What do we know about feline pancreatitis? (Proceedings)

Pancreatitis

Inflammation of the pancreas

• Acute

• Chronic

Common

Spectrum of Disease

Mild, edematous

• Mild, rapid recovery

• Interstitial edema

Hemorrhagic, necrotic

• Severe, prolonged

• Complications

• Necrosis

Pathophysiology

Autodigestion of the pancreas

• Premature activation of zymogen granules

Pancreatic Protection

• Enzymes stored as inactive zymogens

• Cleaved by proteases in small intestine

• Zymogens and lysosomal enzymes separate

• Pancreatic secretory trypsin inhibitor

Risk Factors

Fat!

• Obesity

• Hyperlipidemia

• Dietary indiscretion

• High fat diet

Endocrine diseases

• Diabetes Mellitus

• Cushing's Disease

Pancreatic factors

• Duct obstruction

• Trauma/ischemia

• 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

• Inflammatory bowel disease

• Cholangiohepatitis

• Pancreatitis

Signalment

• Cats

• ??

Clinical Signs (Feline)

• Lethargy

• Anorexia

• Dehydration

• +/- Hypothermia

• +/- Vomiting

• +/- Abdominal pain

• +/- Dyspnea

• +/- Ataxia

• +/- Diarrhea

• +/- Icterus

• +/- Weight loss

Complications

• DIC

• Acute Renal Failure

• Respiratory distress: pulmonary edema, PTE

• Vascular collapse, shock

• Diabetes mellitus/EPI (chronic or acute recurrent)

Diagnosis

• No pathognomonic test!

• Definitive diagnosis = biopsy

Baseline Bloodwork

CBC

• Leukocytosis with a left shift

• PCV elevated (dehydration)

• Anemia

Chemistry

• Azotemia (prerenal or acute renal failure)

• Elevated LES

• Hyperbilirubinemia

• Hyperglycemia

• Hypocalcemia

• Hyperlipidemia

• Hypertriglyceridemia

Amylase and lipase

• Lack of sensitivity

• Lack of specificity

• If very high (3-4 x baseline) than suggestive

Urinalysis

Coagulation Screen

• PT

• PTT

• FDP

• D-dimers

Diagnosis

Feline pancreatitic lipase immunoreactivity (fPLI)

• Specific

• Sensitivity?

• Long turn around time

• Chronic pancreatitis

Imaging

• Radiographs

• Ultrasound

• CT scanning?

• MRI?

• Cytology? FNA, abdominocentesis

• Exploratory laparotomy?

Whole clinical picture

Ultrasound imaging

Cats are tricky . . .

• Vague signs: anorexia, vomiting?

• Ultrasound

• May require biopsy

Treatment Objectives

↓ Stimulation of pancreas

Manage hypovolemia

Supportive care

• Pain

• Nausea

• Nutrition

• Gastric hyperacidity

• Infection

Fluids & Antiemetics

Maintain pancreatic perfusion

Give IV

Replace deficits quickly!

Use antiemetics

• Metoclopramide

• Dolazetron

• Cerenia

USE ANALGESICS!

• Buprenorphine

• Meperidine

• Fentanyl

Gastric Antacids

Nutritional Support

• NPO 24 to 48 hr

• Water first

• OK to feed if no vomiting!

Parenteral nutrition:

• If NPO > 2 days

• TPN

• PPN

J tube?

Antibiotics???

• If septic or suspect necrotizing form, protect against enteric bacteria

Plasma

• Provides:

• Protease inhibitor

• Colloid

• Coagulation factors

• Protein

• Consider if

• Hypoalbuminemia

• DIC

• Enzyme

• Negative feedback in humans

• Benefit in dogs uncertain

• Oral

• Antioxidants

• Benefit in humans

• Dogs?

• Selenium

• Vitamin E

• SAMe

Finally . . .

Anticoagulants, if

• DIC

• PTE

Corticosteroids?

• Cat with IBD?

• Autoimmune pancreatitis

• Sepsis (physiologic)

Prognosis

About Cats . . .

Complicated by other disease

• IBD
• Cholangiohepatitis
• Hepatic lipidosis

Prognosis difficult