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74 Cards in this Set
- Front
- Back
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What additional specialty laboratory testing may be required to diagnose specific GI diseases?
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trypsin-like immunoreactivity, Cobalamin/B12 levels, imaging studies, cytology or biopsy
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What is TLI?
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trypsin-like immunoreactivity
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What is maldigestion?
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failure to adequately digest food
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What causes malabsorption (failure to adequately digest food)?
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TLI
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What causes inadequate secretion of digestive enzymes leading to maldigestion?
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EPI: exocrine pancreatic insufficiency
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What causes EPI leading to malabsorption? (3)
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loss of pancreatic functional mass, juvenile acinar atrophy or chronic pancreatitis
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What is malabsorption?
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failure of GI tract to absorb adequately digested nutrients
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What is affected by malabsorption?
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vitamin B12 and Folate
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What can cause malabsorption?
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focal or diffuse intestinal disease
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What types of focal or diffuse intestinal diseases cause malabsorption?
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inflammatory, neoplastic, lymphagiectasia
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What are the similar clinical signs for maldigestion and malabsorption?
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increased fecal volume, weight loss, soft feces, steatorrhea
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What are the two fecal tests that are used in diagnosis for maldigestion and malabsorption?
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fecal occult blood and fecal cytology
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What fecal tests are ignored in maldigestion and malabsorption diagnosis?
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digestion/absorption screening tests, BT-PABA, D-Xylose
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What does fecal occult blood test detect?
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presence of blood in feces at concentrations 20--50 fold less than that resulting in frossly visible blood
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What causes a false positive in a fecal occult blood test? (3)
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meat-based diets causing myoglobin, plant peroxidases, and specific foods like tomatoes and beets
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What causes false negative tests? (1)
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uneven distribution of blood
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What is the sensitivity and specificity of a fecal cytology test?
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low sensitivity and low specificity
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What is fecal cytology test used to detect?
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specific pathogenic organisms and to confirm presence of inflammation
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What organisms are detected in fecal cytology test in birds?
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yeast/fungi
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What bacterial overgrowth will be detected in a fecal cytology test?
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clostridium and campylobacter spp
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What bacterial overgrowth is rarely detected during fecal cytology test?
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Giardia
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What is TLI specific and sensitive for? (disease)
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EPI
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What two specific components does TLI measure?
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trypsin and trypsinogen
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Where is Vitamin B12 absorbed?
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distal SI
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Where is folate absorbed?
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proximal SI
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What does malabsorption in proximal SI cause?
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decreased serum folate and normal B12
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What does malabsorption in distal SI cause?
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decreased B12 and normal serum folate
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What does malabsorption with diffuse SI disease cause?
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both B12 and folate decrease
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What does exocrine pancreatic insufficiency in cats look like?
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decreased B12 from decreased intrinsic factor and decreased folate from concurrent intestinal disease
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What does exocrine pancreatic insufficiency in dogs look like?
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slight to moderately decreased B12 and normal to increased folate due to bacterial overgrowth as a sequela to EPI
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What effect does bacterial overgrowth have in dogs with exocrine pancreatic insufficiency?
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bacterial synthesis of folate (increase) and bacterial binding to B12 (decrease)
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What does EPI look like in dogs as far as folate and cobalamin?
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increased folate and decreased cobalamin
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What does small intestinal bacterial overgrowth look like in dogs as far as folate and cobalamin?
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increased folate and decreased cobalamin
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What does diffuse intestinal disease look like in dogs as far as folate and cobalamin?
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decreased folate and decreased or normal cobalamin
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What do the blood results of polycythemia look like?
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increased Hct, HgB, RBC and total protein
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What does prerenal azotemia look like in lab results?
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increased BUN and increased Creat
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What does prerenal azotemia (increased BUN and increased creat) indicate?
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dehydration
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What does neutropenia and neutrophilia indicate?
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inflammation
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What are five lab abnormalities are associated with diarrhea and vomiting?
