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740 Pancreatitis, Cat

Pancreatitis, Cat Client Education
Sheet
VetBooks.ir Etiology and Pathophysiology

BASIC INFORMATION
• In most cats with pancreatitis, the underlying around the pancreas, hypoechoic (necrosis)
or, less common, hyperechoic (fibrosis)
Definition cause remains unknown, but several risk pancreas, hyperechoic peripancreatic fat
A common inflammatory condition of the factors have been identified (see Risk Factors (peripancreatic fat necrosis), or dilated
pancreas that can be acute or chronic. Chronic section, above). pancreatic duct
pancreatitis, which can be differentiated from • In general, premature activation of pancreatic ○ False-negative and false-positive results are
acute pancreatitis only based on histopathologic digestive enzymes leads to initiation of pan- possible for ultrasonographic recognition
findings, is more common than acute pancre- creatitis, and the inflammatory response leads of feline pancreatitis and are somewhat
atitis in cats and is associated with permanent to progression of the disease and systemic machine and operator dependent.
changes (i.e., pancreatic fibrosis and/or atrophy). complications. • Measurement of serum amylase activity
is neither sensitive nor specific for feline
Epidemiology pancreatitis.
SPECIES, AGE, SEX DIAGNOSIS • Serum total lipase activity can be measured
No known age or sex predispositions Diagnostic Overview using various substrates and assays, but
Serum feline pancreatic lipase immunoreactivity none (including 1,2-diglyceride, triolein,
RISK FACTORS (fPLI) concentration, as measured by Spec fPL, 1,2-O-dilauryl-rac-glycero-3-glutaric acid
In most cats, pancreatitis remains idiopathic, is the most sensitive and specific laboratory (6′-methyl resorufin) ester [DGGR]) specifi-
but some risk factors have been identified: test currently available for feline pancreatitis. cally measures pancreatic lipase. Sensitivities
• Blunt abdominal trauma However, integration of all clinical data available vary largely and cannot be compared even
• Hypercalcemia affords the most accurate diagnosis. A point-of- when using the same substrate.
• Pancreatic hypoperfusion care rapid assay (i.e., SNAP fPL) is available. • Serum feline trypsin-like immunoreactivity
• High-fat diets (e.g., low-carbohydrate diets, A negative test result makes pancreatitis highly (fTLI) concentration has a limited diagnostic
diets for patients with chronic kidney disease) unlikely and should prompt the clinician to value for feline pancreatitis.
• Pharmaceuticals: organophosphates and look for other disorders. A positive test result • Point-of-care fPLI assay can help rule out
others should be followed by quantitative laboratory pancreatitis or provide support for the
○ There is no evidence that corticosteroids Spec fPL measurement. diagnosis.
cause pancreatitis in cats. • Serum fPL immunoreactivity (Spec fPL)
• Infections: Toxoplasma gondii, hepatic fluke Differential Diagnosis concentration
infestation (Amphimerus pseudofelineus), • Primary acute or chronic gastrointestinal ○ Measures concentration of pancreatic
possibly feline infectious peritonitis (FIP), (GI) disorders lipase in serum (many other lipases
and others • Acute or chronic metabolic or systemic contribute to total serum lipase activity)
disorders: hepatobiliary, renal, thyroid, ○ Reference interval: 0.1-3.5 mcg/L; cutoff
ASSOCIATED DISORDERS systemic, or (less likely) central nervous value for pancreatitis: 5.4 mcg/L
• Feline pancreatitis can occur concurrently system (CNS) or heartworm disease ○ Highly specific for exocrine pancreatic
with cholangitis and/or inflammatory bowel function, although positive tests do not
disease (called triaditis when inflammation Initial Database always reflect primary pancreatic disease
occurs in all three sites at the same time), • A CBC and chemistry profile should be (specificity is approximately 80%)
but a cause-and-effect relationship has not evaluated for all patients suspected of having ○ Highly sensitive for acute and chronic
been demonstrated. pancreatitis. Although findings are variable pancreatitis, but false-negative results are
• Pancreatitis can cause extrahepatic bile duct and nonspecific for pancreatitis, results from possible (sensitivity is 85%-90%)
obstruction (EHBO [p. 118]). both are critical for assessing disease severity, ○ Serial measurements allow for monitoring
identifying complications, and ruling out of disease progression in a specific animal.
Clinical Presentation other disorders. • Because of the potential relationship between
DISEASE FORMS/SUBTYPES ○ Serum calcium and fasting triglyceride pancreatitis and intestinal disease (as occurs
• Acute or chronic concentrations should be assessed in in cases of triaditis), measurement of serum
• Subclinical (no clinical signs), mild (not cats with pancreatitis, and conditions folate and cobalamin may be useful (p. 543).
associated with systemic or pancreatic (e.g., hyperlipidemia of other causes, • Specific infectious disease testing may be
complications), or severe (associated with hypocalcemia of other causes) causing appropriate in some cases (e.g., Toxoplasma
systemic and/or pancreatic complications) abnormalities in these parameters should serology [p. 984]).
be managed before the changes are attrib-
HISTORY, CHIEF COMPLAINT uted to pancreatitis. TREATMENT
Vague clinical signs (e.g., lethargy, inappetence) • Retroviral testing is appropriate for all sick
are typical. About one-third of cases experience cats. Treatment Overview
vomiting. • Abdominal radiographs are not useful for The mainstay of pancreatitis therapy is sup-
diagnosing pancreatitis but are useful for portive care to treat clinical signs that cause
PHYSICAL EXAM FINDINGS ruling out other differential diagnoses of morbidity (e.g., abdominal pain, vomiting),
There are no specific findings. Lethargy is pancreatitis. identify and treat systemic and pancreatic
common. In severe cases, dehydration and/or complications, and provide nutritional support.
hypothermia may be recognized. Abdominal Advanced or Confirmatory Testing
pain is reported in about one-fourth of cases. • Abdominal ultrasound can be useful in the Acute General Treatment
Icterus can occur with EHBO or concurrent diagnosis of feline pancreatitis. • If possible, remove potential risk factors
hepatopathy (e.g., cholangitis, lipidosis), triaditis ○ Diagnostic criteria: pancreatic enlarge- (e.g., medications or infections implicated
(p. 160), or secondary hepatic lipidosis (p. 444). ment or mass effect, fluid accumulation in pancreatitis).

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