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| | Cats mainly suffer from mild chronic interstitial pancreatitis. | | Cats mainly suffer from mild chronic interstitial pancreatitis. |
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| − | ==Signalment==
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| − | Predisposed breeds include: Labradors, Miniature Poodles, Miniature Schnauzers, Yorkshire Terriers
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| − | Increased risk of disease occurs with obesity, [[Diabetes Mellitus|diabetes mellitus]], [[Hyperadrenocorticism|hyperadrenocorticalism]], prior gastrointestinal disease or [[Seizures|recurrent seizures]].
| + | == Introduction Pancreatitis, Acute Haemorrhagic== |
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| − | Additionally, middle aged dogs are more commonly affected and male and spayed females are affected more frequently than entire females.
| + | This term is often interchangeable with [[Pancreatic Necrosis, Acute|acute pancreatic necrosis]] or '''acute pancreatitis'''. The condition can be mild or severe, non-fatal or fatal. It usually occurs as a sudden onset condition, often after ingestion of a meal rich in fat, but this depends on what species the condition occurs. |
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| − | ==History and Clinical Signs==
| + | The [[Pancreas - Anatomy & Physiology#Endocrine|Islets of Langerhans]] may become involved thus causing the signs if insulin insufficiency. Pancreatitis may be initiated by trauma which initiates the leakage of enzymes. It can also present as recurrent acute pancreatitis - repeated inflammation with minimal permanent pathology. In the disease process, proteolytic degradation of pancreatic parenchyma, vascular damage and haemorrhage occur as well as necrosis of fat by lipolytic enzymes in the pancreas and surrounding omentum. These changes are concentrated at the periphery of lobules and infiltration by leukocytes indicates inflammation. In mild cases oedema of the interstitial tissue occurs. In more severe cases the [[Pancreas - Anatomy & Physiology|pancreas]] is haemorrhagic and oedematous with greyish white areas of necrosis and this may be interspersed with normal parenchyma. The [[Peritoneal Cavity - Anatomy & Physiology|peritoneal cavity]] may contain blood-stained fluid sometimes with droplets of fat. Due to these large amounts of necrotic debris, infection by microorganisms from the [[Alimentary System Overview - Anatomy & Physiology|GIT]] is likely, causing abscesses. |
| − | There is often a history of eating a fatty meal.
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| − | Clinical signs include anorexia, vomiting, abdominal pain, lethargy, depression and nausea.
| + | == Acute Pancreatitis in other animals<br> == |
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| − | [[Diarrhoea|Diarrhoea]] is also a common feature sometimes with blood, fresh or melaena this occurs due to the proximity of inflamed pancreas to the [[Duodenum - Anatomy & Physiology|duodenum]] and [[Colon - Anatomy & Physiology|colon]].
| + | In horses, necrosis and inflammation results due to migration of parasites, usually strongyle larvae, releasing pancreatic enzymes causing autodigestion. Destructive granulomatous pancreatitis is a part of multisystemic eosinophilic epitheliotrophic syndrome. |
| − | More severe cases may present in [[Shock|shock]], [[Kidney Renal Failure - Pathology#Acute|acute renal failure]], [[Icterus|jaundiced]] (due to focal hepatic necrosis), or with cardiac arrhythmias. Pulmonary oedema, pleural effusions, widespread haemorrhage, [[Disseminated Intravascular Coagulation|DIC]], mild ascites, dehydration (mild to moderate) and pyrexia may also be present.
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| − | '''Acute haemorrhagic pancreatitis''' may present as shock and collapse.
| + | In pigs suppuration of the pancreas can occasionally arise as an extension from nearby infection, eg. peritonitis and perforated oesophageal ulcers.<br> |
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| − | A cranial abdominal mass may be palpated.
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| − | Affected '''cats''' have a very varied presentation. If severe, they present with lethargy and anorexia with vomiting and abdominal pain being reported less than in the dog, hypothermia is also common sign occurring in 68% of affected cats. Mild chronic pancreatitis may show anorexia and weight loss.
| + | == Introduction Pancreatitis, Chronic Interstitial== |
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| − | ==Laboratory Tests==
| + | Chronic pancreatitis often occurs following ongoing inflammation with progression to irreversible damage and impaired function. There is usually fibrosis and reduction in acinar mass. This condition can occur in all species as a consequence of obstruction of the pancreatic ducts, vitamin A deficiency may predispose to this. The condition is most common in the dog, but also in cat, horse and cattle. The [[Pancreas - Anatomy & Physiology#Endocrine|islets of Langerhans]] tend to be preserved. If chronic pancreatitis persisits it can lead to Exocrine Pancreatic Insufficiency (EPI). In cats, chronic pancreatitis can also lead to Diabetes Meliitus developing.<br> |
| − | On Haematology there may be a leucocytosis, an increased [[Packed Cell Volume]] due to dehydration, [[Platelet Abnormalities#Thrombocytopaenia|thrombocytopaenia]], [[Neutrophilia|neutrophilia]] and a left shift.
