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74 Cards in this Set
- Front
- Back
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Is acute pancreatitis more common in the dog or cat?
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Dog
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Is chronic pancreatitis more common in the dog or cat?
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Cat
-and seen in some dog breeds e.g. miniature schnauzers (but manifests different) |
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What are 2 reasons that pancreatic inflammatory disease is difficult to diagnose?
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1) Anatomic relationships make it difficult to examine
2) Signs & symptoms are non-specific |
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What are the signs and symptoms of pancreatic inflammatory disease?
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Abdominal pain, vomiting, malaise, weight loss, diarrhea, poor coat, variable appetite, severe shock, hypovolemia, collapse
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What are the 4 possible pathophysiologies that account for pancreatitis?
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1) Inappropriate digestive enzyme release
-overstimulation 2) Hydrostatic pressure in pancreatic ducts 3) Ischemia/ reperfusion -post surgical post resuscitation, hyperlipemia 4) Drug induced |
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What are 2 causes of increased hydrostatic pressure that can damage the pancreas?
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1) If pancreatic secretions are thick and sticky they can't be excreted effectively --> increased hydrostatic pressure--> pressure on pancreas
2) Ductal obstruction |
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How can drugs cause pancreatic inflammation?
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Dexamethason and prednisone decreases high volume fluid of 3rd phase of pancreatic digestion---> high viscosity pancreatic secretions (lots of enzymes not much fluid)
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What is the worse scenario (pathophysiology) that causes pancreatitis?
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Ischemia/ reperfusion
-esp if post-op bc not totally stable and really deteriorate rapidly -not much redundant flow so susceptible to ischemia |
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What are the local effects of pancreatitis? (6)
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1) Pancreatic edema
2) Pancreatic and peripancreatic inflammation 3) Pancreatic necrosis -circulation shuts down 4) Peripancreatic fat necrosis -can lead to fat thrombi 5) Pancreatic hypoxia -due to fat thrombi 6) Pancreatic hemorrhage |
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What are 8 systemic effects of pancreatitis?
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1) Systemic inflammation
2) Hypotension 3) Acute renal failure 4) Acute respiratory failure 5) Disseminated intravascular coagulation 6) Pancreatic encephalopathy 7) systemic lipodystrophy 8) Multiple organ failure (SIRS) |
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Why does pancreatitis have systemic effects?
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When inflamed it starts synthesizing TNFalpha and IL-6 which causes massive recruitment of neutrophils into pancreas, problem is whole body is exposed to TNFalpha so demargination, degranulation and infiltration all over the place gets circulating enzymes causing damage all over the place
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Why can pancreatitis cause pancreatic encephalopathy?
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Enzymes can damage myelin
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What is the first major organ affected by the systemic inflammation caused by pancreatitis?
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Lungs--> acute respiratory distress= "pancreatitis lung"
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What 2 breeds are predisposed to developing acute pancreatitis?
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Silky terrier
Cocker spaniel |
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What signalment of dogs are most over represented for acute pancreatitis?
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Spayed female, high BCS score
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What is the mean age of dogs that get acute pancreatitis?
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7.5 years
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What 3 breeds most commonly get chronic pancreatitis?
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Miniature schnauzer
silky terrier chihuahua |
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What is different about the signalment of miniature schnauzers that get chronic pancreatitis?
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Usually first diagnosed as young adult
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What are 4 pre-existing diseases that are risk factors for lethal acute pancreatitis? What does this mean?
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1) Obesity
2) Diabetes mellitus* 3) Hyperadrenocorticism * 4) Pre-existing GI disease* -means that if you have one of these diseases and then get pancreatitis you are more likely to die from the pancreatitis |
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What are the sign of acute pancreatitis in dogs? (5)
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1) Vomiting*
2) Abdominal pain* (often severe) 3) Lethargy, inappetence 4) Tachycardia/ pyrexia 5) Dehydration (hypovolemia), hemoconcentration 6) Hypertriglyceridemia/ lipemia |
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What are the main signs of chronic pancreatitis in cats and miniature schnauzers?
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1) Abdominal pain
2) Lethargy, inappetence 3) Vomiting (less common) 4) Tachycardia/ pyrexia |
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What does the "prayer" sign in dogs indicate?
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Cranial abdominal pain (nonspecific to any condition- FBs, gastritis, intussusception, pancreatitis)
-common behavioral sign in dogs w/ chronic pancreatitis, may hold for prolonged periods |
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How can you tell the "prayer" sign isn't a dog just trying to play with you but really is indicative of pain?
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1) Don't look comfortable
2) Stay in position for long time 3) Don't play with you |
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It's the middle of the night and you get a call of a dog that has severe abdominal pain and is vomiting. You suspect the dog has pancreatitis, so what clinical chemistry should you run?
