What do we know about feline pancreatitis? (Proceedings)

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What do we know about feline pancreatitis? (Proceedings)

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Apr 01, 2008

Pancreatitis
Inflammation of the pancreas

  • Acute
  • Chronic
Common

Spectrum of Disease
Mild, edematous

  • Mild, rapid recovery
  • Interstitial edema
Hemorrhagic, necrotic
  • Severe, prolonged
  • Complications
  • Necrosis

Pathophysiology
Autodigestion of the pancreas

  • Premature activation of zymogen granules

Pancreatic Protection
  • Enzymes stored as inactive zymogens
  • Cleaved by proteases in small intestine
  • Zymogens and lysosomal enzymes separate
  • Pancreatic secretory trypsin inhibitor

Risk Factors
Fat!

  • Obesity
  • Hyperlipidemia
  • Dietary indiscretion
  • High fat diet
Endocrine diseases
  • Diabetes Mellitus
  • Cushing's Disease
Pancreatic factors
  • Duct obstruction
  • Trauma/ischemia
  • Neoplasia

Drugs & Toxins

  • Potassium bromide (KBr)
  • Azathioprine (Imuran™)
  • L-asparaginase (Elspar™)
  • Organophosphates
  • Furosemide (Lasix™)?
  • Corticosteroids?

Additional Risk Factors in Cats

  • Trauma (high-rise syndrome)
  • Toxoplasma ?
  • FIP ?
  • Triaditis
  • Inflammatory bowel disease
  • Cholangiohepatitis
  • Pancreatitis

Signalment

  • Cats
  • ??

Clinical Signs (Feline)

  • Lethargy
  • Anorexia
  • Dehydration
  • +/- Hypothermia
  • +/- Vomiting
  • +/- Abdominal pain
  • +/- Dyspnea
  • +/- Ataxia
  • +/- Diarrhea
  • +/- Icterus
  • +/- Weight loss

Complications

  • DIC
  • Acute Renal Failure
  • Respiratory distress: pulmonary edema, PTE
  • Vascular collapse, shock
  • Diabetes mellitus/EPI (chronic or acute recurrent)

Diagnosis

  • No pathognomonic test!
  • Definitive diagnosis = biopsy

Baseline Bloodwork
CBC

  • Leukocytosis with a left shift
  • PCV elevated (dehydration)
  • Anemia
Chemistry
  • Azotemia (prerenal or acute renal failure)
  • Elevated LES
  • Hyperbilirubinemia
  • Hyperglycemia
  • Hypocalcemia
  • Hyperlipidemia
  • Hypertriglyceridemia
Amylase and lipase
  • Lack of sensitivity
  • Lack of specificity
  • If very high (3-4 x baseline) than suggestive