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| − | On Biochemistry changes may include an [[Azotaemia|azotaemia]], increased liver enzymes, hyperbilirubinaemia,
| + | <br> |
| − | hyperglycaemia in cases of nectrotizing pancreatitis and hypoglycaemia in cats with suppurative pancreatitis.
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| − | In dogs hypercholesterolaemia and hypertriglyceridaemia are also common changes.
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| − | An increase in pancreatic digestive enzymes (amylase, lipase, trypsin-like immunoreactivity (TLI), phospholipase A2 and pancreatic lipase immunoreactivity (PLI) will also be present.
| + | == Chronic Pancreatitis in other animals<br> == |
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| − | ===Pancreas-specific laboratory tests===
| + | '''In sheep'''<br> |
| − | All pancreatic enzymes increase following [[Kidney Renal Failure - Pathology|renal failure]] (apart from PLI) making it difficult to determine the true cause of the increase. However increases of three fold are mainly due to pancreatitis, whereas five fold increases are rarely not found to be pancreatitis. Rises in lipase, amylase and phospholipase A2 may also be hepatic, gastric, intestinal or neoplastic in origin.
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| − | '''In cats:''' Amylase and lipase are of no diagnostic value. Serum feline trypsin-like immunoreactivity (fTLI) is a specific test for exocrine pancreatic function but the test's sensitivity varies between 30% and 60%. In comparison, the serum feline pancreatic lipase immunoreactivity test (fPLI) has been found to be more specific and sensitive in diagnosing feline pancreatitis.
| + | Necrosis of [[Pancreas - Anatomy & Physiology#Exocrine|exocrine pancreatic cells]] followed by fibrosis can be caused by zinc toxicosis. Focal pancreatitis may occur during [[Picornaviridae#Foot_and_Mouth_Disease_Virus|Foot and Mouth disease]] resulting in [[DM|diabetes mellitus]] during recovery.<br> |
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| − | '''In dogs:''' Marked increases in serum lipase is a more reliable marker than amylase. However corticosteroid administration raises lipase activity by up to five fold. Serum canine pancreatic lipase immunoreactivity (cPLI) is the most sensitive and specific test for diagnosing canine pancreatitis. | + | '''In horses'''<br> |
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| − | ==Diagnostic Imaging==
| + | Chronic pancreatitis can occur sporadically and is usually a consequence of [[Pancreas - Parasitic Pathology|parasitic migration]] or from ascending bacterial infection of pancreatic ducts. It can occur alongside '''chronic eosinophilic gastroenteritis''' and is usually clinically silent. Organ tends to be replaced by scar tissue.<br> |
| − | '''Survey Radiographs''' are rarely helpful but findings may include an increased density in the right cranial abdomen, decreased contrast, decreased granularity and the stomach may be displaced to the left. | |
| − | Additionally the descending duodenum may be displaced to the right, with the presence of a medial mass and thickened walls.
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| − | Gastric distension may be visible and barium passage may be delayed indicating abnormal peristalsis.
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| − | Radiography is useful to rule out differentials.
| + | '''In cattle'''<br> |
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| − | '''Abdominal Ultrasound''' is highly specific with a sensitivity of 70% in dogs and 30% in cats but is operator-dependant. Findings include
| + | Focal pancreatitis may occur during [[Picornaviridae#Foot_and_Mouth_Disease_Virus|Foot and Mouth disease]] resulting in [[DM|diabetes mellitus]] during recovery.<br> |
| − | pancreatic enlargement, peritoneal effusion, hypoechogenic pancreas (pancreatic necrosis) and hyperechogenic surrounding tissue.
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| − | ==Exploratory Laparotomy/Necropsy Findings==
| + | <br> |
| − | The pancreas will be oedematous and soft with fibrinous attachments to surrounding organs, there may be free fluid within the peritoneal cavity and pancreas liquefaction if severe enough.
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| − | Pseudocysts may be present, as well as omental and pancreatic [[Haemorrhage|haemorrhages]] and areas of fat necrosis.
