Diagnosis and management of feline pancreatitis (Proceedings) - Veterinary Healthcare
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Diagnosis and management of feline pancreatitis (Proceedings)


CVC IN KANSAS CITY PROCEEDINGS


Treatment of acute pancreatitis

Acute necrotizing pancreatitis in cats can be a significant therapeutic challenge. As with the treatment of dogs, the therapy is supportive and aimed at restoring circulating blood volume while allowing the pancreas to "rest". If an inciting cause can be identified, it should be corrected; however, greater than 90% of cases are idiopathic. The mainstay of treatment is aggressive fluid therapy, and if the cat is vomiting, withholding food and water for 2-3 days. Colloid support can be obtained with hydroxyethyl starch (Hetastarch) or plasma if it is available. If the cat is unable to tolerate water or food after the 2-3 day period, alternative routes of nutritional support must be considered to prevent development of hepatic lipidosis or protein/calorie malnutrition and immunosuppression. If the cat is not vomiting, placement of an esophagostomy (E) or percutaneous endoscopic gastrostomy (PEG) tube are reasonable alternatives – especially in cats with known or suspected hepatic lipidosis as a concurrent problem. In vomiting cats, either parenteral (IV) nutrition or placement of a jejunal feeding tube is optimal. The key point is this: you can't starve cats with pancreatitis. In cats with chronic, low grade pancreatitis this is even a more important aspect of long term management. Another important aspect of therapy that must be considered in cats with pancreatitis is pain management (whether or not they show overt pain this is important). Careful palpation in most cats will reveal cranial quadrant pain in cats with significant pancreatic inflammation. Pain relief can be achieved with buprenorphine (0.005-0.01 mg/kg IV, or IM q 4-8 hr), meperidine (1-2 mg/kg IM q2-4 hr), or butorphanol (0.2-0.4 mg/kg IM q2-4 hr). In addition, low dose CRI ketamine or lidocaine infusions are effective in reducing somatic pain, and lidocaine at these low doses has prokinetic activity. Morphine should be avoided as it can cause pancreatic duct spasm. The other aspects of supportive therapy to consider are antibiotic therapy, control of vomiting, and anti-coagulants (for cats in DIC). Antibiotic therapy is generally indicated in all cats with severe pancreatitis, or in cats with systemic inflammatory response syndrome (SIRS) as the risk of bacterial translocation and secondary sepsis are considerable. In general, broad spectrum antibiotics that cover intestinal aerobes and anaerobes should be chosen. Cefotaxime at a dose of 50 mg/kg administered intramuscularly every eight hours prevents bacterial colonization of the pancreas.

Chronic pancreatitis

Therapy of chronic pancreatitis is somewhat controversial because there are no evidence based studies yet available reporting specific therapeutic approaches that are beneficial. Many have advocated the use of steroid therapy, and in some cats with chronic pancreatitis this may be reasonable, where LP inflammation is the primary problem causing clinical signs. However, in end stage cats where fibrosis and pancreatic degeneration, not inflammation, is occurring, steroids would be expected to be counterproductive. At this time, appetite stimulation (using cyproheptadine) and pain control (buprenorphine) are the most commonly recommended therapeutic approaches. Pancreatic biopsy is the most effective means of providing the information needed to determine the best course of therapy in these cats. At this time, fluid therapy to maintain hydration, appetite stimulation and a highly digestible or hypoallergenic diet, pain control, and judicious use of steroids are the mainstay of therapy. Further work on the underlying causes of this disease are needed to better define therapy.

Nutritional therapy of pancreatitis

The diet chosen should be highly digestible and palatable, but the concept of low fat diet to reduce stimulation of pancreatic secretions is not recognized as an important aspect of therapy (as it is in dogs) due to the different causes and histologic types (LP) pancreatitis. Ultimately, the goal is to find an appropriate diet for the cat that is highly digestible, commercially available and acceptable to the cat. An important point about feeding cats during this period is to avoid force feeding – not only because it is very difficult to achieve the appropriate level of caloric intake by this method, but also because it can induce food aversion.

References

Steiner, J. Feline Pancreatitis. Vet Clin N Am, 2003.

Washabau, R. Feline Pancreatitis. August's Consultations in Feline Internal Medicine, 2006.


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