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Pancreatitis in cats (Proceedings)

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Apr 01, 2009

Only in the past decade has pancreatitis even been well-recognized in cats. In contrast to some other species, diagnosis of pancreatitis in cats is difficult, and there are few evidence-based recommendations for diagnosis and treatment. We will review some of the physiology and pathophysiology of the pancreas, and then discuss the diagnosis and management of pancreatitis in the cat. Pancreatitis involves autodigestion, and activation of zymogens. This occurs within the acinar cell, and involves fusion of zymogen granules with other vesicles.

Cats have two forms of pancreatitis

• Acute Necrotizing

o Can be mild (edematous) or severe (hemorrhagic)

o Severe cases can lead to multisystem failure, complications (pseudocyst or abscess)

• Chronic Nonsuppurative

o Can be subclinical

o Can lead to morphologic changes in the pancreas and eventual loss of exocrine or endocrine function

Causes of pancreatitis

• Nutritional Causes

o Low-protein, high-fat diets can induce

o Refeeding after prolonged malnutrition

• Hyperlipoproteinemia

o Cause or effect? Not documented in cats

o Related to abdominal fat necrosis associated with inflammation?

o Increased incidence of pancreatitis in human patients with familiar hyperlipoproteinemia

• Chemicals

o Elspar, azathioprine, 6-mercaptopurine, valproate

o Uncommon (in people) but maybe important in cats . . not studied!: ACE inhibitors, acetominophen, furosemide, sulfasalazine, thiazides

o Rare (in people): estrogens, tetracyclines, glucocorticoids

• Evidence for glucocorticoids is weak at best

• Cause elevation in lipase

• Hypercalcemia

• Scorpion stings (CCK)

• Orghanophosphates (CCK and Ach)

• Duodenal/biliary reflux

o Probably more important in cats than in other species

o Reflux normally does not occur, but bile duct and pancreatic duct are anatomically associated in cats.

o Antireflux mechanisms can fail due to increases in duodenal pressure (vomiting) or trauma to duodenum

• Pancreatic duct obstruction

o Experimental

o Tumors

o Parasites

o Inflammation and edema of the duct wall

• Associated with cholangiohepatitis and IBD in cats

• Surgical manipulation or duct obstruction

• Infectious

o Not documented in dogs and cats

o Increased incidence of pancreatitis in people with septic peritonitis

Diagnosis of pancreatitis in cats

Diagnosing pancreatitis is difficult in cats, because there are no sensitive or specific tests. In the cat, pancreatitis is commonly associated with other diseases. It can be associated with liver diseases, intestinal diseases, chronic renal disease, diabetes, and others. Cause and effect relationships are not clear.

• Chronic Pancreatitis

o Can be extremely difficult . . . vague clinical signs and laboratory changes

• Acute

o Dehydration 92%

o Tachypnea 74%

o Hypothermia 68%

o Icterus 64%