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Pancreas

Hayley Pfeffer 4th year Pathology, semester 1 AS - Level Inglés 76 fichas

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  1. 1What is the function of the pancreas?secretes enzymes that aid in digestion and absorption of nutrients
    releases hormones involved in control of blood glucose
  2. 2In which animals is pancreatic disease uncommon in?grass eaters
  3. 3What may cause too little activity in the pancreas?EPI
    DM
  4. 4What may cause too much activity in the pancreas?pancreatitis
    neoplasia
  5. 5What is pancreatic acinar atrophy?immune mediated destruction of the pancreatic cells- end up with almost no pancreas
  6. 6Which breed is predisposed to pancreatic acinar atrophy? when do signs of maldigestion start to occur?German shepphards
    6-12 months
  7. 7What CS do you see with pancreatic acinar atrophy?rapid weigt loss despite big appetite
    DM doesn't develop
  8. 8What does chronic pancreatitis or repeated acute pancreatitis lead to? what age usually affected?repeated inflammation leads to fibrosis
    pancreatic tissue becomes hard
    EPI develops
    older than 5
  9. 9What is a gross sequalae to pancreatic atrophy?numerous hyperplastic nodules
  10. 10Are pancretic nodulars always indicative of pancreatitis?no- can also be seen as incidental lesions in dogs and cats
  11. 11What are the effects of EPI on the body?Too little enzyme activity reduced digestion
    less aborption from intestine
    get weight loss and malnutrition
    undigested food in GIT also encourages bacterial fermentation- diarrhoea/bad smell
    animals often vitamin deficent
    Cats loose ability to absorb B12
  12. 12Why are cats with EPI low in vitamin B12?can't make intrinsic factor- only made in pancreas in cats
  13. 13What are the CS of EPI?weight loss
    polyphagia
    vomiting, diarrhoea- due to irritation of absorption of toxins
    poor hair coat
    pale, voluminous, greasy faeces
  14. 14What is the Clin path of EPI? -blood work -biochem -blood glucose -amylse + lipase -TLImild anaemia
    stress leukogram
    -occassional liver damage
    -sometimes hyperglycaemia if concurrent DM
    -amalyse + lipase normal
    -low TLI
  15. 15What is the difference between acute pancreatic necrosis and pancreatitis?APN is spontaneous activation of enzymes in the pancreas causing necrosis adn pancreatitis is due to spread of infecton
  16. 16What animal does acute pancreatic necrosis affect? why? what CS can it casue?dogs- indiscriminate eaters
    abdominal pain- praying position
    anorexia, vomiting, lethargy. dehydration
  17. 17What can acute pancreatic necrosis lead to?EPI and DM
  18. 18What is affected in the mild, mod and serious forms of acute pancreatic necrosis?mild- inflam and necrosis in pancreasis
    mod- nearby organs affected- fat, stomach, duo
    serious- distal organs affeted
  19. 19What may acute pancreatitis necrosis be associated with in dogs?obesity
    high fat-low protein diet
    recent fatty meal
    abdominal trauma
    ect
  20. 20What may acute pancreatic be associated with in cats?trauma- 2ndary to ischemia
    toxoplasma gondii infection
    FIP
    ect
  21. 21What clinical signs do you see in cats with pancreatitis?Hard signs!
    anorexia, lethargy, dehydration
  22. 22how does acute pancreatic necrosis appear grossly?necrosis and nodular hyperplasia
    haemorrhgae and fibrosis
  23. 23What do you see on acute pancreatic necrosis CBC?inflammatory leukogram- dogs
    HCT elevated due to dehydration
  24. 24What do you see on acute pancreatic necrosis biochem?Increased ALT + AST= hepatic ischemia due to hypovolaemia or toic products from pancreas
    Increased ALP and cholestrol = choleostasis
    Azotaemia
    -pre renal (may become renal) - secondary to dehydration adn hypovolaemia
  25. 25What do you see on acute pancreatic necrosis pancreatic enzymes?Amylase and lipase peak within hours- then drops over days to weeks
    positive pancreatic specific lipase
  26. 26Can you say an animal has pancreatitis if amylase and lipase increased? why??no- they arise from the pancrease, small intestine and liver and excreted in the urine
    so..pancreatic, intestinal, hepatic or renal disease may increase activity
  27. 27What test is more specific to the pancreas then lipase and amylase?Pancreatic specific lipase TLI
  28. 28What may cause pancreatitis in horses?Gi, hepatic or immunological disease
    secondary to migrating strongyle larvae adn cholangitis
  29. 29How common are exocrine pancreatic neoplasms?rare
  30. 30What are the CS and Clin path of exocrine pancreatic neoplasms similar to?pancreatitis
  31. 31What does the endocrine pancreas secrete?Insulin
    glucagon
    somatostatin
  32. 32What does insulin do?moves glucose into cells and prevents new glucose formation in the liver
  33. 33What does glucagon do?moves glucose out of cells
  34. 34What does somatostatin do?decreases the release of insulin, glucagon adn digestive enzymes
  35. 35What disease causes underactivity of the pancrease?DM
  36. 36What disease causes over activity of the pancreas?insulinoma
  37. 37What type of diabetes do dogs get? how?Type 1 -inadequate production by pancreatic beta cells
    low insulin production follows chronic relapsing pancreatitis-pancreatic tissue replaced by non functional fibrous connective tissue
  38. 38What type of DM do cats get? How?Type 2- insulin resistance- decreased sensitivity of target cells
    High blood glucose causes insulin antagonism by cortisol. Beta cells secrete insulin- get co-secretion of amylin- amylin doesn't readily break down and accumulates- poisons beta cells which reduce insulin secretion- results in woresening hyperglycaemia. Chronic hyperglycaemia results in glucose toxicity- damaged further b cells
