Drugs associated with acute pancreatitis in dogs (8)
- potentiated sulphonamides
- phenobarbital
- potassium bromide
- azathioprine
- L-asparaginase
- meglumine antimoniate
- N-méthyl glucamine
- clomipramine
in cats: organophosphate cholinesterase inhibitors (topic fentathion)
True or false: zinc intoxication is associated to canine AP
true
What is the role of SPINK1?
SPINK1 = intracellular pancreatic secretory trypsin inhibitor
=> complete the protective mechanism of separation of proenzyme (zymogen granules) and lysosomal enzyme (lysosomes) by Golgi apparatus
In the pathogenesis of AP, what is the role of lymphocyte function associated antigen 1 (LAF-1)?
key role in the emigration of neutrophils from blood to tissue
=> LFA-1 antagonist might be of benefit for treating AP
FUZAPLADIB
What is the receptor which mediates pain in AP?
neurokinin-1
=> maropitant = receptor antagonist of neurokinin-1
What is the key cells intervening in chronic pancreatitis?
Pancreatic stellate cells
True or false: spec CPL >/= 400 µg/L is not suggestive of pancreatitis
false
spec CPL >/= 400 µg/L is highly suggestive of pancreatitis
Sensitivity and specificity of spec cPL in dogs
Se= 72-78%; Sp= 81-100%
Sensitivity and specificity of SNAP cPL in dogs
Se= 91-94 %; Sp= 71-78%
=> to rule out pancreatitis => most important is Se
Sensitivity and specificity of US for diagnosis of acute pancreatitits, caveats in dogs
Depends on the number of criteria used:
- 1 criteria (pancreatic enlargement or hypoechoic areas within the pancreas) => Se= 89%; Sp= 43%
- If multiple criteria used=> Se= 43%; Sp= 92%
True or false: cytological of pancreatis is very often non diagnostic for pancreatic disease and the agreement with histopathological analysis is low
false
diagnostic in 74% of cases
agreement of 91%
What are the physiological consequences of pain? (4)
- decreased appetite
- decreased GI motility
- impaired regional blood flow of abdominal organs
- catabolic state
Definition of ultra-low fat diet (g of fat/1000 kcal)
20g of fat per 1000 kcal
What is the evidence of AI etiology in chronic pancreatitis in English Cocker Spaniel?
positive staining for IgG4 of plasma cells
True or false: hypercalcemia is associated with AP in cats
true
True or false: hyperglycemia is rarely encountered in feline AP
false
45% of cases
due to relative or absolute insulin deficiency
DDX of increased fTLI (5)
-EPI
- pancreatitis
- decreased GFR
- CE
- GI lymphoma
Se, PPV, NPV for Spec fPL
moderate to severe pancreatitis: Se= 100%
mild pancreatitis: Se= 54%
PPV= 90%; NPV= 76%
3 US criteria of chronic pancreatitis in cats
- irregular pancreatic capsular margins
- dilation of the pancreatic duct (>2.5 mm) or common bile duct
- hyperechoic pancreatic echogenicity
Se, Sp, PPV, NPV of US for diagnosing pancreatitis in cats
Se= 11-67%
Sp= 73%
PPV= 80%
NPV= 57%
WHich is the best pancereatic lobe to biopsy in order to obtain a diagnosis of pancreatitis?
left lobe
For enteral nutrition in cats, what are the 2 most important AA contents to avoid hepatic lipidosis?
arginine, methionine
Causes of EPI in dogs and cats
the most common cause is an absolute lack of pancreatic acinar cells due to:
- destruction of acinar cells secondary to chronic pancreatitis (dogs cats)
- depletion of acinal cells due to pancreatic acinar atrophy (dogs)
other causes less frequent:
- obstruction of the pancreatic duct by trauma, tumor, surgical damage
- exocrine pancreatic aplasia or hypoplasia (1 kitten)
- isolated lipase deficiency
What is the role of colipase secreted by exocrine pancreas?
necessary to overcome the lipase-inhibiting properties of bile acids