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polycythemia, prerenal azotemia, neutropenia/neutrophilia, increased liver enzyme activity and acid-base and electrolyte changes
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What does increased liver enzyme activity indicate?
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hepatocyte damage from toxins absorbed from the GI tract
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What electrolyte changes is secretory diarrhea associated with?
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loss of Na, Cl, K and base
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What acid-base change is secretory diarrhea associated with?
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normal gap acidoses
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What electrolyte changes is vomiting associated with?
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loss of HCl
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What acid-base change is vomiting associated with?
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selective chloride loss leading to alkalosis
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What is the primary function of exocrine pancreas?
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synthesis and secretion of digestive enzymes which hydrolyze proteins, lipids ans starches
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What are two major disorders of the pancreas?
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pancreatic injury and insufficiency production and secretion of pancreatic enzymes
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What are two types of pancreatic injury?
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inflammation and pancreatitis
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What are three disorders that cause insufficient production and secretion of pancreatic enzymes?
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loss of pancreatic acinar cells, EPI and maldigestion
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What are three lab tests that are NOT sensitive or specific for pancreatitis?
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serum amylase, serum lipase, serum TLI
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Where is the anatomic location of amylase?
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several tissues: pancreas and GI epithelial cells
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What are five things that increase amylase?
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pancreatic injury, GI disease, hepatic disease, neoplasia, increases with renal dysfunction
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What are three pathologies leading to renal dysfunction and increased amylase?
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prerenal, renalor post renal azotemia, decreased GFR, pancreatic injury secondary to uremic toxins
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What is the rule of thumb for amylase diagnosis of pancreatic injury?
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3X the upper reference interval as suggestive of pancreatic injury
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Where is the anatomic location of lipase?
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present in pancreas, adipose tissues, gastric mucosa and duodenal mucosa
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What are five things that increase lipase?
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pancreatic injury, renal dysfunction, hepatic disease, steroid therapy, and GI disease
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What are two pathologies associated with renal dysfunction causing an increase in lipase?
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renal degradation and decreased GFR
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What is the usual result of lipase in relation to steroid therapy?
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5x reference interval
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What does viral enteritis usually cause in reference to lipase?
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increased lipase of 2-5x the reference range
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What does renal disease cause in regards to amylase and lipase?
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increase the serum amylase and lipase up to 2-3 times the upper limit of the reference range
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What does dexamethasone cause in regards to amylase and lipase?
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serum lipase increased and serum amylase decreased
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What can extra-pancreatic cause in regards to amylase and lipase?
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increase in both
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In cats, is amylase or lipase a good indicator of pancreatitis?
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neither!
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What two species is pancreatitis rare?
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cattle and horses
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What species is pancreatitis most common in?
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dogs
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What does pancreatitis look like in dogs as far as lipase and amylase?
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normal serum lipase and amylase activity
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What does the amylase and lipase look like in pancreatitis in the first 5 days?
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lipase and amylase increase within the first 24 hours and peak at day 4-5 post pancreatic injury
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What lab results usually lead to a diagnosis of pancreatitis?
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>3-5x elevation of amylase and lipase and there is NO renal disease and NO steroids
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Why does an injury to the pancreas sometimes lead to an increase in TLI?
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injury may lead to leakage of trypsinogen into extracellular space that is then activated to trypsin, where it binds to serum protease inhibitors
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When two species does measurement is serum TLI may be useful in diagnosis of pancreatic injury?
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dogs and cats
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Besides pancreatic injury, what two other clinical states can TLI increase?
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decreased GFR and dexamethazone administration
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What is the gold standard for the diagnosis of EPI in dogs?
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TLI decreased
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Where is LPL found?
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surface or hepatocyte and adipocytes
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What is used to determine the pancreatic lipase immunoreactivity in dogs and cats?
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radioimmunoassay (RIA)
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What is the most sensitive and specific diagnosis of pancreatitis in dogs and cats?
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serum PLI
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