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| − | A biopsy should be taken to provide evidence of inflammation.
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| | ==Treatment== | | ==Treatment== |
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| | The disease varies widely and the prognosis can vary from full recovery to death. Generally if the case is an uncomplicated single episode patients will make a good recovery. | | The disease varies widely and the prognosis can vary from full recovery to death. Generally if the case is an uncomplicated single episode patients will make a good recovery. |
| | | | |
| − | == Introduction Pancreatitis, Acute Haemorrhagic==
| |
| | | | |
| − | This term is often interchangeable with [[Pancreatic Necrosis, Acute|acute pancreatic necrosis]] or '''acute pancreatitis'''. The condition can be mild or severe, non-fatal or fatal. It usually occurs as a sudden onset condition, often after ingestion of a meal rich in fat, but this depends on what species the condition occurs.
| |
| | | | |
| − | The [[Pancreas - Anatomy & Physiology#Endocrine|Islets of Langerhans]] may become involved thus causing the signs if insulin insufficiency. Pancreatitis may be initiated by trauma which initiates the leakage of enzymes. It can also present as recurrent acute pancreatitis - repeated inflammation with minimal permanent pathology. In the disease process, proteolytic degradation of pancreatic parenchyma, vascular damage and haemorrhage occur as well as necrosis of fat by lipolytic enzymes in the pancreas and surrounding omentum. These changes are concentrated at the periphery of lobules and infiltration by leukocytes indicates inflammation. In mild cases oedema of the interstitial tissue occurs. In more severe cases the [[Pancreas - Anatomy & Physiology|pancreas]] is haemorrhagic and oedematous with greyish white areas of necrosis and this may be interspersed with normal parenchyma. The [[Peritoneal Cavity - Anatomy & Physiology|peritoneal cavity]] may contain blood-stained fluid sometimes with droplets of fat. Due to these large amounts of necrotic debris, infection by microorganisms from the [[Alimentary System Overview - Anatomy & Physiology|GIT]] is likely, causing abscesses.
| + | ==Literature Search== |
| | + | [[File:CABI logo.jpg|left|90px]] |
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| − | == Acute Pancreatitis in other animals<br> ==
| |
| | | | |
| − | In horses, necrosis and inflammation results due to migration of parasites, usually strongyle larvae, releasing pancreatic enzymes causing autodigestion. Destructive granulomatous pancreatitis is a part of multisystemic eosinophilic epitheliotrophic syndrome.
| + | Use these links to find recent scientific publications via CAB Abstracts (log in required unless accessing from a subscribing organisation). |
| | + | <br><br><br> |
| | + | [http://www.cabdirect.org/search.html?q=title%3A%28%22pancreatitis%22%29+AND+%28od%3A%28cats%29+OR+title%3A%28dogs%29%29&fq=sc%3A%22ve%22 Pancreatitis in cats and dogs publications] |
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| − | In pigs suppuration of the pancreas can occasionally arise as an extension from nearby infection, eg. peritonitis and perforated oesophageal ulcers.<br>
| |
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| | + | ==References== |
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| − | == Introduction Pancreatitis, Chronic Interstitial==
| + | Andrews, A.H, Blowey, R.W, Boyd, H and Eddy, R.G. (2004) '''Bovine Medicine''' (Second edition), ''Blackwell Publishing'' |
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| − | Chronic pancreatitis often occurs following ongoing inflammation with progression to irreversible damage and impaired function. There is usually fibrosis and reduction in acinar mass. This condition can occur in all species as a consequence of obstruction of the pancreatic ducts, vitamin A deficiency may predispose to this. The condition is most common in the dog, but also in cat, horse and cattle. The [[Pancreas - Anatomy & Physiology#Endocrine|islets of Langerhans]] tend to be preserved. If chronic pancreatitis persisits it can lead to Exocrine Pancreatic Insufficiency (EPI). In cats, chronic pancreatitis can also lead to Diabetes Meliitus developing.<br>
| + | Bertone, J. (2006) '''Equine Geriatric Medicine and Surgery''', ''Elsevier'' |
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| − | <br>
| + | Blood, D.C. and Studdert, V. P. (1999) '''Saunders Comprehensive Veterinary Dictionary''' (2nd Edition), ''Elsevier Science'' |
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| − | == Chronic Pancreatitis in other animals<br> ==
| + | Brown, C.M, Bertone, J.J. (2002) '''The 5-Minute Veterinary Consult- Equine''', Lippincott, ''Williams & Wilkins'' |
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| − | '''In sheep'''<br> | + | Cowart, R.P. and Casteel, S.W. (2001) '''An Outline of Swine diseases: a handbook,''' ''Wiley-Blackwell'' |
