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68 Cards in this Set
- Front
- Back
- 3rd side (hint)
Is exocrine pancreatic insufficiency a disease?
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No, it's a syndrome
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What are the 6 primary clinical signs of EPI?
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1) Malabsorption
2) Malassimilation 3) Diarrhea (severe) 4) Steathorrea 5) Weight loss 6) Failure to thrive* -most common except cats |
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What dog is most commonly affected by EPI?
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German shepherd
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Why do we see decline in growth rates and potentially weight loss in animals with EPI?
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Pancreatic acinar atrophy starts manifesting at about 6-9 months of age and a peak diagnosis at about 12 mo of age= still growing at this time so see decline in growth
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What age of dogs usually develop EPI?
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Adults
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Exocrine pancreatic insufficiency is the end result of________.
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Pancreatic Acinar atrophy
= selective loss of enzyme secreting acinar cells |
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Are the cells of the endocrine pancreas or pancreatic duct cells affected by EPI?
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NO= NOT associated with diabetes mellitus, bicarbonate excretion is normal
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What dogs have evidence of an inherited link to pancreatic acinar atrophy?
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German shepherds and rough coated collies
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If pancreas' with pancreatic acinar atrophy are biopsied and pathologists try to identify those who will develop EPI, what are they looking for?
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Early histology shows chronic lymphocytic/ plasmacytic pancreatitis correlates
-autoimmune?- but don't benefit from glucocorticoids |
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What is most likely the main cause of EPI in cats?
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Chronic pancreatitis
-also common in humans |
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What are 5 other potential causes of EPI other than pancreatic acinar atrophy?
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1) Chronic pancreatitis
2) Congenital pancreatic hypoplasia -pancreas didn't develop in first place 3) Pancreatectomy surgery -remove part of pancreas it's going to be insufficient 4) Pancreatic cancer 5) Pancreatic duct abnormalities -aberrant duct entering the LI instead of the SI (need enzymes to get to right place to work) |
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What is the only possible other cause of EPI (not pancreatic acinar atrophy) that does not decrease serum TLI? Why?
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Pancreatic duct abnormalities: normal bc normal size pancreas delivering enzymes to wrong place whereas everything else has a loss of pancreatic mass; may need enzyme replacement therapy
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Why do animals with pancreatitis have maldigestion and malabsorption?
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Lack of digestive enzymes
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What type of diarrhea do animals with EPI get? What do the feces look like?
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Small intestinal
-loose poorly formed "pulpy" feces |
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Describe the defecation frequency and fecal volume of an animal with EPI.
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Large volume but normal number of defecations
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How can you tell when an animal has fat malabsorption (like with EPI)?
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Steatorrhea: Light tan to grey feces
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What's the major cause of diarrhea in animals with EPI?
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fat malabsorption
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What causes the osmotic pull of water into the small intestine in animals with EPI?
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Oxidation and degradation of fat by intestinal bacteria produces toxic fatty acids, stimulates additional water secretion by small intestine
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Why do dogs with EPI show signs of copraphagy?
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Because they're hungry
-occasionally seen in cats |
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At what age do dogs with pancreatic acinar atrophy tend to show signs of EPI?
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18 months to 2 years of age
-normal growth, then weight loss, failure to continue to grow |
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Why do animals with EPI get lots of gurgling noises and flatulence?
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Because lots of bacterial fermentation producing gases
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What is a common sign of EPI in cats?
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Poor hair coat
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Are clinical signs for EPI pathognomonic?
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Nope, similar signs to small intestinal disease bc pathology is essentially due to decreased SI absorption so it makes sense
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What are the 3 primary differential diagnoses for EPI?
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1) Small intestinal disease
2) Hyperthyroidism** -cats w/ diarrhea & wt. loss -same signs 3) Diabetes mellitus -polyphagia & wt loss |
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What are 7 types of small intestinal disease that are a differential diagnosis for EPI?
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1) IBD
2) Ecological disorders -small intestinal bowel disease 3) Chronic salmonellosis, campylobacteriosis 4) Helminths: hookworm, whipworm 5) Protozoal diseases: giardia 5) Dietary intolerance or allergy -very rare to have true allergy 5) Lymphangectasia -lymph is a main route of absorbing fat |
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Though there are rarely significant changes in routine chemistry in animals with EPI, what are 3 changes you may see on a CBC/chem & UA?
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1) Mild elevation in liver enzyme activities
2) Hypoproteinemia / hypoalbuminmia if secondary 3) Hypocholesterolemia |
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Are amylase/lipase levels relevant to EPI diagnosis?
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NO
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What is the purpose of doing a fecal float or smear in a dog that you suspect has EPI?
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Looking for parasites such as giardia that cause small intestinal disease
-for giardia use ZnSO4 |
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What are some specialty tests that you can request when you suspect EPI?
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TLI
Cobalamin Folate |
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Why would we want to measure cobalamin in an animal that you suspect has EPI?
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Cobalamin deficiency is common in patients with EPI and if they do have this it makes it harder to manage them and makes them feel unwell in general
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What is the test of choice for EPI and pancreatic acinar atrophy in dogs and EPI in cats?
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Serum trypsin-like immunoreactivity (TLI)
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****In a dog when are TLI levels diagnostic for EPI?
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Serum [TLI] <2 ug/L
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*****In a cat when are TLI levels highly suggestive of EPI?
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Serum [TLI] <8 ug/L
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How do you test fecal proteolytic activity?
