Page 1458 - Cote clinical veterinary advisor dogs and cats 4th

Pancreatitis, Cat 741

• Aggressive but judicious crystalloid fluid when inflammation exists in all three sites) • Chronic recurrent pancreatitis may be a risk
therapy benefit from appropriate management of factor for endocrine (i.e., diabetes mellitus)
VetBooks.ir pain should be assumed to be present in • Avoid diets that are high in fat content, Recommended Monitoring Diseases and Disorders
or exocrine (i.e., exocrine pancreatic insuf-
comorbid conditions.
• Analgesia is very important. Abdominal
ficiency) pancreatic dysfunction.
such as low-carbohydrate diets and diets
any cat with pancreatitis, whether clinically
apparent or not. Analgesia can be achieved
with intermittent dosing or continuous-rate intended for patients with chronic kidney • Short-term monitoring: CBC, serum bio-
disease.
infusion. Acceptable options include one of • Many cats with chronic pancreatitis have chemistry profile, coagulation panel, fPLI
the following: a lymphocytic infiltration of the pancreas, (every 2-3 days for cats with acute disease
○ Meperidine 2-4 mg/kg IM, as needed; similar to humans with autoimmune pancre- and every 2-3 weeks for patients with chronic
short half-life or adverse effects can be atitis. If no risk factors are identified and the disease)
limiting patient does not improve spontaneously, a • Ultrasound is of little value in monitoring
○ Butorphanol 0.1-0.4 mg/kg SQ, IM, or therapeutic trial with an immunosuppressive short-term progress.
IV q 8h agent can be undertaken. A baseline serum • Long-term monitoring: fPLI (initially
○ Buprenorphine 0.005-0.015 mg/kg IM fPLI concentration is measured, and pred- every 2-3 weeks; less frequently as patient
or IV q 8h nisolone 1-2 mg/kg PO q 12h is given for 10 normalizes)
○ Morphine 0.05-0.2 mg/kg q 2-6h SQ or days or cyclosporine 5 mg/kg PO q 24h for
IM, may cause dysphoria or nausea 3 weeks. A second serum fPLI concentration PROGNOSIS & OUTCOME
○ Fentanyl 0.002-0.003 mg/kg IV once; measured at this point indicates whether to
then if needed, as a constant-rate infusion: stop treatment (fPLI the same or higher and/ The prognosis for cats with pancreatitis is
0.001-0.004 mg/kg/h IV or clinical signs unaltered or worsened) or directly related to the severity of the disease.
• Antiemetic therapy for vomiting continue on a tapering schedule based on Mild disease without pancreatic and systemic
○ Maropitant has peripheral and central positive response (i.e., fPLI decreased and/ complications carries a good prognosis. Severe
antiemetic properties (1 mg/kg IV, SQ, or clinical signs improved). disease with pancreatic (e.g., pancreatic necrosis,
or PO q 24h). pancreatic or peripancreatic fluid accumulations;
○ Dolasetron and ondansetron are 5-HT 3 Nutrition/Diet other) or systemic complications carries a poor
receptor antagonists with strong antiemetic • Nutritional support, preferably enteral to grave prognosis.
properties. Dolasetron 0.3-0.6 mg/kg IV, nutrition, has numerous beneficial effects,
SQ, or PO q 12-24h and ondansetron including reduction of risk for anorexia- PEARLS & CONSIDERATIONS
0.1-0.2 mg/kg slowly IV q 12h can be associated hepatic lipidosis.
used safely in cats. • In cats that are eating and not vomiting, Comments
○ Simultaneous use of maropitant and a low-fat diet should be offered in small Pancreatitis is diagnosed with increasing
5-HT 3 antagonists can provide additive amounts and given multiple times per day. frequency in cats. It is intriguing to speculate
effects. • Tube feeding (nasogastric, esophagostomy, that at least some cats with chronic pancreatitis
○ Metoclopramide is a dopamine antagonist percutaneous endoscopic gastrostomy, or have a condition that is similar to autoimmune
and a weak antiemetic but may also have jejunostomy tube [pp. 1106, 1107, and pancreatitis in humans and, like humans with
a negative impact on pancreatic perfu- 1109]) should be considered for cats that this disease, may benefit from immunosuppres-
sion and therefore is not the first drug refuse food for more than 3 to 4 days. sive therapy (see above).
of choice. • If vomiting despite the use of antiemetics
• Monitor for complications as early interven- precludes enteral nutrition, total or partial Technician Tips
tion can be lifesaving. parenteral nutrition (TPN or PPN [p. 1148]) Cats with pancreatitis should be frequently and
• Antibiotic therapy should be implemented should be considered. carefully reassessed for evidence of abdominal
only when there is a specific suspicion for discomfort.
an infectious complication of pancreatitis. Drug Interactions
• Glucocorticoid therapy may be helpful, Avoid any drugs implicated in causing SUGGESTED READING
especially if there is concurrent histologically pancreatitis. Steiner JM: Exocrine pancreas. In Steiner JM, editor:
confirmed (or suspected) inflammatory bowel Small animal gastroenterology, Hannover, 2008,
disease and/or cholangitis. Possible Complications Schlütersche-Verlagsgesellschaft, pp 283-306.
• Although nothing per os was recommended • Pancreatic abscessation has been reported AUTHOR: Jörg M. Steiner, Dr.med.vet., PhD, DACVIM,
in years past, nutritional support is crucial. for only two cats. DECVIM, AGAF
If anorexia is prolonged, nasoesophageal or • Pancreatitis can lead to EHBO; most such EDITOR: Keith P. Richter, DVM, MSEL, DACVIM
esophagostomy tube feeding may be war- obstructions resolve with supportive care.
ranted (see below). • Systemic complications are rare in cats but
may include disseminated intravascular
Chronic Treatment coagulation (DIC), thrombocytopenia, acute
• Cats with concurrent inflammatory bowel kidney injury and uremia, pleural effusion,
disease (IBD) and/or cholangitis (triaditis and peritonitis.

www.ExpertConsult.com