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==Introduction==
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.
'''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
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, hypertriglyceridaemia and fatty meals.
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.
'''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.
'''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, anaemia, venous occlusion and hypotension.
'''Duodenal juice reflux, pancreatic trauma, ischaemia and reperfusion''' which includes duodenal juice reflux into the pancreatic duct, surgical intervention, [[shock]], [[Anaemia - Introduction|anaemia]], venous occlusion and hypotension.
'''Other''' risk factors include parasitic (babesiosis), viral, mycoplasmal, end stage renal disease, liver disease and auto-immune diseases.
'''Other''' risk factors include parasitic (babesiosis), viral, mycoplasmal, end stage renal disease, liver disease and auto-immune diseases.
==Signalment==
==Signalment==
Predisposed breeds include:
Predisposed breeds include: Labradors, Miniature Poodles, Miniature Schnauzers, Yorkshire Terriers
Increased risk of disease occurs with obesity, [[Diabetes Mellitus|diabetes mellitus]], [[Adrenal Glands - Pathology#Adrenal Hyperfunction|hyperadrenocorticalism]], prior gastrointestinal disease or [[CNS Seizures - Pathology|recurrent seizures]].
Increased risk of disease occurs with obesity, [[Diabetes Mellitus|diabetes mellitus]], [[Adrenal Glands - Pathology#Adrenal Hyperfunction|hyperadrenocorticalism]], prior gastrointestinal disease or [[CNS Seizures - Pathology|recurrent seizures]].
Additionally, middle aged dogs are more commonly affected and male and spayed females are affected more frequently than entire females.
==History and Clinical Signs==
There is often a history of eating a fatty meal.
There is often a history of eating a fatty meal.
Clinical signs include anorexia, vomiting, abdominal pain, lethargy, depression and Nausea.
Clinical signs include anorexia, vomiting, abdominal pain, lethargy, depression and nausea.
[[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.
Acute haemorrhagic pancreatitis may present as shock and collapse.
'''Acute haemorrhagic pancreatitis''' may present as shock and collapse.
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 occuring in 68% of affected cats. Mild chronic pancreatitis may show anorexia and weight loss.
==Laboratory Tests==
On Haematology there may be a leucocytosis, an increased Packed Cell Volume due to dehydration, 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.
On Biochemistry changes may include an [[Azotaemia|azotaemia]], increased liver enzymes, hyperbilirubinaemia,
On Biochemistry changes may include an [[Azotaemia|azotaemia]], increased liver enzymes, hyperbilirubinaemia,
'''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 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.
==Diagnostic Imaging==
'''Survey Radiography''' 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.
Gastric distension may be visible and barium passage may be delayed indicating abnormal peristalsis.
Gastric distension may be visible and barium passage may be delayed indicating abnormal peristalsis.
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==
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 - Pathology|haemorrhages]] and areas of fat necrosis.
Pseudocysts may be present, as well as omental and pancreatic [[Haemorrhage - Pathology|haemorrhages]] and areas of fat necrosis.
Food can be gradually introduced with a low protein and fat content as these are more likely to cause signs. Fat can be further introduced if symptoms have still not returned. If signs reoccur then further starvation should be carried out. Total parenteral nutrition can be used to sustain animals that are unable to tolerate food at all.
Food can be gradually introduced with a low protein and fat content as these are more likely to cause signs. Fat can be further introduced if symptoms have still not returned. If signs reoccur then further starvation should be carried out. Total parenteral nutrition can be used to sustain animals that are unable to tolerate food at all.
Cases often require supportive care, aggressive [[Principles of Fluid Therapy|fluid therapy]] will be needed to treat dehydration and fluid loss from [[Diarrhoea|diarrhoea]] and vomiting. Renal function and potassium levels should be monitored and if necessary pottasium should be supplemented.
Cases often require supportive care, aggressive [[Principles of Fluid Therapy|fluid therapy]] will be needed to treat dehydration and fluid loss from [[Diarrhoea|diarrhoea]] and vomiting. Renal function and potassium levels should be monitored and if necessary potassium should be supplemented.
Patients may also develop a metabolic acidosis in acute pancreatitis or be alkalotic due to vomiting. Should [[Diabetes Mellitus|diabetes mellitus]] develop, this may require treatment with insulin. Further management may be required for respiratory distress, bleeding disorders, renal failure, cardiovascular problems and neurological disorders.
Patients may also develop a metabolic acidosis in acute pancreatitis or be alkalotic due to vomiting. Should [[Diabetes Mellitus|diabetes mellitus]] develop, this may require treatment with insulin. Further management may be required for respiratory distress, bleeding disorders, renal failure, cardiovascular problems and neurological disorders.
Additionally a whole blood or plasma transfusion can be given with severe disease to replace α-macroglobulins. Albumin also provides oncotic support and limits pancreatic ischaemia and oedema.
Additionally a whole blood or plasma transfusion can be given with severe disease to replace α-macroglobulins. Albumin also provides oncotic support and limits pancreatic ischaemia and oedema.
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===
==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.
==Literature Search==
[[File:CABI logo.jpg|left|90px]]
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]
==References==
==References==
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
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
Merck & Co (2008) '''The Merck Veterinary Manual''' ''Merial''
Merck & Co (2008) '''The Merck Veterinary Manual''' ''Merial''
[[Category:Pancreas_-_Inflammatory_Pathology]][[Category:Dog]][[Category:Cat]]
[[Category:Pancreas_-_Inflammatory_Pathology]][[Category:Dog]][[Category:Cat]]
[[Category:To_Do_-_Review]]
[[Category:Expert_Review]]