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-Big 4
-USG -draw samples for CBC/chem *Do all before fluids |
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What CBC abnormalities do you see in an animal with pancreatitis?
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Neutrophilic leukocytosis, often with left shift
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Why can the pancreas cause elevated liver enzymes?
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May reflect hepatic ischemia, toxic insult from compromised gut permeability
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Does pancreatitis affect bilirubin levels?
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Yes, increases bilirubin bc of severe hepatocellular damage, swollen pancreas obstructing the bile duct
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Why are animals with pancreatitis often hyperglycemic?
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When pancreas is inflamed islets produce more glucagon also see stress hyperglycemia in cats
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What does the big 4 consist of?
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1) PCV & total protein
2) Blood glucose 3) Blood urea 4) Urine specific gravity |
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Can you rule out pancreatitis based on amylase and lipase? Why or why not?
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NO
-useless in cats -poor sensitivity & specificity is poor in dog -sensitivity of lipase activity in dog is ~50% |
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Can you rule out pancreatitis based on normal specific pancreatic lipase levels?
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Yes
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During the process of diagnosing pancreatitis, clinical history and exam are definitely important. What are 4 other diagnostic techniques used to diagnose pancreatitis?
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1) Pancreatic lipase Immunoreativity
-Snap Spec cPL/ fPL -confirms pancreatitis 2) Enzyme activities -serum lipase & amylase -be suspicious 3) Diagnostic imaging -plain rads, ultrasonagraphy 4) Exploratory laparotomy/ histopathology |
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What are some differential diagnoses for pancreatitis? (there's a ton!)
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-Acute/chronic gastritis
-Acute/chronic renal failure -Diabetes mellitus -Diabetic ketoacidosis -Acute/ chronic hepatitis -Hypoadrenocorticism -Acute/ chronic enteritis (especially in cats) -Foreign body -Toxins |
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How do cats normally present with acute pancreatitis?
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-Subtle signs of acute pancreatitis
-Clinical signs of acute pancreatitis are catastrophic |
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What are the top 3 clinical signs of cats with pancreatitis?
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1) Lethargy (100%)
2) Anorexia 3) Dehydration |
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What can amylase/ lipase tell you about pancreatitis in a cat?
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NOTHING
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What are the top 4 chemistry findings in a cat with pancreatitis?
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1) Elevation of ALT (68%)
2) Hyperbilirubinemia 3) Hypercholesterolemia 4) Hyperglycemia (64%) |
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Why do we think that pancreatitis in the cat has been underdiagnosed?
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Signs in cat are more subtle and usually get a chronic form of the disease
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What diseases can chronic pancreatitis in the cat DEFINITELY lead to?
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Diabetes mellitus and exocrine pancreas insufficiency (bc get fibrosis w/ long term inflammation)
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What are 2 differential diagnoses in a cat with inappetence, occasional vomiting, and weight loss?
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1) Chronic pancreatitis
2) Chronic small intestinal disease |
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There is a strong breed predisposition to the development of chronic pancreatitis in the __________.
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Miniature schnauzer
-heritable cause suggested |
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Chronic pancreatitis in the min schnauzer often accompanies a persistent idiopathic ________.
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Hyperlipidemia
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At what age do miniature schnauzers typically present with chronic pancreatitis?
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Young
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What are the 5 therapeutic considerations for severe acute pancreatitis?
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1) Treatment of cause
-never know 2) Aggressive fluid therapy* 3) Rigorous monitoring 4) Early intervention against complications 5) Resting of the pancreas -witholding food and don't even give water until stop vomiting -he doesn't like, most hold food for ~24 hours |
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What is the only difference b/w treatment for acute pancreatitis and diabetic ketoacidosis?
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If have diabetic ketoacidosis need to feed them right away
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How do you treat acute pancreatitis? (3)
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1) IV fluids
-crystalloids for volume replacement - shock dose -can add K+ if needed 2) Monitor PCV/TP -if becoming hypoproteinemic consider oncotic support 3) Monitor coagulation parameters -give plasma if coagulopathy present/developing |
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Why should you give plasma to a dog that with acute pancreatitis that is hypoproteinemic and why?
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Plasma because these animals are at risk for DIC and we can't measure antithrombin III
-PT/PTT/D-dimers tell you you're already in trouble |
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Is pancreatitis a very painful condition?
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Yes- give analgesia!
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What type of pain control do we use in acute pancreatitis cases?
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Buprenorphine & lidocaine CRI, alone or together
-morphine avoided in humans to due to sphincter of oddi spasm |
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Should we give an animal with acute pancreatitis insulin if they're hyperglycemic? If so when?
