Page 1461 - Cote clinical veterinary advisor dogs and cats 4th

Pancreatitis, Dog 743

to a different class of drug with the same or there is suspicion of a concurrent infectious Surgical drainage may be the best option.
complication (e.g., aspiration pneumonia).
similar effect. • There is no evidence that any other thera- Intensive antibiotic therapy should be insti-
VetBooks.ir portive care. This includes aggressive fluid peutic strategy is clinically efficacious in dogs culture results show an absence of infectious Diseases and Disorders
• The mainstay of pancreatitis therapy is sup-
tuted after draining the abscess, at least until
therapy and careful monitoring for signs of
organisms.
with pancreatitis. Exploratory laparotomy
ensuing complications. After a complication
the obstruction resolves with supportive
the rare patient with suspected pancreatic
has become established in a patient, treat- is rarely indicated but may be necessary for • Pancreatitis can lead to EHBO. In most cases,
ment of it may become increasingly difficult. necrosis. care. However, rare patients need surgery
• Abdominal pain is a key clinical sign in people to reroute the bile duct (p. 118).
with pancreatitis and should be assumed Chronic Treatment • Systemic complications may include DIC,
to be present in any dog with pancreatitis, • Dogs with chronic pancreatitis should thrombocytopenia, acute kidney injury,
whether or not this is clinically apparent. be evaluated for potential risk factors for pulmonary emboli, myocarditis, peritonitis,
Analgesia is of paramount importance and pancreatitis. An 18-hour fasting serum tri- and/or aspiration pneumonia.
can be achieved with intermittent dosing or glyceride concentration should be measured,
continuous-rate infusion. Acceptable options and treatment measures should be employed Recommended Monitoring
include one of the following: for hyperlipidemic animals to keep the serum • Short-term monitoring: CBC, serum bio-
○ Meperidine 5-10 mg/kg IM or slowly IV triglyceride concentration below 500 mg/dL chemistry profile, coagulation panel, Spec
as needed (q 1-4h); short half-life can be (p. 496). cPL
limiting. • The serum calcium concentration should be • Ultrasound is of little value in monitoring
○ Butorphanol 0.2-0.7 mg/kg SQ, IM, or measured and a detailed drug history taken. short-term progress.
IV q 3-6h • Dietary measures are important in the • Long-term monitoring: serum Spec cPL
○ Buprenorphine 0.01-0.02 mg/kg IM or successful treatment of dogs with chronic concentration
IV q 4-8h pancreatitis (see below). Antioxidants may
○ Fentanyl 0.002-0.01 mg/kg SQ, IM, or be of benefit. PROGNOSIS & OUTCOME
IV once, then as a constant-rate infusion • Measurement of serum Spec cPL concentra-
at 0.003-0.006 mg/kg/h; alternatively, may tion can be used to objectively monitor dogs The prognosis for dogs with pancreatitis directly
be administered as transdermal patch, with chronic pancreatitis. correlates with the severity of disease and level of
which takes > 12 hours to take effect supportive care. Mild disease without pancreatic
• Antiemetic therapy can be important. Nutrition/Diet and systemic complications carries an excellent
○ Maropitant 1 mg/kg IV or SQ q 24h or • Although once standard therapy for acute prognosis. Severe disease with pancreatic (e.g.,
2 mg/kg PO q 24h is an NK 1 receptor pancreatitis, withholding food and water is no pancreatic necrosis, pancreatic fluid accumula-
antagonist, which has peripheral and longer recommended. Nutritional support, tions, other) or systemic (e.g., kidney injury,
central antiemetic properties. preferably enteral nutritional support unless respiratory failure, DIC, other) complications
○ Dolasetron and ondansetron are 5-HT 3 uncontrollable vomiting prevents it, can have carries a poor to grave prognosis.
receptor antagonists that have strong beneficial effects in dogs with pancreatitis,
antiemetic properties. Dolasetron 0.3- especially in those with severe disease. PEARLS & CONSIDERATIONS
0.6 mg/kg IV, SQ, or PO q 12-24h and • If uncontrollable vomiting persists for several
ondansetron 0.1-0.2 mg/kg slowly IV, or days, total or partial parenteral nutrition Comments
0.4-1 mg/kg SQ, or PO q 6-12h can be (TPN or PPN [p. 1148]) should be con- Pancreatitis is being diagnosed with increasing
safely used in dogs. sidered for nutritional support. Alternatively, frequency in dogs. Most dogs that die for any
○ Patients can be treated with a 5-HT 3 and a jejunostomy tube placed surgically or reason have histopathologic changes of the
an NK 1 inhibitor simultaneously. Because by endoscopy can be used for nutritional exocrine pancreas, suggesting that subclinical
both classes of drugs act through different support. exocrine pancreatic disease and inflammation
mechanisms, effects are additive. • Dogs with pancreatitis should be fed an are common in dogs.
○ Metoclopramide is a dopamine antagonist ultralow-fat diet. Care should be taken to
and may have a negative impact on avoid treats that may be high in fat. Owners Prevention
pancreatic perfusion and therefore is not should be encouraged to switch treats to Eliminating risk factors aids in the prevention
the drug of first choice. vegetables, fruits, or commercial ultralow-fat of pancreatitis.
• Dogs with severe pancreatitis associated treats.
with dehydration, electrolyte and acid-base Technician Tips
abnormalities, DIC, and/or other systemic Drug Interactions The vital parameters for dogs with severe forms
complications may benefit from plasma Avoid drugs implicated in causing pancreatitis of acute pancreatitis can change rapidly. Fre-
transfusions on a daily basis (e.g., 10 mL/ (see Risk Factors above). quent re-evaluation is essential for recognizing
kg IV for 1-2 hours [p. 1169]), although changes early, before complications manifest.
there is little scientific evidence that plasma Possible Complications
administration is clinically useful in humans • Pancreatic fluid collections or pseudocyst (an SUGGESTED READING
or dogs with pancreatitis. However, many encapsulated fluid collection in the region of Steiner JM. Canine pancreatitis: diagnosis and
veterinary gastroenterologists think there the pancreas) rarely develop in dogs with pan- treatment. In Ettinger SJ, et al, editors: Textbook
appears to be a clinical benefit. creatitis. Little is known about appropriate of veterinary internal medicine, ed 8, St. Louis,
• Antibiotics have failed to show benefit in management in dogs. In humans, pancreatic 2017, Elsevier, pp 1683-1688.
human patients with pancreatitis. Dogs pseudocysts are carefully monitored and are AUTHOR: Jörg M. Steiner, Dr.med.vet., PhD, DACVIM,
with pancreatitis rarely develop infectious drained only if they increase in size. DECVIM, AGAF
complications of pancreatitis, and antibiotic • Pancreatic abscesses have been reported in EDITOR: Keith P. Richter, DVM, MSEL, DACVIM
therapy should be implemented only when only a few dogs. Most were not infected.

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