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11 Cards in this Set
- Front
- Back
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Causes of Exocrine Pancreatic insufficiency (EPI)
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- Pancreatic acinar atrophy
- Young GSD - Heritable - May be proceded by lymphocytic infiltration - Pancreatic hypoplasia- - Rare, congenital, dogs <6mo - May be assoc. c DM - Chronic pancreatitis - Most common cause in cats (although still rare) |
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Clinical signs of EPI-
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- Steatorrhoea- greasy, foul smelling faeces
- Consistancy ranging from putting to diarrhoea - Weight loss/ emaciation - Polyphagia - Coprophagia - Vomiting - Dry scurfy coat |
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Dx of EPI-
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- Serum trypsin-like immunoreactivity (TLI) test
- Tests for trypsin in the blood after fasting - Normal dog >5, normal cat >8 - Absent/ reduced in EPI - Spp. specific tests |
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Tx of EPI-
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- Oral pancreatic extract
- Uncoated powders work best - Fresh frozen pancreas - Diet - Highly digestible- little and often - High in good quality protein - Low fat? - Simple carbs - AB if 2o infection suspected - Vitamin supplements- esp. B12 |
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Pancreatic neoplasia-
Types- |
- Uncommon
- Ductular and acinar adenocarcinoma - Old dogs - Silent unti severe dz- poor prognosis - Bile duct obstruct.(cholestasis), metastat., pancreatitis - Islet cell tumours- Functionally active- - Insulinoma---> Inc. serum insulin + hypoglycaemia - Tx- Excision - Medical- steroids/ diazoxide (blocks insulin release)/ streptozotocin (destroys islet cells) - Gastrinoma (gasrtin)---> Inc gastric acid---> ulcers |
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Acute pancreatitis-
Describe- Cause- |
- Fairly common in dogs
- (Obese, middle aged, sedentry females) - Rarer in cats - Cause- - Usually idiopathic but several predisposing factors- - Fat- high fat diet, lack of exercise, hyperlipidaemia, - Pancreatic ischaemia (neoplasia/ inflam/ calculi etc.) - Trauma - Drug related - Virus |
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Sequence of pancreatitis-
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- Intracellular activation of proteases in the pancreas
- Due to fusion of zymogens and lysosomes - Natural antiproteases defences overwhelmed - E.g. Pancreatic secretory trypsin inhibitors (PSTI)... - Enzymatic digestion of pancreas - Vascular damage- oedema, haem., thrombosis - Act. of further inflam mediators- ROS, cytokines etc - Further tissue damage ---> Local effects- peritonitits, fat necrosis ---> Systemic effects- renal fail. arrhyth., pleural effusion, shock, DIC, death - Possible sequalae- - Chronic recurrent pancreatitis - EPI - DM |
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Clinical signs of pancreatitis-
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- Depression and anorexia
- Vomiting - Ab pain - Diarrhoea +/- blood - Pyrexia - Jaundice - Causing- - Dehydration - Tachypnoea - Tachycardia - Collapse |
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Dx of pancreatitis-
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- History and exam.
- Radiographs and US - Lab tests - Leukocytosis (L shift), - Hyperglycaemia - Hyperlipidaemia - HypoCa, hyperK - Inc liver enzymes - Azotaemia - Pancreas-specific proteins - PLI- pancreatic-lipase immunoreactivity |
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Tx of acute pancreatitis-
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- Pancreatic rest
- CV support - Feeding- traditionall NPO, but need nutrients - enterostomy tube/ IV fluids preferred - IV fluids- - Crystalloids/ whole blood - Analgesia - Anti-emetics - AB - Covalescent therapy - Guarded prognosis |
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Chronic pancreatitis-
Dogs- Causes Sequalae Cats Causes Dx and Tx |
- Dogs- Relatively common in older springers/ CKCS
- Causes- - Repeated acute pancreatitis - Chronic low grade, sub-clinical pancreatitis - Duct centred fibrosis in spaniels ---> Progressive destruct. of glandular tiss. + fibrosis ---> EPI +/or DM - Cats- - Chronic persistent low grade pancreatitis - Lymphocytic cholangiohepatitis + IBD + chonic pancreatitis = "Triaditis" - Dx - As with acute pancreatitis - Lab tests often less helpful - Pancreatic mass and calcification - Tx - Dietary control + weight reduction |
