Page 474 - Problem-Based Feline Medicine

466 PART 7 SICK CAT WITH SPECIFIC SIGNS

Treatment feline pancreatic lipase immunoreactivity. No laboratory
abnormality appears to be correlated with the develop-
None required.
ment or severity of effusion.
● Peritoneal effusion is usually a modified transudate,
PANCREATITIS** but may be a non-septic exudate.
Diagnostic imaging findings are also variable.
Classical signs
● On abdominal radiographs, decreased contrast may
● Acute depression and anorexia. be present due to effusion. This may be restricted to
● Ascites may develop. the cranial abdomen or be more generalized.
● Other radiographic findings supportive of pancre-
See main reference on page 272 (The Cat With atitis include a mass effect in the right cranial quad-
Depression, Anorexia or Dehydration). rant (displacement of organs), and localized
dilation of loops of intestine (ileus). Normal find-
ings do not rule out pancreatitis.
Clinical signs
● On abdominal ultrasonography, accumulation of
Cat may be of any age, with no sex or breed predilec- peritoneal fluid around the pancreas is a highly
tion, except perhaps for Siamese cats. specific finding for pancreatitis. Generalized peri-
toneal effusion is a less specific finding.
Duration of clinical signs prior to presentation varies
● Other ultrasonographic findings with a high speci-
from several days to more than 3 weeks.
ficity for pancreatitis include pancreatic regular or
Depression and/or anorexia are the most common irregular enlargement, pancreatic hypoechogenic-
historical signs and may be the only signs present. The ity, hyperechogenicity of peripancreatic fat (may be
most common physical abnormalities are dehydra- difficult to appreciate), and dilation of the pancre-
tion and hypothermia. Fever is uncommon. atic duct in the left lobe. Normal findings do not
rule out pancreatitis.
Other inconsistent signs include weight loss, vomit-
● Definitive ante-mortem diagnosis requires biopsy
ing, diarrhea, cranial abdominal pain, cranial abdomi-
obtained by exploratory laparotomy or laparoscopy.
nal mass, dyspnea, ataxia and disorientation, and
shock. Polydipsia may be present, but is usually due to Differential diagnosis
concurrent diabetes mellitus.
● Peritoneal effusion may occur, and in some cases Differential diagnoses for cats with pancreatitis caus-
may be of sufficient quantity to cause abdominal ing acute depression and abdominal fluid include
distention. Peritoneal effusion may be more likely septic peritonitis, acute abdominal hemorrhage, right
to occur when there is concurrent liver disease. heart failure, ruptured urinary bladder, ruptured gall
Pleural effusion may also occur. bladder, steatitis, toxoplasmosis, ligation of a porto-
systemic shunt and, uncommonly, hepatic encephalo-
Diagnosis pathy where liver disease is also causing ascites.
For cats with pancreatitis causing subacute depres-
Because clinical and laboratory findings are non-
sion and abdominal fluid, the primary differential
specific, diagnosis requires a high index of suspicion.
diagnoses are neoplasia, feline infectious peritonitis
Pancreatitis should be considered in any cat with and right heart failure.
unexplained acute depression. Pancreatitis should
also be considered in any critically ill cat developing
ascites, pleural effusion or hypothermia. Treatment

Laboratory findings are variable and are most valu- Address the inciting cause if one is identified.
able in ruling out other causes of depression and
The remainder of therapy is largely supportive.
anorexia. The most sensitive and specific tests are ele-
vations in feline trypsin-like immunoreactivity and Antiemetics and analgesics.