Page 1258 - Cote clinical veterinary advisor dogs and cats 4th

Mass, Pancreatic 629.e3

○ Evidence of secondary biliary obstruction; ○ Perform biopsy of possible metastatic Technician Tips
lesions.
any mass when sufficiently large: ○ Correct biliary obstruction. Pancreatitis can cause severe abdominal pain.
VetBooks.ir ○ Possible ultrasound-guided fine-needle ○ Place feeding tube for nutritional support. close attention to adequacy of analgesia. If pain Diseases and Disorders
Common bile duct dilation (p. 118)
Be careful in handing these patients, and pay
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aspiration (cytologic exam) or needle
is apparent, discuss additional analgesia with
○ Place biliary stent if needed (i.e., temporary
biopsy of pancreatic mass:
Possible metastatic sites: regional lymph relief of common bile duct compression the attending clinician.
from adjacent, treatable disease or pallia-
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nodes, liver tion of biliary obstruction for inoperable SUGGESTED READING
• Suspected insulinoma disease). Charles JA: Pancreas. In Maxie MG, editor: Jubb,
○ Simultaneous measurement of fasting Kennedy, and Palmer’s Pathology of domestic
blood glucose and serum insulin Nutrition/Diet animals, ed 5, New York, 2007, Elsevier, pp
concentrations In animals with pancreatitis or patients that have 389-424.
undergone extensive pancreatic/duodenal resec-
TREATMENT tions, enteral (or rarely parenteral) nutritional ADDITIONAL SUGGESTED
support should be provided postoperatively (pp. READINGS
Treatment Overview 1106, 1107, 1109, and 1148). Cordner, et al: Cytologic findings and diagnostic yield
Treatment depends on the type of the pancreatic in 92 dogs undergoing fine-needle aspiration of the
mass and typically includes intensive supportive Possible Complications pancreas. J Vet Diagn Invest 27:236-240, 2015.
care, surgical correction, and/or nutritional • Ongoing or recurrent pancreatitis Isidoro-Ayza M, et al: Superficial necrolytic dermatitis
support. Chemotherapy or antibiotics may be • Iatrogenically induced pancreatitis in a dog with an insulin-producing pancreatic islet
appropriate for neoplastic or infectious disease, • Persistent hypoglycemia caused by incomplete cell carcinoma. Vet Pathol 51:805-808, 2015.
respectively. removal of primary insulinoma or function- Jubb KVF: The pancreas. In Jubb KVF, et al, editors:
Pathology of domestic animals, vol 2, Orlando, FL,
ing metastatic lesions
1985, Academic Press, pp 412-424.
Acute and Chronic Treatment • Perforating gastric ulcer from gastrinoma Mayhew PD, et al: Evaluation of coagulation in
Treatment depends on type of pancreatic mass: • Neoplastic metastasis dogs with partial or complete extrahepatic biliary
• Address pancreatitis (pp. 740 and 742), if • Acute respiratory distress syndrome (p. 27) obstruction by means of thromboelastography. J
present. Am Vet Med Assoc 242:778-785, 2013.
• Rehydration by IV administration of bal- Recommended Monitoring Mayhew PD, et al: Pathogenesis and outcome of
anced electrolyte solution and possibly colloid • Depends on cause of pancreatic mass but extrahepatic biliary obstruction in cats. J Small
solutions: correction of fluid deficits, normal- may include Anim Pract 43:247-253, 2002.
ization of serum electrolyte concentrations ○ CBC and serum biochemistry profile Pratschke KM, et al: Pancreatic surgical biopsy in 24
• Possible administration of fresh-frozen plasma: ○ Blood glucose concentrations dogs and 19 cats: postoperative complications and
clinical relevance of histological findings. J Small
hypoproteinemia, possible coagulopathy ○ Serum amylase and lipase concentrations Anim Pract 56:60-66, 2015.
• Transfusion (p. 1169) if severe anemia present • Repeat abdominal ultrasound exam: Seaman RL: Exocrine pancreatic neoplasia in the cat:
• Implement analgesic regimen, as appropriate; ○ Resolution or progression of pancreatic a case series. J Am Anim Hosp Assoc 40:238-245,
options include disease 2004.
○ Meperidine 5-10 mg/kg IM or slowly IV ○ Regrowth of pancreatic neoplasm Xenoulis PG: Diagnosis of pancreatitis in dogs and
as needed (q 1-4h); short half-life can be ○ Development of metastatic disease cats. J Small Anim Pract 56:13-26, 2015.
limiting.
○ Butorphanol 0.2-0.7 mg/kg SQ, IM, or PROGNOSIS & OUTCOME RELATED CLIENT EDUCATION
IV q 3-6h SHEETS
○ Buprenorphine: 0.01-0.02 mg/kg IM or • Fair to guarded in animals with pancreatitis
IV with or without secondary development of Consent to Perform Abdominal Ultrasound
○ Fentanyl: 0.002-0.01 mg/kg SQ, IM, or abscesses Consent to Perform Computed Tomography
IV once, then as a constant-rate infusion • Poor in animals with malignant exocrine (CT Scan)
at 0.003-0.006 mg/kg/h; alternatively, may pancreatic neoplasia (adenocarcinoma) Consent to Perform Exploratory Laparotomy
be administered as transdermal patch, • Insulinoma Consent to Perform Fine-Needle Aspiration
which takes > 12 hours to take effect ○ Persistent hypoglycemia or inability to of Masses
• Treat hypoglycemia if present (p. 552). completely resect all neoplastic disease Consent to Perform General Anesthesia
○ Addition of dextrose (5%) to IV fluids indicates a poor prognosis.
○ Change of diet and feeding schedule ○ Resolution of hypoglycemia or complete AUTHOR: David Holt, BVSc, DACVS
○ Glucocorticoids and/or diazoxide resection of neoplastic disease indicates a EDITOR: Elizabeth A. Swanson, DVM, MS, DACVS
• Vitamin K administration if biliary obstruc- good prognosis in the short term; long-
tion is present and depending on results of term prognosis is guarded.
coagulation screen and thromboelastography
(p. 1325): vitamin K 1 2.5-5 mg/kg SQ or PEARLS & CONSIDERATIONS
IM q 12h for 3 days, then once weekly until
obstruction relieved Comments
• Exploratory laparotomy A pancreatic mass is a nonspecific finding, and
○ Identify pancreatic mass and extent of appropriate treatment and prognosis depend
intraabdominal disease. on identifying the nature of the mass.
○ Remove mass or perform biopsy.
○ Drain and omentalize pancreatic abscess
if present.

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