What are the functions of the pancreas?
Secretes digestive enzymes, bicarbonate, and colipase
Promotes SI function
Protects against autodigestion (both local and systemic inhibitors)
What pancreatic cells primarily control the exocrine function of the pancreas?
How does the pancreas defend against autodigestion?
Synthesis of inactive zymogens
Storage in the rough ER
Production of trypsin inhibitor (PSTi)
Plasma protease inhibitors (alpha-macroglobulins)
What he wants us to recognize is that there is a local and systemic inhibitor
What is exocrine pancreatic insufficiency (EPI)?
insufficient secretion of digestive enzymes
Is EPI more common in dogs or cats?
What disease processes can cause EPI?
Pancreatic acinar atrophy (PAA) - most common in young dogs
Chronic pancreatitis - in cats
Pancreatic neoplasia - adenocarcinoma
What imbalances is EPI associated with?
microbial imbalances with hypocobalaminemia
What history and signs is associated with EPI?
Weight loss but good appetite, small bowel diarrhea, flatulence, borborygmus, poor hair coat, coprophagia, and cats may have a reduced appetite
If a patient has both EPI and diabetes mellitus what clinical sign might it have?
What is coprophagia?
How is EPI diagnosed?
based on clinical signs, hypocobalaminemia, TLI assay, and Cobalamin assay
What is the test of choice for diagnosing EPI?
TLI assay - species specific
What will the results of a TLI assay show if a dog has EPI?
The TLI levels will be subnormal levels
How is EPI treated?
highly digestible diets, oral pancreatic enzyme supplements, vitamine/mineral supplements, and/or high quality maintenance diet
What is given as treatment for ARD in non-responsive patients?
When should EPI patients respond to therapy?
within 3-5 days
Once patients begin responding to EPI therapy, what should be done with the enzyme dosages?
You should gradually decrease the dose of enzymes
If there is no response to EPI therapy, what next step should be considered?
Dysbiosis - use tylosin
What is the prognosis of EPI?
True or False: Once EPI is treated initially, you do not need to continue to treat.
False - it requires life-long therapy
Is there permanent damage associated with acute pancreatitis?
There is rarely permanent damage
What are the two forms of acute pancreatitis?
edematous and necrotizing form
Is there permanent damage associated with chronic pancreatitis?
yes, it is associated with irreversible damage with fibrosis
What are the risk factors associated with pancreatitis?
Dietary indiscretion (high fat), pancreatic ischemia, hypercalcemia, disturbances in lipid metabolism, hepatobiliary disease, drugs, and some breed predispositions
What disease processes can cause disturbances in lipid metabolism?
Cushings and Diabetes mellitus
What species typically gets hepatobiliary disease?
What drugs can lead to pancreatitis?
Phenobarbital and azathioprine
True or False: The underlying cause of pancreatitis is often known.
false - it is often unknown
What are the mechanisms of injury to the pancreas?
Premature activation of zymogens, reactive oxygen metabolites cause direct cellular damage, and depletion of protease inhibitors