Difference between revisions of "Pancreatitis"

Revision as of 14:33, 12 August 2009

Signalment

Yorkshire terriers, Labradors, Miniature Schnauzers and Miniature Poodles are predisposed
Middle-old aged dogs
Increased risk with obesity, diabetes mellitus, hyperadrenocorticalism, prior GIT disease or epilepsy (?treatment associated).
Male and speyed females > intact females.

Description

Is due to the activation of digestive enzymes within the 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 occuring post recovery. This may completely resolve or 'wax and wane' into 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:

Nutritional: including obesity, low protein and high fat diets, feeding of ethionine, hypertriglyceridaemia and fatty meals.
Drugs and toxins: including L-asparginase, oestrogen, azathioprine, potassium bromide, furosemide, thiazide diuretics, salicylates, tetracyclines, sulphonamides, vinca alkaloids, zinc toxicosis, cholinesterase inhibitor insecticides, cholinergic agonist and hypercalcaemia.
Pancreatic Duct obstruction: 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: including duodenal juice reflux into the pancreatic duct, surgical intervention, shock, anaemia, venous occlusion and hypotension.
Other: including parasitic (babesiosis), viral, mycoplasmal, end stage renal disease, liver disease and auto-immune diseases.

Cats mainly suffer from mild chronic interstitial pancreatitis.

Diagnosis

History

Clinical Signs

Anorexia
Vomiting
Abdominal pain
Lethargy
Depression
Nausea
Diarrhoea (sometimes with blood, fresh or melaena, due to the proximity of inflamed pancreas to the duodenum and colon)
More severe cases may present in shock, acute renal failure, jaundiced (due to focal hepatic necrosis), or with cardiac arrhythmias or pulmonary oedema or pleural effusions, widespread haemorrhage or DIC
Acute haemorrhagic pancreatitis may present as circulatory collapse

Laboratory Tests

Diagnostic Imaging

Exploratory Laparotomy/Necropsy Findings

The pancreas will be oedematous, soft with fibrinous attachments to surrounding organs
Free fluid within the peritoneal cavity
Pancreas liquefaction if severe enough
Formation of pseudocysts
Omental and pancreatic haemorrhages
Areas of fat necrosis

Treatment

Prognosis

References

Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA

Merck & Co (2008) The Merck Veterinary Manual

@@ Line 17: / Line 17: @@
 #'''Drugs and toxins''': including L-asparginase, oestrogen, azathioprine, potassium bromide, furosemide, thiazide diuretics, salicylates, tetracyclines, sulphonamides, vinca alkaloids, zinc toxicosis, cholinesterase inhibitor insecticides, cholinergic agonist and hypercalcaemia.
 #'''Pancreatic Duct obstruction''': 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''':
+#'''Duodenal juice reflux, Pancreatic trauma, ischaemia and reperfusion''': including duodenal juice reflux into the pancreatic duct, surgical intervention, shock, anaemia, venous occlusion and hypotension.
-#'''Other''':
+#'''Other''': including parasitic (babesiosis), viral, mycoplasmal, end stage renal disease, liver disease and auto-immune diseases.
 Cats mainly suffer from mild chronic interstitial pancreatitis.