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==Introduction==
[[Image:Pancreatitis.jpg|right|thumb|200px|<small><center>Pancreatitis (Image sourced from Bristol Biomed Image Archive with permission)</center></small>]]
Pancreatitis occurs following activation of digestive enzymes within the [[Pancreas - Anatomy & Physiology|pancreas]] leading to autodigestion of the gland. Can be referred to as acute or chronic pancreatitis.
'''Acute''' pancreatitis is rapid onset inflammation of the pancreas with little or no pathological changes occurring post recovery. This may completely resolve or 'wax and wane' in the future.
'''Chronic''' pancreatitis is continued inflammation leading to irreversible pathological changes (fibrosis, atrophy) and possible decreases in function.
The specific cause is usually idiopathic but several risk factors exist including:
A '''Nutritional''' basis which refers to obesity, low protein and high fat diets, feeding of ethionine and hypertriglyceridaemia.
'''Drugs and toxins''' including L-asparginase, oestrogen, azathioprine, potassium bromide, furosemide, thiazide diuretics, salicylates, [[Tetracyclines|tetracyclines]], [[Sulphonamides|sulphonamides]], vinca alkaloids, zinc toxicosis, cholinesterase inhibitor insecticides, cholinergic agonist and hypercalcaemia.
'''Pancreatic duct obstruction''' which is caused by biliary calculi, sphincter spasm, duct wall oedema, duodenal wall oedema, neoplasia, parasites, trauma and iatrogenic reasons.
'''Duodenal juice reflux, pancreatic trauma, ischaemia and reperfusion''' which includes duodenal juice reflux into the pancreatic duct, surgical intervention, [[shock]], [[Regenerative and Non-Regenerative Anaemias|anaemia]], venous occlusion and hypotension.
'''Other''' risk factors include parasitic (babesiosis), viral, mycoplasmal, end stage renal disease, liver disease and auto-immune diseases.
Cats mainly suffer from mild chronic interstitial pancreatitis.
Cats mainly suffer from mild chronic interstitial pancreatitis.
===Pancreas-specific laboratory tests===
== Acute Haemorrhagic Pancreatitis ==
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.
=== Cats and Dogs===
See [[Pancreatitis - Cat]] and [[Pancreatitis - Dog]]
=== Other Animals ===
'''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 cPLI is the most sensitive and specific test for diagnosing canine pancreatitis but serum cTLI can be used if there is no azotaemia.
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.
'''Abdominal Ultrasound''': Highly specific with a sensitivity of 70% in dogs and 30% in cats. Findings include:
In '''pigs''' suppuration of the pancreas can occasionally arise as an extension from nearby infection, eg. peritonitis and perforated oesophageal ulcers.
===Exploratory Laparotomy/Necropsy Findings===
== Chronic Interstitial Pancreatitis ==
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|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 Mellitus]] developing.
=== Cats and Dogs===
See [[Pancreatitis - Cat]] and [[Pancreatitis - Dog]]
=== Other Animals ===
'''Corticosteroids''':for short term use in fulminating pancreatitis to be given alongside fluids. Long term treatment may lead to unwanted complications.
'''In sheep'''
Necrosis of [[Pancreas - Anatomy & Physiology#Exocrine|exocrine pancreatic cells]] followed by fibrosis can be caused by zinc toxicosis. Focal pancreatitis may occur during [[Foot_and_Mouth_Disease|Foot and Mouth disease]] resulting in [[DM|diabetes mellitus]] during recovery.
'''Secretion prevention''': Has been found to have limited clinical use but high intravenous doses of secretin has been beneficial in rat models of pancreatitis.
'''In horses'''
'''Enzyme inhibitors''': are at the experimental stage.
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.
'''Peritoneal dialysis''': May be of value in removing toxic material in certain cases, especially if pancreatitis has been diagnosed by exploratory laparotomy.
'''In cattle'''
Focal pancreatitis may occur during [[Foot_and_Mouth_Disease|Foot and Mouth disease]] resulting in [[DM|diabetes mellitus]] during recovery.<br>{{Learning
|Vetstream = [https://www.vetstream.com/felis/search?s=pancreatitis Pancreatitis]
|literature search = [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]
}}
{{Chapter}}
{{Mansonchapter
|chapterlink = http://www.mansonpublishing.co.uk/book-images/9781840761115_sample.pdf
|chaptername = Acute Pancreatitis
|book = Clinical Medicine of the Dog and Cat, 2nd edition
|author = Michael Schaer
|isbn = 9781840761115
}}
==References==
==References==
Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
Andrews, A.H, Blowey, R.W, Boyd, H and Eddy, R.G. (2004) '''Bovine Medicine''' (Second edition), ''Blackwell Publishing''
Bertone, J. (2006) '''Equine Geriatric Medicine and Surgery''', ''Elsevier''
Blood, D.C. and Studdert, V. P. (1999) '''Saunders Comprehensive Veterinary Dictionary''' (2nd Edition), ''Elsevier Science''
Brown, C.M, Bertone, J.J. (2002) '''The 5-Minute Veterinary Consult- Equine''', Lippincott, ''Williams & Wilkins''
Cowart, R.P. and Casteel, S.W. (2001) '''An Outline of Swine diseases: a handbook,''' ''Wiley-Blackwell''
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''
Ettinger, S.J, Feldman, E.C. (2005) '''Textbook of Veterinary Internal Medicine''' (6th edition, volume 2), ''W.B. Saunders Company''
Fossum, T. W. et. al. (2007) '''Small Animal Surgery''' (Third Edition), ''Mosby Elsevier''
Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition),''' ''BSAVA''
Jackson, G.G. and Cockcroft, P.D. (2007) '''Handbook of Pig Medicine,''' ''Saunders Elsevier''
Knottenbelt, D.C. '''A Handbook of Equine Medicine for Final Year Students University of Liverpool'''
Merck & Co (2008) '''The Merck Veterinary Manual''' ''Merial''
Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine''' (Fourth Edition) ''Mosby Elsevier''
Sturgess, K. (2003) '''Notes on Feline Internal Medicine''' ''Blackwell Publishing''
Tilley, L.P. and Smith, F.W.K.(2004) '''The 5-minute Veterinary Consult''' (Third edition) Lippincott, ''Williams & Wilkins''
{{review}}
{{OpenPages}}
[[Category:Pancreas_-_Inflammatory_Pathology]][[Category:Pancreatic Diseases - Dog]][[Category:Pancreatic Diseases - Cat]]
[[Category:Pancreatic_Diseases_-_Pig]] [[Category:To_Do_-_Review]] [[Category:Pancreatic_Diseases_-_Horse]][[Category:Pancreatic_Diseases_-_Sheep]]