Page 328 - Problem-Based Feline Medicine

320 PART 6 CAT WITH WEIGHT LOSS OR CHRONIC ILLNESS

lymphosarcoma, hyperthyroidism and the other Prognosis
malassimilation syndromes should be considered as
Prognosis depends on the severity of damage. Many
important differentials.
cats live with low-grade smoldering pancreatitis for
Treatment many years, however, once exocrine pancreatic insuffi-
ciency and/or diabetes has developed the prognosis is
(For treatment of acute pancreatitis see page 277, The worse.
Cat With Depression, Anorexia or Dehydration)
In rare cases of congenital exocrine pancreatic insuffi-
Replace pancreatic enzymes by adding pancreatic ciency, the prognosis is good, as long as the cat receives
enzyme replacement to food (~ half a teaspoonful of pancreatic supplementation.
powder per meal, or to effect), or add fresh-frozen then
defrosted pig pancreas (~20–40 g per meal, or to effect).
Prevention
Immunosuppression: In the non-suppurative form of
Since it is not known what triggers pancreatitis to
pancreatitis, immunosuppressive doses of corticos-
develop, it is not currently possible to prevent its onset.
teroids may be needed to reduce ongoing inflammation
However, since chronic pancreatitis can progress to
(prednisolone 1–4 mg/kg q 12–24 hours PO, then taper
exocrine pancreatic insufficiency, it would appear sen-
over 1–3 months and maintain on every other day doses
sible to try to control it as well as possible to try to pre-
if needed). Alternately, chlorambucil could be consid-
vent its progression.
2
ered (2–5 mg/m PO up to once every 48 h).
Supportive therapies:
● Feed a highly digestible, “bland enteric diet”,
LYMPHOCYTIC CHOLANGIOHEPATITIS*
which is low in fat. Feed small meals frequently.
● Cobalamin is often reduced by lack of pancreatic
Classical signs
intrinsic factor and malabsorption and should be
supplemented (125–250 μg/week SC or IM for 6–8 ● Typically seen in middle-aged cats, and
weeks or 50–100 μg/cat/day PO). Persian cats may be over-represented.
● Vitamin K1 is often required because fat malab- ● Weight loss, inappetence, some cats may
sorption results in poor absorption of fat-soluble be polyphagic,
vitamins like vitamin K, and this can result in ● ± mild generalized lymphadenopathy,
abnormal hemostasis (0.5 mg/kg/day SC for 3–4 ● ± vomiting and/or diarrhea.
days, then once weekly). ● In some cats, is associated with IBD and/or
● Vitamin E may be given for its anti-oxidative prop- pancreatitis.
erties (50–200 IU/cat/day PO).
Surgical intervention may be required if complete
Pathogenesis
biliary obstruction occurs (cholecystotomy or cholecys-
toduodenostomy), or if a focal pancreatic mass is The cholangitis/cholangiohepatitis complex com-
detected (partial pancrectomy to remove a pancreatic prises chronic non-suppurative (lymphocytic) cholangi-
pseudocyst, abscess, fibrotic mass or tumor). tis/cholangiohepatitis, suppurative cholangitis/cholan-
giohepatitis and biliary cirrhosis.
Diabetes that develops secondary to chronic pancreati-
● The pathogenesis and interaction of the three condi-
tis can be very difficult to stabilize. Insulin require-
tions is poorly understood and it is highly probably
ments may vary widely because of the ongoing
that each of these conditions incorporates a number of
pancreatic pathology, and treatment is complicated fur-
different diseases.
ther when corticosteroids also need to be given.
● Cholangitis describes inflammation of the biliary
It is essential to diagnose and treat any concurrent dis- tract, while cholangiohepatitis describes inflamma-
ease (e.g. IBD and/or cholangitis/cholangiohepatitis tion of the peribiliary hepatocytes as well as the bil-
complex). iary tract.