Feline pancreatitis (Proceedings)
Pancreatitis: Inflammation of the pancreas
Pancreatitis
• Inflammation of the pancreas
o Acute
o Chronic
• Common
Spectrum of Disease
• Mild, edematous
o Mild, rapid recovery
o Interstitial edema
• Hemorrhagic, necrotic
o Severe, prolonged
o Complications
o Necrosis
Pathophysiology
• Autodigestion of the pancreas
o Premature activation of zymogen granules
Pancreatic Protection
o Enzymes stored as inactive zymogens
o Cleaved by proteases in small intestine
o Zymogens and lysosomal enzymes separate
o Pancreatic secretory trypsin inhibitor
Risk Factors
• Fat!
o Obesity
o Hyperlipidemia
o Dietary indiscretion
o High fat diet
• Endocrine diseases
o Diabetes Mellitus
o Cushing's Disease
• Pancreatic factors
o Duct obstruction
o Trauma/ischemia
o Neoplasia
Drugs & Toxins
• Potassium bromide (KBr)
• Azathioprine (Imuran™)
• L-asparaginase (Elspar™)
• Organophosphates
• Furosemide (Lasix™)?
• Corticosteroids?
Additional Risk Factors in Cats
• Trauma (high-rise syndrome)
• Toxoplasma ?
• FIP ?
• Triaditis
o Inflammatory bowel disease
o Cholangiohepatitis
o Pancreatitis
Signalment
• Cats
o ??
Clinical Signs (Feline)
• Lethargy
• Anorexia
• Dehydration
• ± Hypothermia
• ± Vomiting
• ± Abdominal pain
• ± Dyspnea
• ± Ataxia
• ± Diarrhea
• ± Icterus
• ± Weight loss
Complications
• DIC
• Acute Renal Failure
• Respiratory distress
o Pulmonary edema
o PTE
• Vascular collapse, shock
• Diabetes mellitus/EPI (chronic or acute recurrent)
Diagnosis
• No pathognomonic test!
• Definitive diagnosis = biopsy
Baseline Bloodwork
• CBC
o Leukocytosis with a left shift
o PCV elevated (dehydration)
o Anemia
• Chemistry
o Azotemia (prerenal or acute renal failure)
o Elevated LES
o Hyperbilirubinemia
o Hyperglycemia
o Hypocalcemia
o Hyperlipidemia
o Hypertriglyceridemia
• Amylase and lipase
o Lack of sensitivity
o Lack of specificity
o If very high (3-4 x baseline) than suggestive
Urinalysis
Coagulation Screen
• PT
• PTT
• FDP
• D-dimers
Diagnosis
• feline pancreatitic lipase immunoreactivity (fPLI)
o Specific
o Sensitivity
o Chronic pancreatitis
Imaging
• Radiographs
• Ultrasound
• CT scanning?
• MRI?
Cytology?
o FNA
o Abdominocentesis
• Exploratory laparotomy?
Whole clinical picture
Ultrasound imaging
Cats are tricky …
• Vague signs
o Anorexia
oVomiting?
• Ultrasound
• May require biopsy
Treatment Objectives
• ↓ Stimulation of pancreas
• Manage hypovolemia
• Supportive care
o Pain
o Nausea
o Nutrition
o Gastric hyperacidity
o Infection
Fluids & Antiemetics
• Maintain pancreatic perfusion
• Give IV
• Replace deficits quickly!
• Use antiemetics
o Metoclopramide
o Dolazetron
o Cerenia
o Mirtazapine
• USE ANALGESICS!
o Buprenorphine
o Meperidine
o Fentanyl
Gastric Antacids
Nutritional Support
• NPO 24 to 48 hr
• Water first
• OK to feed if no vomiting!
• Parenteral nutrition
o If NPO > 2 days
o TPN
PPN
• J tube?
Antibiotics???
• If septic or suspect necrotizing form, protect against enteric bacteria
Plasma
• Provides
o Protease inhibitor
o Colloid
o Coagulation factors
o Protein
• Consider if
o Hypoalbuminemia
o DIC
• Pancreatic Enzymes
o Negative feedback in humans
o Benefit in dogs uncertain
o Oral
• Antioxidants
o Benefit in humans
o Dogs?
• Selenium
• Vitamin E
• SAMe
Finally …
• Anticoagulants, if
o DIC
o PTE
• Corticosteroids?
oCat with IBD?
o Autoimmune pancreatitis
o Sepsis (physiologic)
Prognosis
About Cats …
Complicated by other disease
o IBD
o Cholangiohepatitis
o Hepatic lipidosis
• Prognosis difficult
