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67 Cards in this Set

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How much of the pancreas is exocrine functions?
~99%
Which part of the pancreas contains the pancreatic islets that have alpha, beta, and delta cells?
Endocrine portion
6 secretions of the pancreas
- Electrolytes
- Alpha-amylase
- Proteolytic enzymes
- Lipase
- Phospholipase A
- Pancreatic intrinsic factor
Fxn of Pancreatic intrinsic factor
Binds to Vitamin B12 to facilitate absorption
Fxn of Phospholipase A
Converts a detergent to active form for emulsification of dietary fat
Fxn of Lipase
Hydrolyzes dietary TRIG
3 miscellaneous functions of the pancreas
- Facilitates Zn absorption
- Suppresses intestinal bacterial overgrowth
- Trophic effect on intestinal mucosa
4 prevention methods of autodigestion in the pancreas
- Enzymes stored seperately from zymogens to prevent activation
- Zymogens secreted and stored in zymogen granules with an inhibitor of trypsinogen activation
- Lysosomal enzymes released only into ductal system
- Proteases that escape into circulation are deactivated by antiproteases
What occurs when prevention methods of autodigestion in the pancreas fail?
Abnormal vacuoles within pancreatic acinar cells form that contain both zymogens and lysosomal enzymes, which leads to activation of zymogens and initiation of autodigestion
7 causes of pancreatitis in dogs
- High fat diets
- Hereditary hyperlipoproteinemia/hypertrigliceridemia
- Drugs/chemicals
- Hypercalcemia
- Parasite infections
- Ischemia
- Duct obstruction
Level of hypercalcemia that predisposes dogs to pancreatitis
> 15 mg/dl
Two drugs that predispose dogs to pancreatitis
- Azathioprine
- OP
Two parasites that predispose dogs to pancreatitis
- Babesia
- Heterobilharzia americana
4 symptoms of acute pancreatitis in dogs
- Paroxysmal (constant) vomiting
- Anorexia
- Diarrhea
- 'Prayer position'
Pathophysiology of acute pancreatitis
Short term, acute onset severe inflammation of the pancreas and surrounding tissue that can be completely reversible and is caused by activation of enzymes within the pancreas and destruction of pancreatic tissue by these digestive enzymes
- Cytokines are released, free radicals generated, and proteolytic enzymes enter circulation to cause severe system inflammation
5 physical exam findings in dogs with acute pancreatitis
- Dehydration
- +/- abdominal pain
- +/- fever
- +/- jaundice
- +/- Cardiac arrhythmias
3 CBC findings in dogs with acute pancreatitis
- Neutrophilic leukocytosis
- Neutropenia with degenerative left shift if severe inflammation, peritonitis, sepsis, or endotoxemia is present
- Relative polycythemia
10 chemistry panel findings in dogs with acute pancreatitis
- Pre-renal azotemia
- Hypoproteinemia
- Increased ALT
- Increased ALP
- Hyperglycemia
- Hypercholesterolemia/hypertriglyceridemia
- Hyperbillirubinemia
- Hypocalcemia
- Low electrolytes
- Metabolic acidosis common (but can be alkalosis)
In dogs with acute pancreatitis, what causes a finding of pre-renal azotemia on the chem panel? (2)
- Increased BUN
- Increased creatinine
In dogs with acute pancreatitis, what causes a finding (on the chem panel) of hypoproteinemia?
'Third space loss peritonitis'
In dogs with acute pancreatitis, what causes a finding (on the chem panel) of increased ALT?
Hepatocellular damage from enzymes, radicals, cytokines, and inflammatory mediators
In dogs with acute pancreatitis, what causes a finding (on the chem panel) of increased ALP?
Cholestasis from liver damage
In dogs with acute pancreatitis, what causes a finding (on the chem panel) of hyperglycemia?
Stress release of steroids and glucagon release from damaged pancreas
In dogs with acute pancreatitis, what causes a finding (on the chem panel) of hypercholesterolemia/hypertriglyceridemia?
Lipoprotein lipase impairment
In dogs with acute pancreatitis, what causes a finding (on the chem panel) of Hyperbilirubinemia?
Cholestasis
In dogs with acute pancreatitis, what causes a finding (on the chem panel) of hypocalcemia?
Glucagon release leading to calcitonin secretion
6 causes of pancreatitis in cats
- Nutrition
- Drugs/chemicals
- Infection
- Trauma
- Ischemia
- Inflammation
What is the primary difference between acute pancreatitis causes in dogs and cats?
