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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
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
Why do dogs with exocrine pancreas insufficiency present with weight loss?
Decreased pancreatic secretions
-maldigestion
--inadequate absorption of nutrients (not prepared to be absorbed)
---weight loss
Exocrine Pancreatic Insufficiency
-causes
-Pancreatic acinar cell atrophy
-Chronic pancreatic disease
-pancreatic duct obstruction
Disorders that can cause intestinal malabsorption
Generalized
-inflammatory (histoplas, lymphocytic, enteritis, pythiosis, giardiasis, ...)
-neoplastic (lymphoma)
-lymphangiectasia (dilated lymphatic vessel)

Selective
-cobalamin deficiency
-folate deficiency
Indication that intestinal malabsorption may be due to cobalamin deficiency
-no weight loss
Current laboratory assays for exocrine pancreas funtion are related to
-trypsinogen
-lipase
Importance of HCO3- production by the pancreas
Makes more alkaline fluid in the intestine
-needed for enzymatic activity
-needed for digestion/absorption
TLI
-define
-Trypin-Like Immunoreactivity concentration
TLI
-production
-clearance
-production: pancratic acinar cells

-removal: kidenys, macrophages
TLI
-preferred sample
-fasting serum
Inc. [TLI]
-reasons
Inc. release from pancreas
-pancreatitis
-postprandial

Dec. renal removal
-dec. GFR (prerenal, renal, postrenal)
Significance of reasons for Inc. [TLI]
-need to be considered as reasons why [TLI] is not decreased
Inc. [TLI] due to pancreatitis in dogs
-tends to parallel increased serum AMS & LPS
Dec. [TLI]
-causes
-immune-mediated atrophic lymphocytic pancreatitis
-chronic pancreatitis
What does dec. [TLI] represent?
-dec. Trypsin activity --> poor protein digestion --> maldigestion
When can there be subclinical pancreatic insufficiency in dogs?
-clinically healthy German shepherds and rough-coated collies
-dec. [TLI]
-histologic evidence of lymphocytic pancreatitis
PLI
-define
-Pancreatic lipase immunoreactivity
PLI
-released from
-cleared by
-release = pancreatic acinar cells

-clearance = kidneys
PLI
-preferred sample
-fasting serum
Inc. [PLI]
-causes
-Inc. release from pancreas (pancreatitis)
-Dec renal clearance (mild)
Pancreatitis causing Inc. PLI
-sensitivity
-high
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
Better indicator of pancreatic insufficiency
-PLI or TLI
-[TLI]
Better indicator of acute pancreatitis
-PLI or TLI
-PLI
When trying to detect current damage to acinar cells use which value?
PLI
When trying to detect decreas pancreatic function tissue use which value?
-TLI
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
Cobalamin is a key factor for...
Folate metabolism
Cobalamin assay
-mechanism
-competitive binding to intrinsic factor
Cobalamin assay
-samples
-Non hemolyzed serum
-Non heparinized plasma
-Avoid light exposure
Inc. [cobalamin]
-causes
-injections of Vit B12
-hepatocyte damage

(uncommon)
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
How does dec. cobalt result in dec. [cobalamin]
-dec. synthesis of cobalamin by ruminal bacteria
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
Whats the Problem
-Folate: dec
-Cobalamin: WRI
-TLI: WRI
Malabsorption in Proximal SI
-dec. folate = proximal mucosal dz
Whats the problem:
-folate: WRI
-cobalamin: dec
-TLI: WRI
Malabsorption in Distal SI
-dec. cobalamin = distal mucosal dz
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
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
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
Inc. fecal a1-PI conc. suggests...
-causes
Suggests a Protein Losing Enteropathy
-lymphangectasia
-IBD
-lymphoma
-inflammation, infiltration, congestion, bleeding
What can be expected to be seen concurrently with Inc. fecal a1-PI conc. ?
hypoproteinemia
When collecting a fecal sample for a1-PI analysis what is important to do?
-avoid blood contamination