Canine Feline diseases of organs associated with GI (pancreas and liver)

Glandular portions of the pancreas

Endocrine and exocrine.

Endocrine portion of pancreas.

Pancreatic islets. “Islets of Langerhans” (1% of pancreas - tail end). Has several different cell types.

What is the pancreas considered

A “mixed gland”.

Endocrine hormones and cells that secrete them in the pancreas.

Glucagon (increase BG levels), insulin (regulates sugar metabolism & maintain sugar), Somatostatin (regulates release of insulin & glucagon.). The cells are alpha, beta and delta.

What part of the pancreas is the endocrine part

The tail the smallest part. (1% of pancreas)

Where is glucagon stored

In the liver

Exocrine portion (physical)

Groups of acini (saclike cavity in gland surrounded by secretory cells). Ducts merge to converge into pancreatic duct.

Exocrine portion what it does

Excretes bicarbonate and digestive enzymes. Anticipation of food causes increase of secretions. Neural and endocrine stimuli increase secretions.

What are vital to digestion (from pancreas). And different types

enzymes. Lipase, amylase, nuclease, protease

Proenzyme (or zymogen)

All proteolytic enzymes secreted in their inactive form!! (pro because not activated)

What starts the activation process of enzymes?

CCK (cholecystokinin)

Pancreatitis

Trypsin is activated prematurely within the pancreatic tissue. Autodigestion of pancreatic tissue which causes inflmmation of necrosis. Is normally acute in dogs and chronic in cats.

Acute Pancreatitis triggers.

Dietary indiscretion, blunt force trauma, hypoperfusion of the pancreas, pancreo toxic drugs.

Chronic pancreatitis causes is often what?

Uknown/ idiopathic

Chronic pancreatitis in cats.

Inflammation of the bile duct, liver or small intestine are often seen with chronic pancreatitis.

Clinical signs of Acute pancreatitis

Anorexia, vomiting, abdominal pain, diarrhea, fever,.

Clinical signs of Chronic Pancreatitis

Anorexia, lethargy, weight loss, hypothermia, vomiting. Can often lead to EPI and DM.

Definitive vs presumptive diagnosis of pancreatitis

Definitive is by biopsy, but presumptive is more common.

Presumptive dx of pancreatitis is based on

Lab work, imaging, and clinical signs.

Treating Acute pancreatitis

IV fluids, analgesics, anti-emetics, mucosal protectants, feeding low fat, bland diet.

Treating Chronic pancreatitis

GI signs, treatment of any concurrent diseases.

Exocrine pancreatic insufficiency

Insufficient production and secretion of pancreatic digestive enzymes

Exocrine pancreatic insufficiency in dogs

Related to pancreatic acinar cell atrophy

Exocrine pancreatic insufficiency in cats

Related to chronic pancreatitis

Result of no digestive enzymes from EPI

Maldigestion and Malabsorption of nutrients

EPI clinical signs

Polyphagia, weight loss, chronic diarrhea, steatorrhea, greasy hair coat from poor absorption of fatty acids.

What is steatorrhea?

Pale, fatty, often voluminous stools.

Treatment of EPI

Oral replacement of pancreatic digestive enzyme given at mealtime.

What oral supplement do we give for EPI

Cobalamin supplementation

What is the Hepatobiliary system combined of?

Liver and gallbladder.

What do you need to do before exam!!

Review anatomy of liver and pancreas.

Hat can severe hepatobiliary disease result in?

Hepatic encephalopathy

Diagnosing Hepatobiliary diseases Lab abnormality increased value?

Increases in serum liver enzymes, bilirubin, ammonia, and bile, acids.

Diagnosing hepatobiliary diseases lab abnormalities decreased values

Decreases in blood glucose, albumin, and urea nitrogen. Can see bilirubinuria, ammonia biurate crystals.

Diagnosing Hepatobiliary diseases diagnosis imaging

Radiographs and ultrasound.

Diagnosing Hepatobiliary diseases histapathology

Biopsy of liver

Hepatobiliary disease treatments

Nutritional support, antioxidant therapy, antibiotics, anti-inflammatories.

Feline hepatic lipidosis What is it

Accumulation of fats or lipids within the cytoplasm of hepatocytes. **Cells swell & casue cholestasis & hepatic damage **

Causes of feline hepatic lipidosis?

