Page 546 - Small Animal Internal Medicine, 6th Edition

PART FOUR Hepatobiliary and Exocrine
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PART IV Hepatobiliary and Exocrine Pancreatic Disorders
Pancreatic Disorders
Penny J. Watson

VetBooks.ir CHAPTER 33

Clinical Manifestations of

Hepatobiliary and

Pancreatic Disease

GENERAL CONSIDERATIONS been shown to be significant negative prognostic indicators
in dogs with chronic hepatitis. The presence of cirrhosis is
Clinical signs of hepatobiliary and pancreatic diseases in dogs also a negative prognostic indicator in dogs, and these cases
and cats are very variable with considerable overlap in signs. are more likely to present with ascites, acquired portosys-
Dogs or cats with disease of either the liver or pancreas can temic shunts (PSS), and hepatic encephalopathy (HE). It
present with nonspecific signs such as anorexia, lethargy, is important to appreciate that any prognostic data is on a
and vomiting, or more specific signs such as jaundice (which population basis, and that individual dogs with chronic hepa-
can be hepatic in origin in liver disease or posthepatic in titis and ascites can have a good prognosis. At the opposite
pancreatic disease due to extrahepatic biliary obstruction) end of the spectrum of hepatobiliary and pancreatic disease,
or cranial abdominal pain, which is more common in pan- because of the tremendous reserve capacity of both the liver
creatitis and biliary tract disease than in hepatic parenchy- and the pancreas, there may be no clues for the presence of
mal disease. Clinical signs of pancreatitis in dogs and cats a hepatic disorder or low-grade chronic pancreatitis except
show a spectrum from mild abdominal pain and anorexia for abnormal screening blood test results obtained before
to “acute abdomen” and potential multiorgan failure and an elective anesthetic procedure. However, it is important to
diffuse intravascular coagulation (DIC). Clinical presenta- investigate persistent elevation of liver enzymes even if there
tion is even more challenging in cats because pancreatic and are no clinical signs, because treatment is likely to be much
liver disease often occur concurrently in this species, but cats more effective if instituted early.
also tend to hide their pain. Clinical signs of hepatobiliary
and pancreatic disease are listed in Box 33.1. It is important
to remember that none of these signs are pathognomonic of GASTROINTESTINAL SIGNS
hepatobiliary or pancreatic disease, and they must be dis-
tinguished from identical signs caused by disease of other Vomiting, diarrhea, and anorexia are common clinical signs
organ systems. Cause of death in severe, acute pancreatitis associated with both pancreas and liver disease. Vomiting in
and acute hepatitis is usually multiorgan failure and DIC. In dogs and cats with liver disease can be as a result of local
lower-grade chronic liver disease, death may eventually occur inflammation, portal hypertension, or HE. Animals with
as a result of loss of function, whereas prolonged survival portal hypertension may have hematemesis and melena as a
is possible with chronic pancreatitis in spite of functional result of upper GI ulceration.
loss, provided this is recognized and treated with enzyme Vomiting is a prominent sign in acute and chronic pan-
supplementation and/or insulin. Dogs and cats with acute creatitis in dogs and cats, and is due to focal or more general-
pancreatitis, more severe clinical signs, and compromise of ized peritonitis, and also delayed gastric emptying and
more organ systems at presentation are more likely to die. duodenal hypomotility due to the proximity of pancreatic
In chronic liver disease, the severity of clinical signs does inflammation. Dogs with severe acute pancreatitis usually
not necessarily correlate with the prognosis or with degree present with acute onset of vomiting, anorexia, marked
of liver injury, although several of these signs are often seen abdominal pain, and varying degrees of dehydration, col-
together, particularly in dogs with end-stage hepatic disease lapse, and shock. Differential diagnoses in these cases include
(e.g., ascites, metabolic encephalopathy from hepatocellular other causes of acute abdomen. Signs in cats overlap the
dysfunction, acquired portosystemic venous shunting with signs of cholangitis and inflammatory bowel disease (IBD),
gastrointestinal [GI] bleeding). Both ascites and jaundice have which often occur concurrently in cats, with anorexia and

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