investigating panc dz

Acute pancreatitis - Pathogenesis

Trypsinogen → trypsin → proteases → tissue damage, coagulation, fibrinolysis, complement, kallikrein kinin

% exocrine pancreas

98%

Acute pancreatitis - Predisposing factors

Breed - spaniel, terrier

F

Neutered

Obese

Drugs

Concurrent dz

Diet - high fat

Purpsoe of exocrine panc

HCO3- production

Enzyme production

Intrinsic factor for vit b12

Disease associations with feline pancreatitis

Cholangitis

IBD

Hepatic lipidosis

DM

Acute pancreatitis - CS in dogs

Dehydration

Anorexia

V

Weak

Abd pain

D

Jaundice

Acute pancreatitis - CS in cats

Leth

Anorexia

V

Abd pain

D

Acute pancreatitis - Dx steps

Hx

PE

Lab tests

Imaging

Biopsy

Acute pancreatitis - What does haem + biochem show

Inc WBC (L shift Neutrophilia)

Inc glucose

Dec Ca

Inc liver enzymes

Jaundice

Acute pancreatitis - Why is measuring panc lipase better than total lipase + amylase

More specific, less affected by azotaemia, SNAP test

Acute pancreatitis - Norm panc enzyme levels in cat

<2000 amylase

<200 lipase

Acute pancreatitis - Norm panc enzyme levels in dog

<2000 amylase

<300 lipase

2.2-102 PLI

Acute pancreatitis - abd US

Hyperechoic mesentery

Enlarged + swollen pancreas

Acute pancreatitis - Issue with panc biopsy

GA exacerbate pancreatitis

Breed associated with primary hyperlipidaemia → Acute pancreatitis

Miniature schnauzer

Acute pancreatitis - Supportive tx options

o Pancreatic enzymes

o Fluid therapy

o Analgesia

o Nutritional support

o Anti-emetics

o AB?

o Steroids?

o sx?

Acute pancreatitis - initial diet therapy for how long

3-7d

Feed once V stops

Acute pancreatitis - ideal feeding tubes

Enterostomy - bypass panc but harder to maintain

Oesophagostomy - easiest

Acute pancreatitis - interim diet therapy for how long

3-28d

Water → small infrequent low fat meals

Acute pancreatitis - purpsoe of panc enzymes as tx

Reduce panc secretion → dec post prandial pain

Use as long as no appetite change

Acute pancreatitis - long term diet therapy for how long

>3w

Weight management

Acute pancreatitis - analgesia options

Buprenorphine

Paracetamol

Tramadol

Gabapentin

Acute pancreatitis - analgesia options to avoid

NSAID

Acute pancreatitis - why to give AB

Leaking intestinal wall → bacteraemia

Acute pancreatitis - anti emetics to give

Maropitant

Metoclopramide

Exocrine pancreatic insufficiency - cause + animal associations

Panc acinar atrophy - German shepherd, rough collie

Panc hypoplasia - <6mon

Chronic pancreatitis - cats

Exocrine pancreatic insufficiency - CS

Faeces- large vol. smell, steatorrhoea, putty like → D

Polyphagia, coprophagia, pica

V

Poor coat

Exocrine pancreatic insufficiency - ideal dx test

Trypsin like immunoreactivity blood test

Exocrine pancreatic insufficiency - TLI norm dog value

>5 μg/l

Exocrine pancreatic insufficiency - TLI EPI dog value

<2.5μg/l

Exocrine pancreatic insufficiency - TLI dog value to repeat in 4w

2.5-5μg/l

Exocrine pancreatic insufficiency - Tx

Pancreatic enzyme - powder, granules, fresh frozen mixed into meals

Highly digestible diet

Cobalamin supplement

Acid blockers

AB

Exocrine pancreatic insufficiency - Ideal food intake for weight

Maintenance x2

Exocrine pancreatic insufficiency - Common age for cats

7yrs

Exocrine pancreatic insufficiency - Feline CS

WL, D, polyphagia, coprophagia, anorexia, flatulence, V

Concurrent dz (leth, hair loss, PUPD, weak)

Exocrine pancreatic insufficiency - Feline dx

Serum TLI

Diet for EPI - calories for weight gain + maintenance

Mod Fat Highly digestible diet

When to give low protein diet

Portosystemic shunt

Exocrine pancreatic insufficiency - Feline tx

Oral panc enzyme

Cobalamin

Diet modification

AB

Treat other dz