Obese cats, environmental stresses, concurrent diseases that promote anorexia, sometimes idiopathic.

Clinical signs of Feline Hepatic Lipidosis

Dramatic weight loss, lethargy, vomiting, icterus, dehydration, encephalopathy.

Definitive and presumptive diagnosis Feline Hepatic Lipidosis

Liver biopsy is the definitive diagnosis. Presumptive dx include Hx, PE, imaging, chemistries.

Treating Feline Hepatic Lipidosis

Aggressive nutritional support, and treating any underlying conditions.

What is Cholangitis?

Inflammation of bile ducts

What is cholangiohepatitis?

Inflammation of bile ducts and liver.

Can Feline Colangitis/Cholangiohepatitis be Acute and chronic?

Yes it can be acute and chronic

Acute Cholangitis

Often from ascending bacterial infection from small intestine, neutrophil infiltration.

Clinical signs of acute feline cholangitis/cholangiohepatitis

Fever, vomiting, lethargy, icterus, abdominal pain.

Possible chronic cholangitis

Immune-mediated dz, progression of acute dz, liver flukes. Lypmhocytic - plasmacytic inflammation.

Clinical signs of chronic cholangitis

Anorexia, weight loss, lethargy, icterus.

How to diagnose and differentiating between Cholangitis and Cholangiohepatitis

History, clinical signs, blood work, imaging, bile culture, liver biopsy.

Treating Feline Cholangitis/Cholangiohepatitis

Fluid therapy, antioxidants, antibiotics, ursodiol (prescription bile acid), nutritional support, vitamin supplements.

What is added to the treatment for chronic cholangitis

Glucocorticoid therapy.

Canine Chronic Hepatitis

Inflammation of liver parenchyma. Chronic after 4-6 months.

Causes of Canine Chronic hepatitis

Viral infections, bacterial infections, copper storage disease, hepatotoxic drugs.

Progression of Canine Chronic hepatitis

Hepatocytes swelling and necrosis, then that leads to loss of hepatic mass, which then leads to loss of liver function. Hepatic fibrosis, high BP in the portal system, Cirrhosis (fibrosis). V

Clinical signs non-specific Canine Chronic hepatitis

Vomiting, diarrhea, anorexia, weight loss, PU/PD, Icterus, ascites with portal hypertension, GI ulceration, hepatic encephalopathy.

How much of liver mass is lost before clinical signs are seen?

75% of the liver mass is lost before clinical signs

Final diagnosis of Canine Chronic hepatitis can only be made with?

Liver biopsy

Presumptive DX of Canine Chronic hepatitis can be made on

Clinical signs, persistently elevated serum liver enzymes, abnormal liver function tests. Diagnostic imaging showing microhepatica.

Portosystemic Shunts and Hepatic Encephalopathy

Vascular abnormalities. Extrahepatic or intrahepatic

Extrahepatic Portosystemic Shunts and Hepatic Encephalopathy

Typically congenital. 1 or 2 vessels that connect the portal vein to VC. Toy breeds are more often affected.

Intrahepatic Portosystemic Shunts and Hepatic Encephalopathy

Portosystemic shunts (Vessels that bypass the liver for ex?), Congenital or acquired, secondary to portal hypertension, multiple small shunts within the liver, usually large breeds are affected.

Portosystemic Shunts Clinical signs

Hepatic encephalopathy, PU/PD, bladder signs due to urate stone formation, hypoglycemic episodes.

Young patient with congenital shunt

Usually are generally unthrifty with poor hair coat and poor BCS.

Diagnosis of Portosystemic Shunts

Elevated serum bile acids, hyperammonemia, visualization of vessels on US, contrast rads, surgery.

Who is usually diagnosed with congenital shunts? when?

Cats and dogs under 2 year of age.

Treatment of choice for Congenital shunts

Surgical ligation of extra-hepatic shunts

Who has more acquired shunts?

Older dogs with chronic hepatitis.

Treatment of Acquired shunts

Medical management is the only treatment for intra-hepatic shunts.

Hepatic Encephalopathy

When the brain is exposed to GI toxins (ammonia) because of decreased liver function or portosystemic shunts (PSS).

Clinical signs of Hepatic Encephalopathy

Seizures, head press.

When are signs of Hepatic Encephalopathy worse???

After eating a meal!!!

Treatment of HE focuses on addressing?

Increased IC pressure and seizures. Decreasing circulating ammonia.