GI
Folate is absorbed in the ____________.
What can cause this to increase? Decrease?
absorbed in: proximal small intestine
Increase: bacterial overgrowth
Decrease: disease affecting proximal small intestine
Your patient has a GI bleed. What do you initially expect to see on this patient's CBC? What can this lead to if bleed becomes chronic?
Starts as: Macrocytic (↑ MCV) and Hypochromic (↓ MCHC) *obviously anemia (↓ PCV)
Chronic: Microcytic (↓ MCV) and hypochromic (↓ MCHC)
* Possible Thrombocytopenia (↑ Platelets)
The endocrine pancreas secretes:
Hormones: Insulin, glucagon
You are caring for a patient that has pancreatitis. You are asked to run a full panel BW ( CBC and Chem). What do you expect to see on the CBC?
* Relative polycythemia (↑ RBC) : caused by v/d, common of pancreatic patients
* ↑ TP (Albumin, Globulins) : dehydration, lack of fluid in blood makes TP appear as elevated
* ↑ WBC (specifically neutrophils) : -itis means inflammation, neutrophils increase due to inflammation. This may appear as a stress leukogram but the neutrophil level is typically higher than normal stress leukogram.
* Thrombocytopenia (↑ Platelets)
* Low BCS
* Ravenous appetite
* BAR
* Diarrhea
Cobalamin is absorbed in the ________.
What causes this to decrease?
absorbed in: distal small intestine (ileum)
Decrease: PEI, bacterial overgrowth
A patient presents with a GI bleed. What do you expect to see on this patient's chemistry profile?
* ↑ BUN (Creat will be WNL, so we know its not kidney)
* ↓ Albumin ( caused by chronic bleeding or ulceration)
* ↑ BUN/ Creat ration
(REMEMBER: If creat and BUN are both elevated the ratio will not increase, but if only 1 is increased then the ratio will increase as well. If they are both elevated then it will be like trying to divide a number by itself 2:2 = 1, 5:1 = 5)
The exocrine pancreas secretes:
Enzymes:
* Lipase = Fat
* Amylase = Sugar
* Protease = Protein
( TIP: Amy is sweet, lipids = fats, pro= protein)
What do you expect to see on a chemistry profile in a patient with pancreatitis?
* ↑ AMY / LIPA = pancreatitis causes enzyme leakage
* ↑ TP (explained in last question)
* ↑ ALT / AST : if inflammation is severe this could cause hypatocellular damage due to close proximity
* ↑ ALP / GGT : same as above
What test is used to diagnose PEI?
TLI : decreased value
Define melena:
dark, tar-like stool
Define lymphangiectasia:
loss of protein-containing lymphatic fluid.
( This can cause ↓ Albumin)
Insulin and glucagon are produced by specialized cells in the pancreas called:
islets of Langerhans
What is the screening test for pancreatitis?
cPL : Increased = pancreatitis
Trysinlike Immunoassay (TLI) measures:
trypsin levels which are activated by normal pancreatic activity
What causes melena?
GI ulcers / bleeding (higher in GI tract)
Why would a patient with chronic blood loss be microcytic (↓ MCV)?
Decreased Iron → decreased hemoglobin → additional RBC division.
(REMEMBER: Iron binds hemoglobin, so if there is less Fe, then the RBC can not carry as much hemoglobin, so RBCs constantly divide to attempt to have hemoglobin concentration WNL)
When is the exocrine pancreas most active?
Eating
What is the diagnostic test for pancreatitis?
TLI : Increased = pancreatitis
Describe the difference:
Type 1 DM:
Type 2 DM:
Type 1: Lack of insulin production ( seen in obese dogs)
Type 2: Insulin resistance in tissues ( seen in cats)
What can increase the chance of a patient developing GI ulcers? Why?
* NSAIDs - blocks prostaglandins, some of these keep stomach acid in proper place, blocking them causes acid to move outside of normal places causing ulcers.
* Steroids - block immune function
* Tumors
What drugs are typically given to patients with GI bleeds?
* Not listed in notes, but something J Rob mentioned, good for real-life cases*
Sucralfate : GI protectant
Omeprazole : anti-acid (brand name: Prilosec)
Enzymes are produced in response to:
ingestion of food and water
T/F: You can confidently confirm a patient has pancreatitis if amylase and lipase are increased?
False: It is indicative of pancreatitis, but best way to DX is by running TLI
What does PEI stand for?
Pancreatic Exocrine Insufficiency