Changes

Cats mainly suffer from mild chronic interstitial pancreatitis.

Cats mainly suffer from mild chronic interstitial pancreatitis.

==Signalment==

 

===Signalment===

Increased risk of disease occurs with obesity, [[Diabetes Mellitus|diabetes mellitus]], [[Hyperadrenocorticism|hyperadrenocorticalism]], prior gastrointestinal disease or [[Seizures|recurrent seizures]].

Increased risk of disease occurs with obesity, [[Diabetes Mellitus|diabetes mellitus]], [[Hyperadrenocorticism|hyperadrenocorticalism]], prior gastrointestinal disease or [[Seizures|recurrent seizures]].

==History and Clinical Signs==

===History and Clinical Signs===

There is often a history of eating a fatty meal.

There is often a history of eating a fatty meal.

[[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]].

[[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]].

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.

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.

A cranial abdominal mass may be palpated.  

A cranial abdominal mass may be palpated.  

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.

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.

==Laboratory Tests==

===Laboratory Tests===

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.

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.

An increase in pancreatic digestive enzymes (amylase, lipase, trypsin-like immunoreactivity (TLI), phospholipase A2 and pancreatic lipase immunoreactivity (PLI) will also be present.

An increase in pancreatic digestive enzymes (amylase, lipase, trypsin-like immunoreactivity (TLI), phospholipase A2 and pancreatic lipase immunoreactivity (PLI) will also be present.

===Pancreas-specific laboratory tests===

====Pancreas-specific laboratory tests====

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.  

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.  

'''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.

'''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.

===Diagnostic Imaging===

 

==Diagnostic Imaging==

'''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.

'''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.

Additionally the descending duodenum may be displaced to the right, with the presence of a medial mass and thickened walls.

pancreatic enlargement, peritoneal effusion, hypoechogenic pancreas (pancreatic necrosis) and hyperechogenic surrounding tissue.

pancreatic enlargement, peritoneal effusion, hypoechogenic pancreas (pancreatic necrosis) and hyperechogenic surrounding tissue.

==Exploratory Laparotomy/Necropsy Findings==

===Exploratory Laparotomy/Necropsy Findings===

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.

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.

Pseudocysts may be present, as well as omental and pancreatic [[Haemorrhage|haemorrhages]] and areas of fat necrosis.

Pseudocysts may be present, as well as omental and pancreatic [[Haemorrhage|haemorrhages]] and areas of fat necrosis.

A biopsy should be taken to provide evidence of inflammation.

A biopsy should be taken to provide evidence of inflammation.

==Treatment==

===Treatment===

===Acute Treatment===

====Acute Treatment====

The general treatment involves fluid correction and maintenance while any underlying cause is treated. Support is then given to allow the inflammatory process to subside. Oral feeding should be witheld for a short period in vomiting patients but enteral and parenteral feeding can be well tolerated.

The general treatment involves fluid correction and maintenance while any underlying cause is treated. Support is then given to allow the inflammatory process to subside. Oral feeding should be witheld for a short period in vomiting patients but enteral and parenteral feeding can be well tolerated.

For short term use in fulminating pancreatitis, [[Steroids|corticosteroids]] can be given alongside fluids. Long term treatment may lead to unwanted complications.

For short term use in fulminating pancreatitis, [[Steroids|corticosteroids]] can be given alongside fluids. Long term treatment may lead to unwanted complications.

===Long-term treatment===

====Long-term treatment====

In most patients that have one episode, they may only need to avoid fatty foods. Recurrent hypertriglyceridaemia may need pharmacological intervention.

In most patients that have one episode, they may only need to avoid fatty foods. Recurrent hypertriglyceridaemia may need pharmacological intervention.

==Prognosis==

===Prognosis===

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.

== Acute Pancreatitis in Cats<br>  ==

== Acute Pancreatitis ==

==== Introduction'''<br>''' ====

==== Introduction  ====

Cats occasionally get the acute necrotizing form seen in dogs, but acute interstitial pancreatitis in seen mainly with systemic toxoplasmosis. Cats mainly get chronic pancreatitis, rather than the acute form. Pyogranulomatous pancreatitis occurs in FIP. Serum amylase and lipase are unreliable (extrahepatic sources and both are excreted by the kidneys). There is usually a high serum glucose and cholesterol, with low serum potassium and calcium present on blood tests. Serum feline tryspin-like immunoreactivity is poorly associated with histopathological diagnosis.<br>  