  39. 39What predisposes cats to DM?Obesity
    systemic disease
    stress
  40. 40Can gets recover from DM?yes- glucose toxicity and insulin resistance decrease
  41. 41CS of DM in dogs? less common CS?progressive weight loss despite polyphagia
    PU/PD
    generally well
    Middle aged +
    cataracts, reduced excercise tolerance, UTI, concurrent ketoacidosis
  42. 42Why may a dog with DM get cataracts?osmotic effect of glucose metabolites within the lens
  43. 43Why may DM cause a UTI?glucose in urine
  44. 44Why may DM cause ketoacidosis?the break down in fat is used as an energy source if DM goes on for long enough
  45. 45Signalment and CS of DM in cats? less common CS?old
    overweight
    often male
    PU/PD, weightloss, anorexia
    muscle wasting, peripheral neuropathy, weakness
  46. 46Why do DM animals get Pu/Pd?Blood glucose exceeds renal threshold- osmotic diuresis- get PU -get secondary PD
  47. 47Why do DM animals loose weight?urinary loss of calories
    muscle and fat catabolism for alternative energy source
  48. 48Why does the liver become damaged in pancreatitis?hepatic lipid infiltration
  49. 49What do you see on CBC in an animal with DMmild non regenerative anaemia
    stress leukogram
  50. 50What do you see on biochem in an animal with DM and why-increased liver enzymes- lipid infiltration
    -increased cholesterol and triglycerides- fat mobilisation
    -pre-renal azotaemia- dehydration
    -renal azotaemia - ascending UTI or hyperglycaemia induced vascular damage
  51. 51What do you see on on blood glucose in an animal with DMfasting blood glucose elevated
  52. 52What else (besdies DM) can cause a mild increase in glucose? which animal can't you dx DM with blood glucose testing?stress
    cats
  53. 53What does fructosamine reflect and why is it useful?blood glucose over 3-4 weeks
    means you don't have stress as a ddx
  54. 54What may you see on An UA in a DM patient?glycosuira
    bacterial infection +/-
  55. 55Explain the pathophysiology of Diabetic ketoacidosisCells are starved of glucose. Adipose tissue releases FFAs as alternative source of energy. FFA go to the liver and are converted into ketones. ketones are produced faster then they can be utilised- accumulate. ketones are strong acids and dissociate into H+ -causing acidosis
  56. 56What are the CS of ketoacidosis?PU/PD
    normal or increased appetite
    CNS depression
    dehydration
    vomiting
  57. 57What is the clin path of ketoacidosis? CBC?haemoconcentration secondary to dehydration
    anaemia due to oxidative damage
    leukcytosis due to inflam or infection
  58. 58What is the clin path of ketoacidosis? biochem?Hyperglycaemia
    ketonaemia
    elevated blood triglycerides
    elevated liver enzymes- lipidosis
    pre renal azotaemia (dehydration)
    renal azotaemia (ascending UTI)
    hyponatreamia- vomiting and urinary loss
    low k+
    Changes in phosphate
  59. 59What can cause phosphate to increase or fall?Increase if GFR falls
    decrease with insulin- dragged intracellularly with glucose
  60. 60What is the clin path of DM ketoacidosis? UA?glucosuria
    ketonuria
    UTI frequent
  61. 61is Equine metabolic syndrome a form of type 1 or 2 diabetes?type 2
    Tissue fails to respond to inssulin due to obesity
  62. 62Do horses with EMS get hyperglycaemia?Not initially because it is compensated but if left long enough BG will rise
  63. 63Which horses are most at risk of developing EMS?obese ones- fat around neck, shoulders and rump
  64. 64EMS should eb considered in horses that are ___ and have ____obese
    lamintis
  65. 65A horse has EMS. what do you expect to see on CBC and biochem?no abnormalities on CBC
    no abnormalities on biochem- rarely see increased glucose as uncompensated insulin resistance uncommon
  66. 66What do you expect insulin to be in an EMS horse?Elevated
    BUT
    acute stress, ecspecially if pain related (laminitis) can decrease insulin
  67. 67When should you measure insulin levels and why?After a period of hay and fasting becasue horses on concentrates can have falsely elevated insulin
  68. 68Which cells is an insulinoma a tumour of?pancreatic beta cells
  69. 69What do insuinoma cause in terms of glucose release?excessive release
  70. 70What animals do insulinomas occur in?ferrets
    dogs
    cattle
  71. 71What are insulinoma CS secondary to? what are the CS?hypoglycaemia
    weakness
    confusion, ataxia, change int temperament
    Seizures
  72. 72Why do seizures not occur sooner? in a normal animal with glucose levels this low they would be seizuringThere is a release of anti-insulin hormones (adrenaline, glucagon) which maintain blood glucose above seizure threshold
  73. 73What do you see on CBC and biochem with a insulinoma?anaemia of chronic disease
    stress leukogram
    hypoglycaemia
    +/- mildly elevated liver enzymes
  74. 74To diagnose a insulinoma, glucose should be___ and insulin should be______low
    high
  75. 75What are DDX for hypoglycaemia?hypoadrenocortisim
    Insulioma
    other tumours
    sepsis
    hepatic insufficiency
    xylitol toxicity
    Artefact
    neonatal and toy dog hypoglycaemia
    working/hunting dogs and endurance horses
    lactational hypoglycemia in high producing dairy cows
  76. 76—

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AS - Level 4th year Pathology, semester 1 Fichas sobre Pancreas, creado por Hayley Pfeffer el 06/06/2016.
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Hayley Pfeffer
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