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62 Cards in this Set
- Front
- Back
Digestive enzymes provided in pancreatic secretions
|
-Proteases
-Amylase, lactase, sucrase -Pancreatic lipase |
|
What happens after nutrients are absorbed into intestinal mucosal cells?
|
-Peptides--> portal blood
-Sugars --> portal blood -Fats --. synthesized into triglycerides, packaged into lipoproteins, lipoproteins enter lymphatics |
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Maldigestion
-definition -causes |
-incomplete digestion of food
Causes -exocrine pancrease insufficiency -impaired bile acid delivery to intesitine (cholestasis) |
|
Malabsorption
-defintion -causes |
-impaired intestinal absorption of nutrients
Causes -mucosal abnormalities -lymphatic obstruction |
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Why do dogs with exocrine pancreas insufficiency present with weight loss?
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Decreased pancreatic secretions
-maldigestion --inadequate absorption of nutrients (not prepared to be absorbed) ---weight loss |
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Exocrine Pancreatic Insufficiency
-causes |
-Pancreatic acinar cell atrophy
-Chronic pancreatic disease -pancreatic duct obstruction |
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Disorders that can cause intestinal malabsorption
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Generalized
-inflammatory (histoplas, lymphocytic, enteritis, pythiosis, giardiasis, ...) -neoplastic (lymphoma) -lymphangiectasia (dilated lymphatic vessel) Selective -cobalamin deficiency -folate deficiency |
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Indication that intestinal malabsorption may be due to cobalamin deficiency
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-no weight loss
|
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Current laboratory assays for exocrine pancreas funtion are related to
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-trypsinogen
-lipase |
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Importance of HCO3- production by the pancreas
|
Makes more alkaline fluid in the intestine
-needed for enzymatic activity -needed for digestion/absorption |
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TLI
-define |
-Trypin-Like Immunoreactivity concentration
|
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TLI
-production -clearance |
-production: pancratic acinar cells
-removal: kidenys, macrophages |
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TLI
-preferred sample |
-fasting serum
|
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Inc. [TLI]
-reasons |
Inc. release from pancreas
-pancreatitis -postprandial Dec. renal removal -dec. GFR (prerenal, renal, postrenal) |
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Significance of reasons for Inc. [TLI]
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-need to be considered as reasons why [TLI] is not decreased
|
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Inc. [TLI] due to pancreatitis in dogs
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-tends to parallel increased serum AMS & LPS
|
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Dec. [TLI]
-causes |
-immune-mediated atrophic lymphocytic pancreatitis
-chronic pancreatitis |
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What does dec. [TLI] represent?
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-dec. Trypsin activity --> poor protein digestion --> maldigestion
|
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When can there be subclinical pancreatic insufficiency in dogs?
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-clinically healthy German shepherds and rough-coated collies
-dec. [TLI] -histologic evidence of lymphocytic pancreatitis |
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PLI
-define |
-Pancreatic lipase immunoreactivity
|
|
PLI
-released from -cleared by |
-release = pancreatic acinar cells
-clearance = kidneys |
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PLI
-preferred sample |
-fasting serum
|
|
Inc. [PLI]
-causes |
-Inc. release from pancreas (pancreatitis)
-Dec renal clearance (mild) |
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Pancreatitis causing Inc. PLI
-sensitivity |
-high
|
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Dec. [PLI]
-causes |
Dec. release from pancreas
-immune mediated atrophic lymphocytic pancreatitis -chronic pancreatitis |
|
What does dec. [PLI] represent?
|
-dec. lipase activity --> poor triglyceride digestion --> maldigestion
|
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Better indicator of pancreatic insufficiency
-PLI or TLI |
-[TLI]
|
|
Better indicator of acute pancreatitis
-PLI or TLI |
-PLI
|
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When trying to detect current damage to acinar cells use which value?
|
PLI
|
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When trying to detect decreas pancreatic function tissue use which value?
|
-TLI
|
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Cobalamin absorption
-describe |
-dietary cobalamin binds to R protein in acidic stomach
-cobalamin than binds to intrinsic factor in alkaline intestine -Cobalamin/IF complex is absorbed in the ileal mucosa -Cobalamin enters portal blood and binds to transcobalamin-2 -Cobalamin will circulate enterohepatically |
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Cobalamin is a key factor for...
