
what is the best test for EPI diagnosis and why
TLI
- best test to detect EPI in dogs and cats
- intestinal Dz will not decrease this value
what other tests might you use for EPI diagnosis or R/O’s.
Fecal elastase
- specific for pancreas
- species specific ELISA
- 20% false (+) rate so better used to exclude than to diagnse EPI
Evaluation of feces for fat or starch
- sudan stain is used to detect lipid
- 2% lugol’s iodine is used to detect starch
Fecal proteolytic activity
- if present, this R/O EPI
- Common to have False (-)
what two things should you consider when faced with chronic diarrhea and weight loss?
Consider
- Maldigestion
- Failure to adequately digest food: EPI is a DfDx
- Malabsorption
- Failure to absorb digested food particulate
- Numerous reasons
- Failure to absorb digested food particulate
the treatment and prognosis will vary depending on the primary cause
you NEED to determine the underlying process!!!
what are the laboratory serum evaluations of GI Dz.
Serum Tests – Folate – Cobalamin – Unconjugated bile acids – Gastrin – GI “functon” assays
what are some laboratory Fecal evaluations for GI Dz
Fecal Tests
– Fecal floata.on, direct smear, wet mount
– Alpha-‐1 anti‐protease inhibitor
- Fecal occult blood
- ELISA or PCR for pathogens
- Cytology
- Evaluation of feces for undigested materials (fat, starch)
