Bryan - Sa Med - Pancreas - Fall 3Rd Year

Front 1

What are the digestive enzymes secreted by the pancreas?

Back 1

Tripsinogen
Chymotrypsinogen
Elastase
Lipase
Amylase
Gelatinase

Front 2

Which of the following does the exocrine pancreas excrete?
a) elastase
b) trypsin
c) chymotrypsinogen
d) insulin
e) gelatin

Back 2

a) elastase
c) chymotrypsinogen

Front 3

What hormone(s) stimulates the exocrine pancrease? What is the source and trigger for the hormone(s)?

Back 3

Cholecystokinin (duodenal fat and protein)
Gastrin (stomach distention)

Front 4

What converts trypsinogen to trypsin?

Back 4

an enterokinase within the SI; trypsin also activates trypsinogen

Front 5

What are some mechanisms that prevent the pancreas from digesting itself?

Back 5

Zymogen enzyme precursors
Pancreatic secretory trypsin inhibitor
SERPINs

Front 6

Which hormone activates pancreatic bicarb secretion? What is its source and trigger?

Back 6

Secretin (low pH in duodenum)

Front 7

What are the mechanisms for pancreatic downregulation?

Back 7

Somatostatin (inhibits CCK and secretin)
Feedback from SI inhibits pancreatic enzymes (somehow)

Front 8

What are the phases of pancreatic secretion? What is secreted in each phase?

Back 8

Cephalic (enzymes)
Gastric (enzymes and bicarb)
Intestinal (bicarb)

Front 9

Compare/contrast cat and dog pancreatic secretory anatomy. What is the clinical significance of this?

Back 9

Cat - Pancreatic duct is major
Dog - Accessory duct is major
Pancreatic duct is close to biliary duct. Thus biliary obstruction leads to pancreatitis in CATS

Front 10

Which pancreatic disease has the greatest short-term risk?

Back 10

Acute pancreatitis

Front 11

What are 3 assumptions that must be made with diagnostic pancreatic tests?

Back 11

assume that enzyme expression is constant, clearance mechanisms are normal, and minimal to no absorption from the intestinal lumen

Front 12

T or F:
Trypsinogen is only synthesized by the pancreas.

Back 12

Tru dat!

Front 13

What are the pancreas specific enzymes?

Back 13

Trypsin
Pancreas-specific lipase

Front 14

Choose TLI or PLI...
...has a longer half-life.

Back 14

PLI

Front 15

Choose TLI or PLI...
...no renal clearance.

Back 15

PLI

Front 16

Choose TLI or PLI...
...more likely to show elevation in an animal with pancreatitis

Back 16

PLI

Front 17

Choose TLI or PLI...
...associated with small intestinal disease in cats.

Back 17

TLI

Front 18

Choose TLI or PLI...
...tests are more sensitive to change.

Back 18

PLI

Front 19

What is the typical appearance of pancreatitis via radiography?

Back 19

Ground-glass appearance; loss of detail, contrast, and increased density in R cranial abdomen

Front 20

What process is extant if the pancreas is hypoechoic by US? Hyperechoic?

Back 20

Hypo - necrosis or fluid
Hyper - fibrosis; fat soponification

Front 21

T or F:
Endoscopic retrograde cholecystopancreatography has become the gold standard for pancreatic imaging in small animals.

Back 21

Um false. Only used experimentally.

Front 22

Acute pancreatitis is more common in the _______ while chronic pancreatitis is more common in the _______.

Back 22

Acute = dog
Chronic = cat (or Mini Schnauzer)

Front 23

What are some causes of pancreatitis?

Back 23

High fat diet
Ductal obstruction
Ischemia/reperfusion injuries
Drug induced

Front 24

T or F:
You should NEVER give corticosteroids in a pancreatitis case.

Back 24

Depends...
In real life, it can maybe help but on the boards, say NO

Front 25

What is a fairly unique feature of Cocker Spaniels with pancreatitis?

Back 25

High circulating lipase breaks down subcutaneous fat causing draining tracts from fat pads.

Front 26

What is a common signalment for an animal with acute pancreatitis?

Back 26

Fat old *******!
Silky terrier & cocker spaniel

Front 27

Which of the following diseases predisposes a patient to pancreatitis?
a) hyperadrenocorticism
b) hypothyroidism
c) obesity
d) diabetes insipidus
e) GI disease

Back 27

NONE OF THEM INCREASE RISK OF PANCREATITIS!!! However, all of them increase the chance of DYING once an animal gets pancreatitis.

Front 28

Which of the following signs are congruent with chronic pancreatitis?
a) tachycardia
b) pyrexia
c) vomiting
d) severe abdominal pain
e) dehydration

Back 28

a) tachycardia
b) pyrexia
c) vomiting
d) severe abdominal pain

Note: dehydration is a sign of ACUTE pancreatitis

Front 29

What are the clinical signs causing one to suspect chronic pancreatitis in a cat?

Back 29

chronic vomiting and weight loss

Front 30

Persistent idiopathic hyperlipidemia is associated with...

Back 30

...Mini Schnauzers

Front 31

What are general principles for treating pancreatitis?

Back 31

Aggressive fluid therapy
Early intervention against complications
Monitoring!
Rest pancreas (on boards)
Narcotic pain control

Front 32

What pain control drugs should be used when treating pancreatistis?

Back 32

Narcotics (not morphine)

Front 33

Why might antibiotics be used in cases of acute pancreatitis? Which antibiotics are acceptable?

Back 33

Prophylacticly to prevent translocation of GI flora;
Ampicillin, enrofloxacin, cephalosporin

Front 34

T or F:
Short-term nil per os therapy for acute pancreatitis is acceptable.

Back 34

Yup. For up to 24h.

Front 35

In a dog with chronic pancreatitis, what is the expected mortality if one organ is affected? 4 organs? 5?

Back 35

1 = 10%
4 = 75%
5 = 90%

Front 36

Exocrine pancreatic insufficiency is the end result of _______ _______ ________.

Back 36

Pancreatic acinar atrophy

Front 37

Which of the following is impacted in EPI?
a) insulin
b) trypsin
c) elastase
d) bicarbonate
e) CCK

Back 37

b) trypsin
c) elastase

Front 38

Which breeds are predisposed to EPI?

Back 38

German Shepherd
Rough Coated Collie

Front 39

What are common signs of EPI?

Back 39

Diarrhea and steatorrhea
Coprophagia
poor hair coat (cats)
etc...pretty much any sign of small intestinal disease

Front 40

What is an important EPI differential in cats?

Back 40

Hyperthyroidism

Front 41

What test is commonly used to diagnose EPI in dogs? Is it effective in cats?

Back 41

TLI <2 is diagnostic in dogs.
TLI <8 is strongly suggestive in cats (but not diagnostic)

Front 42

What is one major difference betwen cats and dogswhen treating EPI and why?

Back 42

Cats need cobalamin supplementation (dogs make intrinsic factor in pancreas and SI while cats only use pancreas)

Front 43

How is EPI treated?

Back 43

enzyme replacement therapy + vitamin supplementation

Front 44

T or F:
Pancreatic nodular hyperplasia has a grave to hopeless prognosis in dogs.

Back 44

False! This is common and benign in older dogs.

Front 45

Choose pancreatic pseudocyst or abscess...
...typically sterile

Back 45

both

Front 46

Choose pancreatic pseudocyst or abscess...
...contains enzymes

Back 46

pseudocyst

Front 47

What are two pancreatic parasites affecting cats?

Back 47

Eurytrema procyonis
Amphimerus pseudofelineus