Acute pancreatitis in cats is not related to hypertriglyceridemia
5 physical signs of acute pancreatitis in cats
- Dyspnea
- Hypothermia
- Tachycardia
- Dehydration
- Abdominal pain
4 CBC results found in cats with acute pancreatitis
- Normocytic, normochromic anemia
- Polycythemia
- Leukocytosis
- Leukopenia
What causes polycythemia in cats with acute pancreatitis?
Dehydration
What laboratory finding in cats with acute pancreatitis indicates a poor prognosis?
Leukopenia
What type of acute pancreatitis causes glucose to increase in cats?
Necrotic pancreatitis
What type of acute pancreatitis causes glucose to decrease in cats?
Suppurative pancreatitis
What serum chemistry result is found more often in cats with acute pancreatitis than in dogs?
Hypocalcemia
- Carries a poor prognosis
How high must amylase test be to be clin sig?
3 - 5x upper reference interval
What must an amylase test always be done in conjunction with?
Serum lipase
What causes a falsely decreased lipase level?
Hemolysis
How high must a lipase test be to support pancreatitis?
3 - 5x upper RI
What drug can cause an increase in lipase?
Dexamethasone
Indication for trypsin-like immunoreactivity (TLI) test
Exocrine pancreatic insufficiency in dogs
Which two species is a trypsin-like immunoreactivity (TLI) test useful in?
- Dogs
- Cats
What is a more sensitive and specific test for acute pancreatitis in cats than trypsin-like immunoreactivity (TLI) test?
Feline Pancreatic Lipase Immunoreactivity (fPLI)
What breed of dog is most susceptible to Exocrine Pancreatic Insufficiency?
GSD
Histopathology of Exocrine Pancreatic Insufficiency in young, large breed dogs
Pancreatic acinar atrophy
Histopathology of Exocrine Pancreatic Insufficiency in older, small breed dogs
Fibrosis and chronic inflammation
History of Exocrine Pancreatic Insufficiency in young, large breed dogs (3)
- Bright, alert, and active
- Progressive weight loss with ravenous appetite
- Loose, voluminous stool
History of Exocrine Pancreatic Insufficiency in older, small breed dogs
- Voluminous, rancid smelling stool
- Borborygmus and flatulence
- Poor hair coat
- +/- abdominal pain
3 physical exam findings of Exocrine Pancreatic Insufficiency (3)
- Thin to emaciated
- Oily hair around perineum
- Gas filled loops of bowel
Test of choice for Exocrine Pancreatic Insufficiency
Trypsin-like immunoreactivity (TLI)
Pathophysiology of Exocrine Pancreatic Insufficiency in cats
Secondary to chronic pancreatitis
Predisposing condition toward Exocrine Pancreatic Insufficiency in cats
Diabetes Mellitus
History of Exocrine Pancreatic Insufficiency in cats
- Severe watery diarrhea
- Oily hair coat
Physical exam findings in cats with Exocrine Pancreatic Insufficiency
- Thin to emaciated
- Oily hair around perineum
- Gas filled loops of bowel
Test of choice for Exocrine Pancreatic Insufficiency in cats
TLI
Second best test for Exocrine Pancreatic Insufficiency in cats
Fecal proteolytic activity
Golden standard for diagnosis of Exocrine Pancreatic Insufficiency
Biopsy
Malassimilation (define)
Term used to describe a GIT disorder that is hcaracterized by a lack of absorption and/or digestion of oral nutrients that leads to weight loss, diarrhea, and subsequent systemic effects of lack of nutrients
Term for malassimilation that involves a loss of protein through GIT
Protein losing enteropathy
7 causes of malassimilation
- Exocrine Pancreatic Insufficiency
- Inflammation/infection/parasitism
- Neoplasia
- Lymphatic disorders
- Immune mediated disorders
- Hereditary disorders of pancreas
- Intestinal microflora imbalances
Two CBC results involved with malassimilation
- Chronic anemia
- +/- inflammatory pattern
5 chemistry values associated with malassimilation
- Hypoproteinemia
- Elevation of BUN if bleeding into upper GIT
- Electrolytes may be decreased if diarrhea is present
- +/- hypocholesterolemia
- +/- hypoglycemia
How do you rule out EPI as a cause of malassimilation?
TLI test
What test is used to determine whether there's bleeding into GIT?
Alpha 1 proteinase inhibitor immunoassay in feces
5 diagnostic tests for malassimilation
- Biopsy of GIT
- Fecal exam w/ cytology
- TLI (to rule out EPI)
- Serum cobalamin and folate (especially in cats)
- Alpha 1 proteinase inhibitor immunoassay in feces
What causes a decrease in serum cobalamin?
EPI due to a deficiency in pancreatic intrinsic factor, which is required for cobalamin absorption in the intestine
What causes an increase of serum folate in malassimilation?
Small intestinal bacterial overgrowth