Page 651 - Small Animal Internal Medicine, 6th Edition

CHAPTER 37 The Exocrine Pancreas 623

TABLE 37.2
VetBooks.ir Differences Between Acute and Chronic Pancreatitis in Dogs and Cats CHRONIC PANCREATITIS

PARAMETER
ACUTE PANCREATITIS
Histopathology Varying degrees of acinar necrosis, Characterized by lymphocytic
edema, inflammation, with neutrophils inflammation and fibrosis, with
and peripancreatic fat necrosis permanent disruption of architecture
Potentially completely reversible, with no Possible to have acute-on-chronic cases
permanent pancreatic architectural or with concurrent neutrophilic
functional changes inflammation and necrosis
Clinical appearance Spectrum from severe and fatal (usually Spectrum from mild, low-grade intermittent
necrotizing) to mild and subclinical (less gastrointestinal signs (most common) to
common) acute-on-chronic episode
indistinguishable from classic acute
pancreatitis
Diagnostic challenge Higher sensitivity of enzyme tests and Lower sensitivity of enzyme tests and
ultrasonography than in chronic disease ultrasonography than in acute disease:
diagnosis much more challenging
Mortality and long-term sequelae High immediate mortality but no long-term Low mortality except acute-on-chronic
sequelae bouts
High risk of eventual exocrine and
endocrine insufficiency

TABLE 37.3
Causes of Acute Pancreatitis in Dogs and Cats

RISK FACTOR CAUSE

Idiopathic, 90% Unknown (some may be hereditary or inherited susceptibility to environmental trigger)
Duct obstruction ± hypersecretion Experimental; neoplasia; surgery ± cholangitis + role in chronic pancreatitis
± bile reflux into pancreatic duct
Hypertriglyceridemia Inherent abnormal lipid metabolism (breed-related—e.g., Miniature Schnauzers)
Endocrine—diabetes mellitus, hyperadrenocorticism, hypothyroidism
Breed, gender (?) Increased risk in terriers ± spayed females—may reflect risk of hypertriglyceridemia
in some (also Miniature Schnauzers; see above) and potentially other mutations
(see text)
Diet Dietary indiscretion, high-fat diet
Malnutrition, obesity (?)
Trauma Road traffic accident, surgery, high-rise syndrome
Ischemia, reperfusion Surgery (not just pancreas), gastric dilation, volvulus; shock, severe immune-mediated
hemolytic anemia (common association if anemia severe)
Hypercalcemia Experimental (more common in cats than dogs); hypercalcemia of malignancy
(uncommon association clinically); primary hyperparathyroidism
Drugs, toxins Organophosphates, azathioprine, asparaginase, thiazides, furosemide, estrogens,
sulfa drugs, tetracycline, procainamide, potassium bromide, clomipramine
Infections Toxoplasma, others (uncommon)

Adapted from Villiers E, Blackwood L, editors: BSAVA manual of canine and feline clinical pathology, ed 2, Gloucestershire, Britain, 2005,
British Small Animal Veterinary Association.