Pancreatitis - Ex 4 Flashcards

1
Q

What two enzymes do we look for when detecting pancreatic injury?

A

Serum Amylase and Lipase most commonly assayed

  • secreted into GI tract to break down carbs/fats
  • Very small amounts present in blood normally
  • amylase and lipase are NOT specific for pancreatic injury!!
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2
Q

Amylase >3-4x upper end of normal =

A

Suggests pancreatitis

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3
Q

Lipase >3-4x upper end of normal =

A

Very suggestive of pancreatic injury

**Exception = steroids in dogs!!

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4
Q

Corticosteroids and Lipase

A

Appears to be unique to dogs, mechanism unknown

Amylase does not go up

*Dog on steroids –> increased lipase, normal amylase

  • *Dexmethasone: up to 5x normal limit
  • *Prednisone: generally less of an increase
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5
Q

The Kidney & Amylase and Lipase

A

Kidneys normally excrete amylase & lipase –> any decrease in GFR (renal, pre-renal, or post-renal) can result in increased Amylase & Lipase

*Approx. 50-60% of dogs with renal failure have increased Amylase and/or Lipase

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6
Q

Peritoneal Levels of Enzymes > Serum levels

A

Highly suggestive of pancreatitis

Can be seen with intestinal perforation/trauma

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7
Q

Pancreatitis in Cats

A

Amylase normal or even decreased

Lipase normal

*Can be difficult to diagnose; abdominal levels of amylase/lipase may help

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8
Q

Pancreatitis in Horses

A

Amylase only slightly increased and lipase levels not explored (hard to diagnose)

  • Relatively common intestinal disease can result in increase amylase (proximal enteritis or colic)
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9
Q

Pancreatitis in NWC

A

Abdominal levels > serum levels of Amylase and Lipase may help

Vague clinical signs (difficult to dx)

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10
Q

Panel abnormalities seen with Pancreatitis (3)

A
  1. Hyperglycemia - combo of stress, excitement, glucagon
  2. Hypocalcemia - not always seen; deposition of Ca in saponified abdominal fat
  3. Increased liver enzymes - cholestastis: bile duct obstruction, inflammation; hepatocyte necrosis: ischemia, toxic damage, ascending inflammation

Inflammatory leukogram

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11
Q

Serum Calcium in Pancreatitis

A

Hypocalcemia can be seen with pancreatitis

Lipase leaks –> saponification & Ca2+ deposition = hypocalcemia

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12
Q

Trypsin-like Immunoreactivity (TLI)

A

Measure both trypsinogen and trypsin

  • leak from injured pancreas
  • Trypsinogen is pancreas-specific

RIA only available for dogs/cats

TLI is not very specific!

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13
Q

TLI and steroids, azotemia, GI disease

A

Dexmethasone administeration:

  • significant rise in TLI in dogs
  • goes back to normal within 7 days after stopping

Increases in TLI have been reported in dogs and cats with azotemia

GI disease (IBD and GI lymphoma) may result in increased TLI levels

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14
Q

TLI in Vet Med

A
  • Used mainly to dx EPI
  • not generally used for canine pancreatitis (not very specific)
  • may have some utility in feline pancreatitis (generally low sensitivity)
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15
Q

Pancreatic Lipase Immunoreactivity (PLI)

A

Specific for pancreatic lipase

Very sensitive

Not affected by renal disease or prednisone administration

Currently offered at Texas A&M GI lab and Idexx

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16
Q

PLI in Vet Med

A

Test of choice for canine pancreatitis

SNAP: high sensitivity, low specificity
* helps rule OUT pancreatitis

One promising study in feline pancreatitis