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| Question | Answer |
| whats the main job of the exocrine cells in the pancreas | Its function is to initiate protein, carbohydrates and lipid digestion. They facilitate Vit B 12 (cobalamine) absorption as well as regulate the small intestinal flora. |
| what will the pancreas look like if it has pancreatitis? | oedematous, there will be necrotic areas and a neutrophilic infiltrate |
| why do neutrophils invade the pancreas during pancreatitis? | the zymogens are activated which means there is active trypsin causing inflammation by killing cells and realising immune mediators and causing a cytokine storm |
| what are the main factors that lead to an animal getting pancreatitis? | dietary factors, drugs, toxins, trauma, reduced pancreatatic perfusion, genetics, hypercalcaemia and duodenal/biliary reflux. |
| what are the symptoms of pancreatitis? | vomiting, anorexia, depression, abdominal pain, dehydration, diarrhoea, jaundice and shock. In rare cases some animals may get coagulopathies, cardiac, respiratory signs and PUPD. |
| what would be expected on a biochem panel in an animal with pancreatitis? | leucocytosis, increased liver enzymes, azotaemia (pre renal), hypokalaemia, hypocalcaemia, hyperlipaemia (it is debatable whether this is a cause or an affect). |
| what are reasons that amylase an lipase might increase? | acute pancreatitis, they increase in GI disease and with reduced GFR also |
| whats the specificity of trypsin like immunoreactivity, also whats its sensitivity like? | 70% (also altered by decreased GFR) and not very sensitive due to short half life |
| What are the tests for pancreatic lipase and what are the sensitivities and specificities for the tests? | SNAP test 91% sensitive but only 77% specific i.e. -ve can be taken as -ve quantification in a lab 85% sensitive and about 95% specific (in dogs). False positives if there is renal disease or steroids have been administered |
| what would you expect on an x-ray of an animal with pancreaitits? | loss of contrast (peritonitis), gastric duodenal angle widening and gastric displacement (very insensitive and unspecific) |
| whats the sensitivity and specificity of U/s and what would be expected to be seen in these cases? | hypoechoic and enlarged enlarged, hyperechoic peri-pancreatic fat, if good operator 68% specific |
| whats the gold standard for pancreatitis diagnosis? | biopsy |
| what are the pros and cons of biopsy in the diagnosis of pancreatitis? | anaesthetic risk!! The pathology is un evenly distributed so so not always very sensitive, not all pathology is significant either so it isn’t all that specific possibly only indicated if was planning sx any way |
| how should pancreatitis be treated? | The inciting cause should be removed if possible. Supportive treatment should be tried; IV fluids, analgesia, anti-emetics, gastric protectants and nutrition. |
| what two things may need to be supplemented if the bloods highlight it? | calcium (in calcium gluconate) and potassium in potassium chloride |
| what pain relief should be given in pancreatitis? | Buprenorphine/methadone although be aware that this doesn't relieve pain in the pancreas. NSAIDs contraindicated |
| What are the anti emetic options? | maropitants (blocks NK-1 receptors), metoclopramide (dopamine antagonist) or ondansetron. |
| if the animal is refusing food and has pancreatitis what should be done? | nasogastric tube and drip feed in at a rate of 1ml/kg/hr |
| why might plasma be given to a pancreatitis animal and whats the pros and cons of this? | Some people suggest giving plasma to supply alpha-2 macroglobulin (a protease inhibitor), there is no true evidence of this working, probably best reserved for coagulopathies and severely affected dogs. |
| why is pancreatic enzyme beneficial? | it decreases pancreas stimulation and provides analgesia |
| should antibiotics be used in pancreatitis? | not unless there is a pyrexia and GI sepsis, it is rare in dogs but common in humans |
| whats the mortality rates of pancreatitis? | 27-58% |
| what decreases the prognosis of pancreaitis? | cardiac abnormalities, respiratory abnormality, altered oncotic/hydrostatic pressure, anorexia for 3 or more days and low calcium. |
| what may chronic pancreatitis cause? | EPI or diabetes mellatitis |
| what is thought to cause pancreatitis in a cat? | Often seen with diseases such as triaditis, L-P enteritis and cholangitis. Bacterial infection may play a role. |
| what are the clinical signs of pancreatitis in cats? | anorexia, lethargy, (vomiting is rare), hypothermia (rarely fever), sometimes a cranial abdominal mass may be felt, diarrhoea, dehydration, icterus, pale mucous membranes, dyspnea, PUPD and polyphagia. |
| what is the cat specific tests? | Feline trypsin like immunoreactivity Feline specific protein lipase (quite sensitive and specific) |
| how is pancreaitits treated in cats? | antibiotics plus normal dog treatment |
| how can chronic pancreatitis different from acute pancreatitis? | mononuclear infiltrate with fibrosis |
| Which dogs are predisposed to chronic pancreatitis? | nclude; cavalier king charles spaniels, english cocker spaniels (multisystemic disease), boxers (although it never changes into EPI and DM) and collies. |
| how is chronic pancreatitis diagnosed? | biopsy |
| how is chronic pancreatitis treated? | analgesia, low fat diet, vitamin B12 if low, consider appetitie stimulands in cats, treat EPI if present as for DM. Consider corticosteroids especially in cats and cocker spaniels). |
| what are signs of EPI? | eight loss, poor hair coat, increase appetite, steatorrhoea, vti B12 deficiency (from lack of intrinsic factor so inability to uptake) diarrhoea and flatulence. |
| how should EPI be diagnosed? | Trypsin like immunoreactivity which is extremely sensitive |
| what should be measured if EPI is confirmed? | Vit B12 |
| how should EPI be treated? | The best management is a low fat diet (chappie!) given little and often, enzyme supplimenation in powder or granules. Enteric coated are the best 1 tsp/10kg is given in each meal initially then it is reduced down until it is at the lowest effective level. Cobalamine deficiency is common it affects the prognosis. Vitamin K should be given if required. |
| how do primary pancreatic neoplasias tend to present? | micro neoplasias discovered as an incidental finding, sometimes there will be non specific signs such as hyperglycaemia |
| where is a pancreatic neoplasia most likely to spread to? | They commonly spread to the liver, local lymph nodes, mesentery, intestines and lungs |
| whats the prognosis for pancreatic neoplasia? | poor! |
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