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Clin Path Quiz 13/14
Lecture 13: Pancreas Exocrine
| Question | Answer |
|---|---|
| location of the pancreas | runs along the descending duodenum, next to the greater curvature of the stomach |
| exocrine function | product digestive enzymes and deposit them directly into the duodenum; consists of groups of acini and secretions contain bicarbonate and pancreatic digestive enzymes |
| acinus | single layer of columnar epithelial cells, resemble a bluster of grapes, surrounding a lumen |
| groups of acini | release secretions into the lumen which merge with other lumina to form ducts; ducts eventually converge into the pancreatic duct which empties into the duodenum |
| digestion | pancreatic cells are first stimulated by anticipation of food; during intestinal digestion, pancreatic secretions continue to increase due to neural and endocrine stimuli, which leads to an increase in pancreatic secretions |
| [pancreatic enzymes | lipase, amylase, trypsin |
| lipase function | breaks down lipids into free fatty acids and monoglyceride |
| amylase function | breaks down starches into maltose (two glucose molecules linked together) |
| trypsin function | break down proteins into amino acids |
| enzymes are secreted form the pancreas in what form? | in an inactive form (proenzyme) and activated in the intestine |
| proenzymes | trypsinogen, chymotrypsinogen, proelastase, and procarboxypeptidase |
| diseases of the pancreas | pancreatitis, exocrine pancreatic insufficiency |
| pancreatitis | inflammation of the pancreas, can be severe and life threatening |
| in dogs, pancreatitis is often secondary to.... | dietary indiscretion |
| acute onset of pancreatitis is due to... | seeping of pancreatic enzymes into the surrounding tissue |
| clinical signs of pancreatitis in dogs | lethargy, anorexia, vomiting, diarrhea, abdominal pain |
| clinical signs of pancreatitis in cats | anorexia, lethargy, weight loss, vomiting (more difficult to diagnose in cats) |
| exocrine pancreatic insufficiency | insufficient amount of enzymes produced and secreted; gradual onset |
| causes of EPI | atrophy of acinar cells (common in GSDs) or pancreatitis |
| clinical signs of acinar cell atrophy | polyphagia (overeating), weight loss, diarrhea |
| tests that detect acinar cell damage (routine tests on in-house chemistry) | amylase, lipase |
| additional tests for pancreatic function (send out or additional in-house tests) | trypsinlike immunoreactivity (TLI), serum pancreatic lipase immunoreactivity (pLI) |
| primary source of amylase in the body | the pancreas; other sources include salivary glands and small intestine |
| amylase | excreted by the kidneys, increase with pancreatic disease (especially when accompanied by increased lipase, increase 2-3x normal); found routinely on larger in-house chemistry tests |
| interpretation of amylase elevation | pancreatitis (acute or chronic), obstruction of pancreatic duct |
| less common causes of increased amylase (due to increased absorption into the blood stream) | inflammation of the small intestine, intestinal obstruction (foreign body, mass), intestinal perforation, decreased clearance by the kidneys (ex -> kidney disease) |
| lipase | primarily produced by the pancreas, not found in significant amounts in other tissues in the body; chemistries will usually check both amylase and lipase; lipase is more SENSITIVE AND SPECIFIC than amylase |
| interpretation of lipase elevation | pancreatitis (especially in conjunction with amylase elevation), renal dysfunction (kidney damage), hepatic dysfunction (liver damage) |
| pancreatitis and amylase and lipase | blood sample (serum or plasma), usually both tests are run if pancreatitis is suspected; affected animals will have LARGE elevations in both enzymes (values at least 2-3x normal); dramatic increase does not indicate increased severity of disease |
| trypsin | FECAL TEST, not blood (more readily detectable in fecal samples), absence of trypsin is normal |
| fecal trypsin tests | gelatin digestion tube test, x-ray film test (less accurate compared to gelatin tube test) |
| trypsin-like immunoreactivity (TLI) | serology test that measures antibodies found only on trypsin and trypsinogen (proenzyme to trypsin); ONLY IN CATS AND DOGS, both trypsin and trypsinogen are found only in the pancreas |
| TLI is | highly SPECIFIC AND SENSITIVE for the diagnosis of EPI in dogs |
| TLI interpretation in DOGS | normal canine range 5-35 mg/L; dogs with EPI will have a low trypsin-like immunoreactivity, due to decreased production by the pancreas, serum TLI may increase after eating |
| TLI decrease in dogs in order to diagnose EPI | <2.5 mg/L |
| pancreatic lipase immunoreactivity (pLI) | extremely SPECIFIC test for FELINE pancreatitis, recommended test to diagnose (rule IN) pancreatitis; in house SNAP test available for same day results, otherwise is a send-out test |
| serum feline pancreatic lipase immunoreactivity | fPLI |
| canine pancreatic lipase immunoreactivity | cPLI |
Created by:
mkroon26
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