SA Med F, Pancreatitis

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SA Med F, Pancreatitis
2013-05-02 21:58:12
SA Med Pancreatitis

SA Med F, Pancreatitis
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  1. What makes up >90% of pancreatic mass, endocrine or exocrine pancreas?
    exocrine pancreas
  2. what are some factors that stimulate pancreatic secretions?
    • -site, smell, consumption of food
    • -acids in duodenum stimulate secretin which triggers release of bicarb rich fluids
    • -food in duodenum stimulates cholecystokinin then release of pancreatic enzymes
  3. What vitamin absorption does pancreas have special role in?
    B12 (intrinsic factor)
  4. what is the inactive form of enzymes released by pancreas? how are they activated?
    zymogens reach duodenum then enterokinase cleaves inactive trypsinogen into active trypsin - then trypsin activates others in cascade effect
  5. what is role of pancreatic secretory trypsin inhibitor made by acinar cells?
    will inactivate any trypsin that is prematurely activated
  6. should zymogens, amylase or lipase be found in normal patient's blood?
    yes, small amounts leak into circulation but protease inhibitors bind/inactivate them
  7. what blocks reflux of duodenal contents back to the pancreas?
    muscular sphincters
  8. what are two factors that can lead to increased severity of pancreatitis?
    • poor perfusion of pancreas
    • inhibitors overwhelmed/consumed
  9. T or F: Pancreatitis always has the potential to be fatal; although this is not common if treated early/aggressively.
  10. what are some possible end results of pancreatitis?
    hypotension, DIC, shock, death
  11. what are some risk factors for pancreatitis?
    • nutrition (obesity/ hi fat diet)
    • hyperlipoproteinemia
    • duodenal reflux
    • ischema/hypovolemia
    • trauma/sx
    • diabetes mellitus, cushings, (hypothyroidism)
    • drugs: L-asparginase, anticonvulsants
  12. what makes miniature schnauzers more prone to pancreatitis?
    hyperlipidemia, hi triglycerides
  13. Although variable, what are some common clinical signs?
    • vomiting (90%)
    • abdominal pain (right cranial or anywhere)
    • weak, anorexia, depressed
    • diarrhea
    • fever, jaundice
  14. what are some signs that pancreatitis is severe case?
    • hemorrhagic diarrhea
    • petechia/ecchymosis
    • resp. distress, tachycardia
    • shock/death
  15. what will MDB show for pancreatitis patient?
    • inflammatory leukogram
    • azotemia (pre-renal, renal)
    • elevated liver enzymes, elevated bilirubin
    • hyperglycemia, hypoK (transient DM)
  16. what is expected acid base balance with pancreatitis?
    • marked metabolic acidosis
    • if vomiting, may be alkalotic
  17. What are some reasons other than pancreatitis that cause elevations in serum lipase/amylase?
    • azotemia
    • dexamethasone; cushings
    • small intestine/other organs also have lipase/amylase
  18. what is a reliable and convenient test for evaluating for pancreatitis?
    canine pancreatic specific lipase (PLI)
  19. what are expected findings with ultrasound?
    • enlarged pancreas
    • hypOechoic (darker than normal)
    • surrounded by hyperechoic omentum
    • (so dark structure surrounded by brightness)
  20. what is usually the basis of a pancreatic abscess?
    • *sterile inflammation*
    • very rarely infectious
  21. how is pancreatitis treated?
    • fluids, electrolytes
    • NPO in the beginning
    • anti-emetics
    • low fat diet
    • potent analgesia
    • plasma if coagulopathy
  22. why do some give plasma even in absence of coagulopathy?
    contains alpha 2 inhibitors that can inactivate circulating enzymes
  23. what is reason for giving antibiotics for pancreatitis patient?
    • *sterile* inflammation but leukopenia and duodenal inflammation can lead to sepsis
    • *pancreatitis is NOT infectious*
  24. what is cause of feline pancreatitis? how do they present?
    • part of triaditis (pancreatitis not primary condition)
    • often subclinical; vomiting NOT common in cats