|
Folate metabolism
|
|
Cobalamin assay
-mechanism |
-competitive binding to intrinsic factor
|
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Cobalamin assay
-samples |
-Non hemolyzed serum
-Non heparinized plasma -Avoid light exposure |
|
Inc. [cobalamin]
-causes |
-injections of Vit B12
-hepatocyte damage (uncommon) |
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Dec. [cobalamin]
-causes |
Cobalt deficiency (cattle)
-grazing on cobalt deficient soil -secondary deficiency of cobalt from excess sulfur, iron, molybdenum Preabsorptive defect -Exocrine pancreas insufficiency (too little IF, too little HCO3-) -Bacterial overgrowth (consume cobalamin) Absorptive Defect -Ileal disease (inflamm, atrophy, resection) -Inherited defect |
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How does dec. cobalt result in dec. [cobalamin]
|
-dec. synthesis of cobalamin by ruminal bacteria
|
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Describe the process of Folate absorption
|
-dietary polyglutamate folate is hydrolyzed to monoglutamate folate at the intestinal brush border
-Folate is absorbed in the proximal small intestine and enters portal blood -Folate is converted to N-methylhydrofolate in cells -Cobalamin is used to convert N-methylhydrofolate to a usable form for DNA synthesis |
|
Folate analysis
-sample |
-serum (avoid hemolysis)
|
|
Inc. Serum Folate conc.
-causes |
Inc. absorption in Small intestine
-bacterial overgrowth (inc. folate prod.) -low intestinal pH -high dietary intake Parenteral supplementation |
|
Dec. Serum Folate conc.
-causes |
Dec. absorption of folate in the Small Intestine
-proximal or diffuse mucosal disease Others -dietary deficiency (rare) -oral antibiotics -neoplastic cells (use folate for DNA) |
|
Whats the problem:
-Folate: inc / WRI -Cobalamin: dec -TLI: dec |
Exocrine Pancreatic Insufficiency
-dec. TLI = dec. Pancreatic acinar cells -dec cobalamin = preabsorptive defect (dec. IF binding, bacterial overgrowth) -inc. Folate = something causing acidic pH --> absorption or bacterial production |
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Whats the Problem
-Folate: dec -Cobalamin: WRI -TLI: WRI |
Malabsorption in Proximal SI
-dec. folate = proximal mucosal dz |
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Whats the problem:
-folate: WRI -cobalamin: dec -TLI: WRI |
Malabsorption in Distal SI
-dec. cobalamin = distal mucosal dz |
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Whats the problem:
-folate: dec -cobalamin: dec -TLI: WRI |
Diffuse SI malabsorption
|
|
Whats the problem:
-folate: inc -cobalamin: dec -TLI: WRI |
Bacterial overgrowth
-inc folate: inc. folate production by bacteria -dec. cobalamin: consumption by bacteria |
|
D-Xylose absorption test
-spp used in |
-dogs
-cats -horses |
|
Xylose
-absorbed where |
-jejunum & ileum
|
|
Xylose
-clearance |
-kidney
-minimal metabolism |
|
Dec. Xylose absorption due to:
|
-small intestinal DZ (jejunum, ileum)
-incomplete delivery (vomiting, delayed gastric emptying, diarrhea/rapid transit) |
|
Glucose absorption test
-spp used in |
-dogs
-cats -horses |
|
Glucose
-absorbed where |
-duodenum
-jejunum |
|
Glucose
-clearance |
-renal
-used by liver and tissues |
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Xylose absorption test
-advantages -disadvantages |
Advantages:
-absorption in jejunum and ileum -no use of xylose by liver and tissues Disadvantages -expensive -delayed gastric emptying or vomiting -uncommon assay |
|
Glucose absorption test
-advantages -disadvantages |
Advantages
-inexpensive -absorption by duodenum and jejunum -common assays Disadvantages -used my liver and tissues |
|
Alpha1-PI
-define |
-Alpha1-Protease Inhibitor
|
|
Alpha1-PI
-found where |
-plasma
-interstitial fluid -lymph |
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Where is a1-PI resistant to proteolysis?
|
-feces
|
|
a1-PI
-similar molecular weight to -what does this mean |
-albumin
-if losing albumin probably losing protein as well |
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Inc. fecal a1-PI conc. suggests...
-causes |
Suggests a Protein Losing Enteropathy
-lymphangectasia -IBD -lymphoma -inflammation, infiltration, congestion, bleeding |
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What can be expected to be seen concurrently with Inc. fecal a1-PI conc. ?
|
hypoproteinemia
|
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When collecting a fecal sample for a1-PI analysis what is important to do?
|
-avoid blood contamination
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