Unit 4 -Pancreas

Question 1

What leads to secretion from the exocrine pancreas?

Answer 1

hormones released by stomach and duodenum in response to gastric distension and/or ingesta

Question 2

What does the pancreas secrete?

Answer 2

bicarbonate-rich fluid and pro-enzymes

Question 3

What is the role of the bicarbonate-rich fluid that is released from the pancreas?

Answer 3

it is to neutralize acid from the stomach

Question 4

What specific pro-enzymes are released from the pancreas?

Answer 4

trypsinogen, chymotrypsinogen, pro-phospholipase, pro-lipase etc.

Question 5

How does the exocrine pancreas prevent autodigestion?

Answer 5

it stores its enzymes and secretes them in an inactive form

Question 6

When are pancreatic enzymes activated?

Answer 6

in the intestinal lumen

Question 7

What is the exocrine pancreas made up of?

Answer 7

acini/acinar cells, ducts, interstitium, vessels, and nerves

Question 8

What do the acinar cells contain?

Answer 8

zymogen granules, which are vesciles filled with pro-enzymes for digestion

Question 9

What defense mechanisms does the exocrine pancreas have to prevent autodigestion?

Answer 9

proenzymes are not activated until in the intestinal lumen, enzyme inhibitors

Question 10

What enzyme inhibitors does the exocrine pancreas have?

Answer 10

Pancreatic secretory trypsin inhibitor, alpha antitrypsin, alpha 2 macroglobulin

Question 11

Generally, what are some lesions/syndromes that can happen to the pancreas?

Answer 11

exocrine pancreatic insufficiency, inflammation, hyperplasia, and neoplasia

Question 12

When does exocrine pancreatic insufficiency occur?

Answer 12

when the pancreas does not produce adequate amounts of digestive enzymes

Question 13

What does exocrine pancreatic insufficiency lead to?

Answer 13

maldigestion

Question 14

You typically need to lose ______ of the exocrine pancreas before clinical signs of EPI to develop.

Answer 14

greater than or equal to 90 percen

Question 15

What clinical signs are associated with exocrine pancreatic insufficiency?

Answer 15

polyphagia, weight loss with muscle wasting, yellowish, poorly digested, loose and pulpy feces, increased fecal volume, and frequent defecation

Question 16

How do you diagnose EPI antemortem?

Answer 16

serum TLI (Trypsin-like immunoreactivity)

Question 17

What does a TLI test measure?

Answer 17

trypsinogen and trypsin-like immunoreactivity in the blood

Question 18

What are some causes of EPI?

Answer 18

juvenile pancreatic atrophy and chronic pancreatitis

Question 19

What species is juvenile pancreatic atrophy the most common cause of EPI in?

Answer 19

dogs

Question 20

What age animal typically gets juvenile pancratic atrophy?

Answer 20

typically 6-36 months

Question 21

What species is juvenile pancreatic atrophy reported in?

Answer 21

dogs and calves

Question 22

What causes juvenile pancreatic atrophy?

Answer 22

either auto-immune destruction of the pancreas or it is congenital

Question 23

What species is chronic pancreatitis the most common cause of EPI in?

Answer 23

cats

Question 24

What age animal typically gets chronic pancreatitis?

Answer 24

typically middle age to older

Question 25

What is chronic pancreatitis the result of?

Answer 25

progressive destruction of the pancreas by necrosis, inflammation, and fibrosis

Question 26

What can be impaired by chronic pancreatitis?

Answer 26

both exocrine and endocrine function

Question 27

What breeds is canine juvenile pancreatic atrophy an inherited condition in?

Answer 27

german shepards and rough-coated collies

Question 28

What provides as evidence for autoimmune disease in canine juvenile pancreatic atrophy?

Answer 28

marked T-lymphocyte infiltration during the progression of acinar atrophy and breed predisposition

Question 29

What is pancreatitis?

Answer 29

inflammation of the pancreas

Question 30

What does pancreatitis result from?

Answer 30

premature activation of digestive enzymes within the pancreatic acinar cells causing pancreatic auto-digestion

Question 31

What forms of pancreatitis are there?

Answer 31

chronic and acute

Question 32

What species is acute pancreatitis clinically important in?

Answer 32

dogs

Question 33

What clinical signs are associated with acute pancreatitis in dogs?

Answer 33

anorexia, vomiting, diarrhea, painful abdomen, and fever

Question 34

What can severe cases of acute pancreatitis lead to?

Answer 34

shock, DIC, and death due to multi-organ dysfunction

Question 35

What clinical signs are associated with acute pancreatitis in horses?

Answer 35

colic, +/- shock, clinical signs are non-specific and resemble signs of small obstruction or inflammation

Question 36

What signalment is associated with acute pancreatitis?

Answer 36

it is more common in middle-aged, obese, sedentary, small-breed bitches\

Question 37

What may an animal with acute pancreatitis have a history of?

