Pancreatic Necrosis, Acute

Pancreatic necrosis (Image sourced from Bristol Biomed Image Archive with permission)

• (Often interchangable with acute pancreatitis or atrophy)

Clinical signs

• Occurs mainly in the dog, especially obese bitches, less often in cats
• Severe abdominal pain
• Cardiovascular collapse
• Disease may be unnoticed until signs of EPI and/or DM appear terminally
• Death often soon follows

Pathology

• Pathological changes occur in interstitial tissue and peripancreatic adipose tissue
• Necrosis caused by destructive action of pancreatic enzymes (mainly phospholipase A and elastase) activated within ducts, or released into pancreatic parenchyma by rupture of ducts and then activated
• Followed by the release of inflammatory mediators which attracts inflammatory cells
• The Islets of Langerhans may become involved thus causing the signs if insulin insufficiency
• Adhesions are absent or minimal

• Gross appearance
  • Oedematous
  • Blood stained fluid containing droplets of fat in the abdominal cavity
  • Haemorrhages in the omentum may be present
  • Areas of fat necrosis
  • Unusually greasy texture

• Microscopic appearance
  • Necrosis of adipose and parenchymal tissue
  • Inflammatory infiltrate forming a border between viable and necrotic tissue
  • Necrosis is initially perilobular at the periphery of affected pancreatic lobules
  • Foci of acinar tissue shrunken and acidophilic, undergoing coagulative necrosis
  • Occlusion of capillaries, sometimes veins and small arteries, by fibrin thrombi

Predisposing factors

• are unclear
  • Prolonged corticosteroid therapy
  • Surgical manipulation or trauma which initiates the leakage of enzymes
  • Obese bitches
  • Dogs fed high fat and low protein diet