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| − | Necrosis of [[Pancreas - Anatomy & Physiology#Exocrine|exocrine pancreatic cells]] followed by fibrosis can be caused by zinc toxicosis. Focal pancreatitis may occur during [[Picornaviridae#Foot_and_Mouth_Disease_Virus|Foot and Mouth disease]] resulting in [[DM|diabetes mellitus]] during recovery.<br>
| + | Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat''' Volume 2 (Fifth Edition), ''W.B. Saunders Company'' |
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| − | '''In horses'''<br> | + | Ettinger, S.J, Feldman, E.C. (2005) '''Textbook of Veterinary Internal Medicine''' (6th edition, volume 2), ''W.B. Saunders Company'' |
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| − | Chronic pancreatitis can occur sporadically and is usually a consequence of [[Pancreas - Parasitic Pathology|parasitic migration]] or from ascending bacterial infection of pancreatic ducts. It can occur alongside '''chronic eosinophilic gastroenteritis''' and is usually clinically silent. Organ tends to be replaced by scar tissue.<br>
| + | Fossum, T. W. et. al. (2007) '''Small Animal Surgery''' (Third Edition), ''Mosby Elsevier'' |
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| − | '''In cattle'''<br> | + | Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition),''' ''BSAVA'' |
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| − | Focal pancreatitis may occur during [[Picornaviridae#Foot_and_Mouth_Disease_Virus|Foot and Mouth disease]] resulting in [[DM|diabetes mellitus]] during recovery.<br>
| + | Jackson, G.G. and Cockcroft, P.D. (2007) '''Handbook of Pig Medicine,''' ''Saunders Elsevier'' |
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| − | <br>
| + | Knottenbelt, D.C. '''A Handbook of Equine Medicine for Final Year Students University of Liverpool''' |
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| | + | Merck & Co (2008) '''The Merck Veterinary Manual''' ''Merial'' |
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| | + | Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine''' (Fourth Edition) ''Mosby Elsevier'' |
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| − | ==Literature Search==
| + | Sturgess, K. (2003) '''Notes on Feline Internal Medicine''' ''Blackwell Publishing'' |
| − | [[File:CABI logo.jpg|left|90px]]
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| | + | Tilley, L.P. and Smith, F.W.K.(2004) '''The 5-minute Veterinary Consult''' (Third edition) Lippincott, ''Williams & Wilkins'' |
| | | | |
| − | Use these links to find recent scientific publications via CAB Abstracts (log in required unless accessing from a subscribing organisation).
| |
| − | <br><br><br>
| |
| − | [http://www.cabdirect.org/search.html?q=title%3A%28%22pancreatitis%22%29+AND+%28od%3A%28cats%29+OR+title%3A%28dogs%29%29&fq=sc%3A%22ve%22 Pancreatitis in cats and dogs publications]
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| − | [http://www.cabi.org/cabdirect/FullTextPDF/2007/20073085504.pdf '''Update on pancreatitis in dogs.''' Simpson, K. W.; Svoboda, M. ; Czech Small Animal Veterinary Association, Prague, Czech Republic, 2006 World Congress Proceedings. 31st World Small Animal Association Congress, 12th European Congress FECAVA, & 14th Czech Small Animal Veterinary Association Congress, Prague, Czech Republic, 11-14 October, 2006, 2006, pp 382-389 - '''Full Text Article''']
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| − | [http://www.cabi.org/cabdirect/FullTextPDF/2006/20063041204.pdf ''' Pancreatitis in cats.''' Graves, T. K.; Ontario Veterinary Medical Association, Milton, Canada, Ahead of the curve: OVMA Conference Proceedings, 26-28 January, 2006, 2006, pp 158-163 - '''Full Text Article''']
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| − | ==References==
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| − | For further information on canine pancreatitis see: [http://inpractice.bvapublications.com/cgi/reprint/26/2/64?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=feline+pancreatitis&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT Pancreatitis in the dog:. dealing with a spectrum of disease] In Practice article
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| − | For further information on feline pancreatitis see: [http://inpractice.bvapublications.com/cgi/reprint/29/8/470?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=feline+pancreatitis&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT Feline pancreatitis: current concepts and treatment guidelines] In Practice article
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| − | Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
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| − | Merck & Co (2008) '''The Merck Veterinary Manual''' ''Merial''
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