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X-ray degradation test, Gelatin degradation
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Is fecal proteolytic activity measured very commonly when diagnosing EPI? Why or why not?
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No, because false negatives and false positives are common
-but still useful in exotics |
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What are 4 diagnostic tests used to diagnose EPI?
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1) Serum TLI
2) Fecal proteolytic activity 3) Fecal elastase -in europe 4) Fecal fat determination -steatorrhea is seen in lots of other diseases |
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What is the only advantage that fecal elastase has over TLI for diagnosing EPI?
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TLI is a radioimmunoassay so have to use radioactive materials and fecal elastase doesn't use radiation
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Do cats or dogs get EPI more commonly?
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Much lower in cats
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What most commonly causes the signs that are seen in animals with EPI in cats?
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Small intestinal disease by far
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What is a big difference in the vitamin levels of a dog with EPI compared to a cat with EPI?
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Almost all cats with EPI have cobalamin deficiency
-in the dog it's less common |
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What does it mean if a dog's serum concentration of TLI <5 but >2?
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may represent a subclinical state of EPI, PAA cases that have not yet reached full-blown EPI, or just normal for the dog
-Exocrine pancreas has sizable reserves, need to lose essentially all exocrine tissue to see clinical signs |
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How should you medically manage a dog that has signs of small intestinal disease with a serum concentration of TLI <5 but >2?
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Most dogs respond well to dietary change (fat restriction) and don't need enzyme supplementation
-W/D, R/D |
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When do we use enzyme replacement therapy for animals with EPI?
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If full blown loss of exocrine pancreas
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What should you use for enzyme replacement therapy
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Porcine Pancreatic enzyme extracts (Pancreazyme, Viokase)
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what type of enzyme replacement therapy does NOT work?
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Plant derived-products
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How much enzyme replacement therapy should you give an animal with EPI?
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Start w/ 1 tsp of powdered extract/ meal for typical german shepherd dog
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What type of vitamin supplementation should be given to an animal with EPI?
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-Fat solubles (A,D,E,K)
-Cobalamin in all cats and many dogs |
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What are 4 things to consider if there's no response to an animal whose been on treatment for EPI for 2-3 weeks?
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1) Consider dose increase
-risk of gingivitis and periodontal bleeding (from increasing enzymes & mouth isn't meant to be exposed to active enzymes) 2) Consider antibiotic therapy -Tylosin for secondary dysbiosis, metronidazole -for secondary bacterial overgrowth 3) Consider antacid therapy -enzymes may be damaged by gastric acid 4) Pred at 1 mg/kg SID for secondary inflammatory disease (abnormal GI function) |
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How long do you have to give enzyme replacement therapy to animals with EPI?
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Lifelong
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Why are ~20% of EPI cases euthanized within 1 year of diagnosis?
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Cost of therapy
-poor response, food aversion in cats |
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What is the prognosis of EPI with treatment?
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Adequate therapy and attention to diet, prognosis is good for a reasonable quality of life
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Why is it so important to diagnose EPI in an animal?
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Because they need enzyme replacement therapy
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What is the most common pancreatic malignancy in dogs?
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Adenocarcinoma, but not a common diagnosis
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What is the prognosis of adenocarcinoma of the pancreas?
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Prognosis is grave to hopeless
-usually present or are diagnosed at a late stage |
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What dogs do not uncommonly get nodular hyperplasia?
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Older dogs
-benign process |
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Pancreatic ______ are also seen in dogs, diagnosed on histopathology.
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Pancreatic adenomas
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What is a pancreatic pseudocyst?
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Fluid filled structure associated with or within the pancreatic parenchyma
-lack an epithelial lining= pseudocyst |
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How are pseudocysts related to pancreatitis?
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Pseudocysts are a complication/ sequel of acute pancreatitis and often present w/ pancreatitis signs, but may be a benign or incidental finding
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Are there any negative consequences of having a pancreatic pseudocyst?
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Yes, often contain large amounts of digestive enzymes, so can rupture and cause acute severe peritonitis signs
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Do pancreatic abscesses contain pancreatic enzymes?
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Nope, a collection of inflammatory cells/ inspissated pus associated with the pancreas, but lacking significant quantities of pancreatic enzymes
-usually sterile, but if infection occurs can get severe disease. |
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What is the treatment of choice for a pancreatic abscess?
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Surgical drainage is treatment of choice. but significant post-operative morbidity and mortality.
-if not clinical, monitor size and treat conservatively |
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What are 2 pancreatic parasites?
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1) Eurytrema procyonis
2) Amphimerus pseudofelineus |
q
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What animals are infected by Eurytrema procyonis?
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Pancreatic fluke of cats, also found in foxes and raccoons
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What are the physical consequences Eurytrema procyonis?
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Heavy infestation can lead to pancreatic duct fibrosis
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How do diagnose Eurytrema procyonis? An how do you treat it?
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-Diagnose from characteristic eggs in feces
-Treat with with fenbendazole for six days |
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What is Amphimerus pseudofelineus? What organ is it found in?
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Hepatic fluke of cats, can also be found in the pancreas, causes signs of chronic pancreatitis
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How do you diagnose Amphimerus pseudofelineus?
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Eggs are destroyed in routine fecal float, need formalin-ethyl acetate sedimentation.
*Have to know your looking for the eggs since fragile |
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What is the treatment for Amphimerus pseudofelineus?
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Treat with praziquantel for 3 days as well as routine approach for chronic pancreatitis
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