Answer 37

high fat meal and dietary indiscrestion

Question 38

What diagnostics are used to diagnose acute pancreatitis?

Answer 38

CBC (leukocytosis), serum chemistries, and imaging

Question 39

What is the pathogenesis of acute pancreatitis?

Answer 39

1. Zymogen granules fuse with lysosomes 2. Cathepsin B activates trypsinogen to trypsin 3. Pancreatic secretory trypsin inhibitor overwhelmed 4. Trypsin activates additional enzymes in the pancreas 5. Autodigestion 6. Inflammation

Question 40

What are some initiating events that lead to acute pancreatitis?

Answer 40

dietary, trauma, ischemia, drugs, toxins, infectious, metabolic, and idiopathic

Question 41

What gross lesions are associated with acute necrotizing pancreatitis?

Answer 41

hyperemia, hemorrhage and necrosis, fibrinopurulent exudate, peripancreatic fat necrosis, and fibrinous adhesions to adjacent structures and omentum

Question 42

What happens to animals with chronic (relapsing) pancreatitis?

Answer 42

they suffer recurrent, intermittent attachs that contribute to the morphological and functional destruction of the gland

Question 43

How does chronic (relapsing) pancreatitis lead to exocrine pancreatic insufficiency and diabetes mellitus?

Answer 43

1. Necrotic/inflamed focus is liquefied, sequestered, or replaced by fibrous connective tissue 2. Loss of pancreatic parenchyma + fibrosis 3. Decreased pancreatic mass leading to exocrine pancreatic insufficiency and diabetes mellitus

Question 44

What are some sequela to pancreatitis?

Answer 44

bile duct obstruction, anorexia and vomiting, hepatic necrosis, peripancreatic fat necrosis, diabetes mellitus, liquefactive necrosis of the pancreas, peripancreatic inflammation, and systemic release of inflammatory mediators and activated digestive enzymes

Question 45

In regards to diabetes mellitus, what can severe acute pancreatitis lead to?

Answer 45

+/- temporary diabetes

Question 46

In regards to diabetes mellitus, what can severe extensive, chronic pancreatitis lead to?

Answer 46

+/- permanent diabetes

Question 47

How does chronic fibrosing pancreatitis with peripancreatic adhesions lead to jaundice?

Answer 47

1. Chronic fibrosing pancreatitis with peripancreatic adhesions 2. bile duct obstruction 3. dilated bile duct and gall bladder 4. jaundice

Question 48

What clinical signs are associated with equine pancreatitis?

Answer 48

colic +/- shock

Question 49

What is the pathogenesis of equine pancreatitis?

Answer 49

1. severe strongyle infection 2. migration of Strongylus equinus larvae through the pancreas 3. Eosinophilic granulomas and/or fibrosis 4. pancreatitis

Question 50

What species has pancreatic exocrine nodular hyperplasia been reported in?

Answer 50

dogs, cats, and cattle

Question 51

True or False: Pancreatic exocrine nodular hyperplasia is considered an incidental finding

Answer 51

TRUE

Question 52

What causes pancreatic exocrine nodular hyperplasia?

Answer 52

age-related hyperplastic foci and response to previous injury

Question 53

What species is age-related hyperplastic foci common in?

Answer 53

dogs and cats

Question 54

Age-related hyperplastic foci have a positive correlation with age ______ of the presence or absence of pancreatic inflammation, necrosis, or fibrosis.

Answer 54

regardless

Question 55

What is the appearance of pancreatic exocrine nodular hyperplasia?

Answer 55

multiple, small, white to tan, well-circumscribed nodules 1-3mm in diameter

Question 56

True or False: Neoplasias of the exocrine pancreas are common

Answer 56

FALSE

Question 57

What types of neoplasias are often found in the exocrine pancreas?

Answer 57

adenoma and adenocarcinomas

Question 58

What do neoplasias of the exocrine pancreas arise from?

Answer 58

acinar or ductal epithelium

Question 59

Are adenomas in the pancreas common?

Answer 59

no they are rare and often clinically silent

Question 60

What is the appearance of pancreatic adenomas?

Answer 60

single/solitary, well-demarcated and encapsulated, typically have multiple nodules with hyperplasia

Question 61

Are pancreatic adenocarcinomas typically benign or malignant?

Answer 61

malignant

Question 62

What animals do pancreatic adenocarcinomas generally occur in?

Answer 62

older dogs

Question 63

What clinical signs are associated with pancreatic neoplasms?

Answer 63

abdominal pain, vomiting, weight loss, abdominal mass, +/- jaundice, +/- ascites

Question 64

What is the biological behavior of pancreatic neoplasias?

Answer 64

they are aggressive tumors - disease is often advanced by the time of diagnosis

Question 65

Where do pancreatic neoplasms typically metastasize to?

Answer 65

lung, liver, spleen, and kidney