Difference between revisions of "Pancreatitis"

Revision as of 15:10, 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 and Clinical Signs

History of eating a fatty meal
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 shock and collapse.
Cranial abdominal mass
Mild ascites
Dehydration (Mild to moderate)
Febrile
A cats presentation is more variable. If severe, they present with lethargy and anorexia with vomiting (35%) and abdominal pain (25%) being reported less than in the dog. Mild chronic pancreatitis may show anorexia and weight loss.

Laboratory Tests

Diagnostic Imaging

Survey Radiography: Rarely helpful but findings may include:

In the right cranial abdomen:
1. Increased density
2. Decreased contrast
3. Decreased granularity
Stomach displaced to left
Angle widened between pyloric antrum and proximal duodenum
Involving the Descending duodenum:
1. Displacement to the right
2. Prescence of a medial mass
3. Gas pattern
4. Thickened walls
Gastric distension
Delayed barium passage indicating abnormal peristalsis

However these findings are generally subjective so radiography is used to rule out differentials. Abdominal Ultrasound: Highly specific with a sensitivity of 70% in dogs and 30% in cats. Findings include:

Pancreatic enlargement
Peritoneal effusion
Hypoechogenic pancreas (pancreatic necrosis)
Hyperechogenic surronding tissue
Chronic pancreatitisand fibrosis may be hyperechogenic

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 1: / Line 1: @@
-{{OpenPagesTop}}
+{{unfinished}}
-==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.
+[[Pancreas Inflammatory - Pathology|See also Pancreas pathology]]
-'''Chronic''' pancreatitis is continued inflammation leading to irreversible pathological changes (fibrosis, atrophy) and possible decreases in function.
+==Signalment==
+*Yorkshire terriers, Labradors, Miniature Schnauzers and Miniature Poodles are predisposed
+*Middle-old aged dogs
+*Increased risk with obesity, [[DM|diabetes mellitus]], [[Adrenal Glands - Pathology#Adrenal Hyperfunction|hyperadrenocorticalism]], prior [[Alimentary - Anatomy & Physiology|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 including:
+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.
-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, 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.
-'''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.
+#'''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.
-'''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.
+==Diagnosis==
+===History and Clinical Signs===
+*History of eating a fatty meal
+*Anorexia
+*[[Control of Feeding - Anatomy & Physiology#The Vomit Reflex|Vomiting]]
+*Abdominal pain
+*Lethargy
+*Depression
+*Nausea
+*[[Intestine Diarrhoea - Pathology|Diarrhoea]] (sometimes with blood, fresh or melaena, 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, 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 shock and collapse.
+*Cranial abdominal mass
+*Mild ascites
+*Dehydration (Mild to moderate)
+*Febrile
+*A cats presentation is more variable. If severe, they present with lethargy and anorexia with vomiting (35%) and abdominal pain (25%) being reported less than in the dog. Mild chronic pancreatitis may show anorexia and weight loss.
+===Laboratory Tests===
-== Acute Haemorrhagic Pancreatitis ==
+===Diagnostic Imaging===
+'''Survey Radiography''': Rarely helpful but findings may include:
-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.
+#In the right cranial abdomen:
+##Increased density
-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.
+##Decreased contrast
+##Decreased granularity
-=== Cats and Dogs===
+#Stomach displaced to left
+#Angle widened between pyloric antrum and proximal duodenum
-See [[Pancreatitis - Cat]] and  [[Pancreatitis - Dog]]
+#Involving the Descending duodenum:
+##Displacement to the right
-=== Other Animals ===
+##Prescence of a medial mass
+##Gas pattern
-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.
+##Thickened walls
+#Gastric distension
-In '''pigs''' suppuration of the pancreas can occasionally arise as an extension from nearby infection, eg. peritonitis and perforated oesophageal ulcers.
+#Delayed barium passage indicating abnormal peristalsis
+However these findings are generally subjective so radiography is used to rule out differentials.
-== Chronic Interstitial Pancreatitis ==
+'''Abdominal Ultrasound''': Highly specific with a sensitivity of 70% in dogs and 30% in cats. Findings include:
+*Pancreatic enlargement
-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.
+*Peritoneal effusion
+*Hypoechogenic pancreas (pancreatic necrosis)
-=== Cats and Dogs===
+*Hyperechogenic surronding tissue
+*Chronic pancreatitisand fibrosis may be hyperechogenic
-See [[Pancreatitis - Cat]] and  [[Pancreatitis - Dog]]
+===Exploratory Laparotomy/Necropsy Findings===
+*The pancreas will be oedematous, soft with fibrinous attachments to surrounding organs
-=== Other Animals ===
+*Free fluid within the peritoneal cavity
+*Pancreas liquefaction if severe enough
-'''In sheep'''
+*Formation of pseudocysts
+*Omental and pancreatic haemorrhages
-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.
+*Areas of fat necrosis
-'''In horses'''
-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.
-'''In cattle'''
-Focal pancreatitis may occur during [[Foot_and_Mouth_Disease|Foot and Mouth disease]] resulting in [[DM|diabetes mellitus]] during recovery.<br>{{Learning
+==Treatment==
-|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}}
+==Prognosis==
-{{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==
-Andrews, A.H, Blowey, R.W, Boyd, H and Eddy, R.G. (2004) '''Bovine Medicine''' (Second edition), ''Blackwell Publishing''
+Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
-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]]
+Merck & Co (2008) '''The Merck Veterinary Manual'''