GENERAL MEDICINE (VCM 401)

DISEASES OF THE LIVER AND PANCREAS

FUNCTIONS OF THE LIVER Metabolism of protein, carbohydrates and lipids Storage of glycogen, minerals and triglycerides Storage and metabolism of vitamins Extra-medullary haematopoiesis Coagulation homeostasis. Immunologic activities Production of bile acids Detoxification of endogenous and exogenous compounds

HEPATIC DISEASES Could be insult from infections agents, toxins or congenital malformation. Signs may not be evident until more than 60-80% of the liver parenchyma is non-functional Or when hepatic dysfunction is 20 to disease in another organ system.

CLINICAL SIGNS Signs of encephalopathy and failure commonly present acutely whether the disease is acute or chronic. Hepatic failure could be acute or chronic. Acute hepatic disorders are commonly caused by toxic or infections agents. Long term prognosis for recovery is favorable if animal survives the initial stages. Chronic hepatic disorders are more likely to be accompanied by irreversible changes (Cirrhosis).

DIAGNOSTIC STRATEGIES Signalment and History: clinical information . History of intolerance to drug History of vaccination e.g DHLPP.

PHYSICAL EXAMINATION Skin and mucous membrane Abdominal Palpation Neurologic Examination Rectal examination

ROUTINE LABORATORY EVALUATIONS Complete blood count Urinalysis Biochemical tests Bile acids tests

DIAGNOSTIC IMAGING Survey Radiography Ultrasonography Angiography Liver biopsy Liver cytology

HEPATIC CONDITIONS Hepatitis: Acute hepatitis and hronic hepatitis Tyzzer ‘s disease Cholangio-hepatitis Hepatic Abscess Portosystemic shunts Liver cirrhosis Cholecystitis

HEPATIC CONDITIONS Cholelithiasis Hepatic Amyloidosis Hepatic neoplasia: Primary hepatic tumors Hemolymphatic tumors Metastatic tumors

DISEASES OF THE PANCREAS

INTRODUCTION Pancreas is a v-shaped gland in the cranial abdomen composed of an exocrine portion and endocrine surrounded by acinar.

PANCREATITIS An acute or chronic inflammatory condition of the pancreas that develops when premature intrapancreatic activation of digestive enzymes result progressive auto-digestion of the pancreas.

CLINICAL MANIFESTATIONS Range from inapparent to fulminating “acute abdominal crisis. Signs include vomiting, cranial abdominal pain, diarrhoea, fever and weakness. There may be palpable cranial abdominal mass. Other signs: lethargy, hypothermia, dyspnoea, icterus and ataxia. Acute collapse in severe cases.

EXOCRINE PANCREATIC INSUFFICIENCY Syndrome that occurs when 90% or more of pancreatic secretory capacity is lost. Common in dogs

CLINICAL SIGNS Chronic small bowel diarrhoea and weight loss are the most consistent signs. Diarrhoea is related to nutrient maldigestion and malabsorption characterized by large volume of soft, semiformed, or unformed faeces. Aetiology: Atrophy, infammation, hypoplasia or neoplasia.

DIABETES MELLITUS Disorder of carbohydrate, fat and protein metabolism resulting from an inability to produce or utilize adequate amount of insulin. Incidence in dogs is about 0.4-5%. Pancreatic lesions causing diabetes mellitus have been recorded in cows, horses and donkeys.

TYPES OF DIABETES MELLITUS Type I DM: As a result of low insulin production by the B-cells. Due to autoimmunity, B-cells are progressively destroyed until it becomes insufficient to produce adequate levels of insulin in response to hyperglycemia.

TYPES OF DIABETES MELLITUS (cont’d) Type II DM: Diabetic state in which insulin secretion is usually sufficient to prevent ketosis but not enough to prevent hyperglycemia Insulin secretion may be high, low or normal but insufficient to overcome insulin resistance in peripheral tissues.

TYPES OF DIABETES MELLITUS (cont’d) Type III(Secondary) DM: Occurs as a result of another primary disease or drug therapy that produces insulin resistance or destroys pancreatic tissues.