Pancreas Clinical Pathology

Question 1

reasons for increased analyte

Answer 1

increased production, absorption, or leakage into blood

decrease elimination or utilization

Question 2

reasons for decreased analyte

Answer 2

increased elimination or utilization

decreased production or absorption

Question 3

EPI mechanism

Answer 3

inadequate pancreatic digestive enzyme secretions cause incomplete digestion of food (maldigestion) leading to malabsorption and clinical signs

Question 4

EPI clinical signs

Answer 4

• low body condition score
• ravenous appetite w/ failure to gain weight
• voluminous foul smelling feces

Question 5

causes of EPI

Answer 5

1. pancreatic acinar atrophy (dogs) - immune mediated destruction of pancreatic cells
2. chronic pancreatitis
3. obstruction of pancreatic duct
4. neoplasia

Question 6

diagnosing EPI

Answer 6

decreased TLI

loss of acinar cells –> decreased trypsinogen released –> less detected in the blood

Question 7

concurrent factors that may increase TLI

Answer 7

1. pancreatitis
2. decreased GFR (dehydration/kidney disease)
3. dexamethasone

Question 8

pancreatitis

Answer 8

inflammation of the pancreas

can be primary (idiopathic) or secondary (infection, toxin, etc)

Question 9

histopathologic diagnosis of pancreatitis

Answer 9

inflammation visible on histology but the animal often lacks clinical signs or lab changes

histology diagnosis can be missed if inflammation is focal

Question 10

clinical diagnosis of pancreatitis

Answer 10

based on clinical signs and lab changes

more clinically relevant

no pathognomonic findings

Question 11

pancreatitis clinical signs in dogs

Answer 11

GI signs
(vomiting, anorexia, diarrhea)

Question 12

pancreatitis clinical signs in cats

Answer 12

lethargy and anorexia

Question 13

pancreatitis CBC

Answer 13

signs of inflammation and dehydration

• leukocytosis with neutrophilia w/ left shift
• hypo or hyperproteinemia (inflamm. vs dehydration)
• inc. or dec. platelets
• relative erythrocytosis

Question 14

pancreatitis chemistry

Answer 14

• prerenal azotemia (from dec. clearance of nitrogenous waste or dehydration)
• electrolyte and acid/base changes
• hypocalcemia
• increased liver enzymes (mixed cholestatic and hepatocellular)
• hyperbilirubinemia
• hyperlipidemia

Question 15

sensitivity

Answer 15

probability that a test will be positive in a diseased animal

high sensitivity = few false negatives

used as a rule out test

Question 16

specificity

Answer 16

probability that a test will be negative in a healthy animal

high specificity = few false positives

used as a rule in test

Question 17

amylase + lipase values

Answer 17

• produced by the pancreas
• increased leakage with pancreatitis
• also produced by other tissues

low sensitivity/specificity

Question 18

DGGR lipase

Answer 18

• enzymatic lipase assay
• DGGR is a substrate that gets broken down by lipase
• other disease processes can cause increase lipase activity

higher sensitivity/lower specificity

Question 19

pancreatic lipase (PL)

Answer 19

specCPL or specFPL
SNAP cPL or fPL

Question 20

specCPL/FPL

Answer 20

quantitative ELISA - gives the number amount of pancreatic lipases present

highest sensitivity and specificity

Question 21

SNAP cPL/fpL

Answer 21

qualitative ELISA - gives normal/elevated/consistent with pancreatitis results

high sensitivity/lower specificity

used as a point of care test to rule out

Question 22

TLI

Answer 22

trypsin like immunoreactivity

injury to pancreas causes leakage of trypsinogen causing increased TLI

more sensitive and specific than amylase and lipase but not best

can be caused by other disease processes

Question 23

effusions with pancreatitis

Answer 23

peritoneal effusion: non septic exudate

pleural effusion: (rare) effusion around lungs; lymphatic blockage or pancreatopleural fistula

Question 24

steps to diagnosing pancreatitis

Answer 24

1. clinical signs
2. CBC
3. chemistry
4. specPL
5. imaging
6. effusions