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If hyperglycemic then go along with fluid therapy and often come back to normal levels, if hit with insulin as volume expand then all the insulin goes into circulation and goes into hypoglycemia, if still hypoglycemic after 6-8 hours especially if acidotic give insulin just like w/ diabetic ketoacidosis
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If you suspect an animal has acute pancreatitis and is also hyperglycemic, what is a MAJOR differential?
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Diabetic ketoacidosis
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When do you give an animal with acute pancreatitis insulin if they're hypoglycemic?
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Expand volume for 6-8 hours BEFORE giving insulin
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When do you feed a dog with acute pancreatitis?
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As soon as vomiting stops
-don't recommend resting the pancreas |
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Why did they used to rest the pancreas in dogs with acute pancreatitis?
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-Reduces pancreatic secretions
-Reduce vomiting and therefore decrease electrolyte loss |
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What should you do if a dog with acute pancreatitis won't stop vomiting?
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1) Maripotant
2) Dolasetron/ ondansetron 3) Metoclopramide CRI -try in this order or various combinations |
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How is maripotant beneficial to an acute pancreatitis patient other than as an antiemetic?
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Acts against receptors in vomiting center to help control nausea, but also acts on one of the major receptors that cause visceral pain
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Should you give an animal with acute pancreatitis antibiotics?
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Invasion of the gland up the pancreatic duct can occur and cause sepsis (GI to pancreas)
-so if use antibiotics typically use IV broadspectrum agents while hospitalized |
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Do they think there's a bacterial component to acute pancreatitis?
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No evidence of a role for bacteria in initiating acute pancreatitis
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What are 3 antibiotics that can be used for acute pancreatitis?
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1) ampicillin
2) Enrofloxacin 3) Cephalosporins |
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Is nutritional support always needed for dogs with acute pancreatitis? Why or why not?
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Not always, NPO for 24 hours is acceptable for many cases, if NPO (Bc of vomiting) for more than 36 hours nutritional support becomes important
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Why is nutritional support so important in a dog with acute pancreatitis after 36 hours?
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1) Critically ill animals are in a negative caloric state negative protein balance
2) Gut permeability and barrier function are compromised--> increased risk of disseminated bacteria |
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How can you feed an animal with acute pancreatitis and help maintain GI barrier function without stimulating the pancreas?
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Nasogastric trickle feeding
-low rate NG feeding w/ enteral nutrition formulas to help maintain barrier function w/o stimulating the pancreas or vomiting |
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What can you use for nutritional support in an animal with acute pancreatitis that goes into surgery?
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Jejunostomy tube- bypasses where pancreatic secretions occur
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What do they do at OSU for nutritional support in a dog with pancreatitis?
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Place esophagostomy tube
-allows standard diet and drugs -quick procedure, don't yank out as much -get away w/ bc of good antiemetics |
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What are 6 speculative therapeutic considerations for severe acute pancreatitis?
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1) Protease inhibitors-plasma
-no evidence in real cases -benefit is maybe oncotic support 2) Antibiotics -bacterial invasion worsened diseases 3) Anti-inflammatories 4) Peritoneal lavage? necrosectomy? 5) Anti-secretory agents? antacids? 6) Dopamine/ dobutamine for hypotension from septic shock -worsened disease in humans |
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What do you need to tell the owners when a dog with acute pancreatitis has recovered and is going home? (2)
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1) Gradually reintroduce food & water when vomiting has stopped
2) Advise that the patient has to switch to a low fat, moderately high carbohydrate diet, avoid treats, table scraps etc |
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If you have a cat with pancreatitis and diabetes, what should you treat firs?
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Diabetes******
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Do we ever use anti-inflammatory agents for acute pancreatitis?
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Yes, becoming very important we are realizing there is an inflammatory component
-prednisone |
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Is enzyme replacement in cases pancreatitis helpful?
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Nope
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A dog with chronic pancreatitis presents to you with an acute onset of abdominal pain, vomiting and a fever, but the dog is not as affected as a classical severe acute pancreatitis case. How should you treat this dog?
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Manage more conservatively
-narcotic pain control -monitor PCV/TP & vomiting -If PCV/TP are w/in normal it may not need IV fluid therapy |
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What is the mainstay therapy of a miniature schnauzer with chronic pancreatitis?
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An ultra low-fat diet
-helps to reduce lipemia and reduces frequency of clinical signs |
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What is the prognosis for mild forms of pancreatitis?
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Good
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What is the prognosis for the severe forms of pancreatitis?
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poor to grave
-intense ICU cases, may have prolonged ICU stay= expensive! |
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How does the extrapancreatic organ system compromise in dogs affect the prognosis?
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Greater number of compromised systems associated with worse prognosis or longer hospital stay
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