Cats occasionally get the acute necrotizing form seen in dogs, but acute interstitial pancreatitis in seen mainly with systemic toxoplasmosis. Cats mainly get chronic pancreatitis, rather than the acute form. Pyogranulomatous pancreatitis occurs in FIP. Serum amylase and lipase are unreliable (extrahepatic sources and both are excreted by the kidneys). There is usually a high serum glucose and cholesterol, with low serum potassium and calcium present on blood tests. Serum feline tryspin-like immunoreactivity is poorly associated with histopathological diagnosis.<br>  

==== Clinical Signs<br> ====

==== Clinical Signs  ====

Signs are very vaue and may include vomiting, diarrhoea and anorexia. <br>  

Signs are very vaue and may include vomiting, diarrhoea and anorexia. <br> '''Acute haemorrhagic pancreatitis''' may present as shock and collapse.

==== Diagnosis<br> ====

==== Diagnosis  ====

In cats it is a much less common disease and so therefore more difficult to diagnose, especially as the clinical signs are so vague. In cats lipase, amylase and Serum trypsin-like immunoreactivity (TLI) have little value. Serum pancreatic lipase immunoreactivity (PLI) is usually raised and cPLI &amp; fPLI look promising as sensitive and specific markers for pancreatic inflammation.<br>  

In cats it is a much less common disease and so therefore more difficult to diagnose, especially as the clinical signs are so vague. In cats lipase, amylase and Serum trypsin-like immunoreactivity (TLI) have little value. Serum pancreatic lipase immunoreactivity (PLI) is usually raised and cPLI &amp; fPLI look promising as sensitive and specific markers for pancreatic inflammation.<br>  

==== Treatment<br> ====

==== Treatment  ====

Do not starve cats. Intravenous fluid therapy is required and a feeding tube may be placed (risk of hepatic lipidosis if do not eat). <br>  

Do not starve cats. Intravenous fluid therapy is required and a feeding tube may be placed (risk of hepatic lipidosis if do not eat). <br>  

<br>

<br>

== Chronic Pancreatitis in Cats<br> ==

== Chronic Pancreatitis ==

[http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=6937 Image of chronic pancreatitis and fibrosis in a cat from Cornell Veterinary Medicine]  

[http://w3.vet.cornell.edu/nst/nst.asp?Fun=Image&imgID=6937 Image of chronic pancreatitis and fibrosis in a cat from Cornell Veterinary Medicine]  

This chronic, relapsing condition is more common than the acute condition in cats. Fibrosis, ductular ectasia with cyst formation and inflammation will be present on the pancreas. The condition has been associated with hepatic lipidosis, cholangiohepatitis and inflammatory bowel disease. <br>

This chronic, relapsing condition is more common than the acute condition in cats. Fibrosis, ductular ectasia with cyst formation and inflammation will be present on the pancreas. The condition has been associated with hepatic lipidosis, cholangiohepatitis and inflammatory bowel disease. <br>

==== Clinical Signs<br> ====

==== Clinical Signs ====

Clinical signs are vague and may include vomiting, diarrhoea, anorexia, lethargy and icterus.<br>

Clinical signs are vague and may include vomiting, diarrhoea, anorexia, lethargy and icterus.<br>

==== Diagnosis<br> ====

==== Diagnosis ====

Blood tests for lipase may be normal or elevated in cats and therfore may or may not be any use. Amylase and Serum trypsin-like immunoreactivity (TLI) are not useful in cats. Serum pancreatic lipase immunoreactivity (PLI) will be raised and cPLI &amp; fPLI look promising as sensitive and specific markers for pancreatic inflammation.<br>

Blood tests for lipase may be normal or elevated in cats and therfore may or may not be any use. Amylase and Serum trypsin-like immunoreactivity (TLI) are not useful in cats. Serum pancreatic lipase immunoreactivity (PLI) will be raised and cPLI &amp; fPLI look promising as sensitive and specific markers for pancreatic inflammation.<br>

==== Treatment<br> ====

==== Treatment ====

 

==Literature Search==

==Literature Search==

[[File:CABI logo.jpg|left|90px]]

[[File:CABI logo.jpg|left|90px]]

Tilley, L.P. and Smith, F.W.K.(2004) '''The 5-minute Veterinary Consult''' (Third edition) Lippincott, ''Williams & Wilkins''

Tilley, L.P. and Smith, F.W.K.(2004) '''The 5-minute Veterinary Consult''' (Third edition) Lippincott, ''Williams & Wilkins''