Diseases of the exocrine pancreas

image of Diseases of the exocrine pancreas
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Secretion of digestive enzymes is the major function of the exocrine pancreas. Pancreatic juice also contains bicarbonate, which contributes to the neutralization of gastric acid; co-lipase, which facilitates the action of pancreatic lipase; and intrinsic factor which is required for absorption of cobalamin. Pancreatic secretions inhibit bacterial proliferation in the proximal small intestine (SI), contribute to the normal degradation of exposed brush border enzymes, and together with biliary secretions, exert a trophic effect on the mucosa. Finally, the pancreas protects itself against autodigestion by several mechanisms, including the synthesis of a specific trypsin inhibitor that is stored and secreted together with the digestive enzymes. This chapter considers Anatomy; physiology and biochemistry; and Diseases of the exocrine pancreas.

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23.2 Anatomical associations of the canine pancreas. There is major variation between individual dogs in the anatomy and degree of anastomosis of the two sub-divisions of the duct system. (Reproduced from with permission from Elsevier)
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23.3 Activation of pancreatic proteases and phospholipase. (Reproduced from with permission from Elsevier)
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23.4 Normal intracellular routing of digestive and lysosomal enzymes by the pancreatic acinar cell. (Reproduced from with permission from Elsevier)
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23.6 Diagrammatic representations of zymogen activation (trypsinogen) and the binding of proteases (trypsin) by major inhibitors. (Reproduced from with permission from Elsevier)
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23.8 Acute pancreatitis in a cat. The pancreas is swollen and oedematous and areas of haemorrhage and chalky fat necrosis are visible in the pancreatic parenchyma and adjacent mesentery. (Courtesy of Steve Holloway)
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23.9 Chronic pancreatitis observed at necropsy of an old dog with a history of several bouts of severe acute pancreatitis. Acinar cells were restricted to a few residual nodular areas of relatively normal looking tissue. The pancreatic pathology was not associated with any clinical signs at the time of euthanasia, although the serum concentration of trypsin-like immunoreactivity was subnormal.
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23.10 Abnormal intracellular routing of digestive enzymes destined for secretion results in mixing of zymogens and lysosomal proteases in abnormal intracellular vacuoles. Subsequent activation of zymogens by lysosomal proteases is currently considered to initiate development of pancreatitis. (Reproduced from with permission from Elsevier)
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23.11 Local and systemic effects of trypsin in pancreatitis. (Reproduced from with permission from Elsevier)
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23.13 Ultrasound scans of the cranial abdomen in two dogs. (a) This dog had severe pancreatitis. The duodenum can be seen in the upper right hand corner (D). The pancreas can be seen as an irregular mixed-echoic structure (P). The dark areas within the pancreas represent areas of pancreatic necrosis. The hyperechoic area right below the mixed-echoic structure represents peripancreatic fat necrosis (F). The hypoechoic area below the peripancreatic fat suggests peritoneal effusion (E). The changes seen here are highly specific for acute pancreatitis. (b) This dog had a pancreatic abscess. There is a large uniformly hypoechoic structure (arrowed) suggesting a fluid-filled mass. Such a fluid-filled mass could represent a pancreatic pseudocyst or a pancreatic abscess and was diagnosed as a pancreatic abscess in this patient following cytological evaluation of aspirated fluid. (Images courtesy of Dr Sharon Shull)
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23.14 Assay of pancreatic enzymes and zymogens in serum. Catalytic assays detect degradation of specific substrates exposed to the active site of the molecule and therefore measure activity. Immunoassays detect antigenic sites over the surface of the molecule and therefore measure enzyme or zymogen concentration. (Reproduced from with permission from Elsevier)
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23.15 Mean serum fTLI and fPLI concentrations over time in six cats with experimentally induced pancreatitis. The pink line shows the mean serum fTLI concentration and the black line shows the mean serum fPLI concentrations over time. The broken line displays the currently recommended cut-off values for diagnosis of pancreatitis of 100 µg/l for fTLI and 12 µg/l for fPLI concentration. The elevation of mean serum fPLI concentration is of far greater duration than that of mean serum fTLI concentration. These data indicate that serum fPLI concentration is more sensitive than serum fTLI concentration for the diagnosis of feline pancreatitis. (Data from )
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23.16 The duodenal limb of the pancreas of a dog with pancreatic acinar atrophy. Residual tissue contains islet (endocrine) cells and blood vessels, so diabetes mellitus is not a feature of this disease. (Reproduced from Williams (1992) with permission from
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23.17 Partial villous atrophy in a jejunal biopsy specimen from a dog with exocrine pancreatic insufficiency due to pancreatic acinar atrophy. Villi are short and stumpy with a broadened plateau at the extrusion zone, and there is evidence of folding or fusion of villi. (Reproduced from Williams . (1987) with permission from the
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23.18 Unkempt and wet appearance of the haircoat of a cat with exocrine pancreatic insufficiency. This may reflect simple greasy soiling (especially around the perineal region) and/or changes secondary to the severe cobalamin deficiency that is commonly seen in affected cats.
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23.19 Serum trypsin-like immunoreactivity in 100 healthy dogs, 50 dogs with small intestinal disease and 25 dogs with exocrine pancreatic insufficiency. (Reproduced from Williams and Batt (1988) with permission from the
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23.20 Unkempt and wet appearance of the haircoat of a cat with experimentally-induced cobalamin deficiency. (Courtesy of Dr Jim Morris)
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23.21 Paraneoplastic alopecia in a cat with pancreatic adenocarcinoma. (Image courtesy of Dr Robert Kennis)
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