19. Acute and chronic pancreatitis, exocrine pancreas insufficiency in dogs and cats Flashcards

1
Q

Classifying pancreatitis?

A

CLASSIFYING PANCREATITIS

§ Acute/Chronic/Recurrent

§ Mild/Severe/Fatal

§ Acute serous/Acute-haemorrhagic-necrotising/Purulent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pathogenesis of acute pancreatitis?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acute Pancreatitis pathogenesis?

A

After generalisation of pancreatitis, local, regional & multisystemic

effects are seen throughout the body:

Local effects

§ Oedema; Inflammation; Haemorrhage; Necrosis

§ Acute fluid accumulation

Regional effects

Damage of adjacent organs

§ Cholestasis; Extrahepatic biliary obstruction (EHBO)

§ Duodenitis; Colitis; Local peritonitis

Multisystemic effects

§ SIRS (systemic inflammatory response syndrome) →

MODS (multiple organ dysfunction syndrome)

§ Kidney: Acute kidney failure

§ Respiratory: ARDS; Pleuritis

§ Cardiac: Arrhythmia

§ GIT: Ischaemia; Inflammation

§ DIC; Septicaemia; Coagulation; Fibrinolysis; Free radicals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acute Pancreatitis Diagnosis, Clinical findings, Diagnostic imaging, Lab D and Differential Diagnosis?

A

DIAGNOSIS

High risk

§ See “predisposed” earlier

§ High fat diets; Hyperlipidaemia

§ Drugs: KBr; Phenobarbital; Tetracyclines; Furosemide

§ Toxins: Organophosphates; Zinc

§ Pathogens: Babesia spp.; Leishmania spp.

§ Pancreatic trauma; Abdominal surgery

§ Ischaemia; ↓ Perfusion

§ Duodenal reflux; Ductal hypertension

Aetiology: Gall stones; Hereditary; Idiopathic

Clinical findings

§ Vomiting § Fever

§ Anorexia § Diarrhoea

§ Lethargy § Jaundice

§ Abdominal pain (Fig 11.2) § Dyspnoea

Diagnostic imaging

Abdominal Ultrasound (specific)

↓ Echogenicity → Pancreatic necrosis

Peripancreatic region: ↑ Echogenicity → Peritonitis

Abdominal radiology (non-specific) 
**_Lab. D_**

Pancreatic lipase immunoreactivity (PLI) (organ-specific)

Spec cPL (canine pancreatic lipase); fPL (Fe.)

Snap cPL (patient-side test)

VetScan cPL (patient-side test)

ELISA tests

(-) Result → Ø Pancreatitis

(+) Result → Confirm with specific cPL

Haematology (non-specific)

↑ PCV: Dehydration; Hypovolaemia

↑ WBC + ↑CRP: Leucocytosis; “Left shift”

↓ Thrombocytes

APTT; PTT; D-dimer

Plasma: Icterus; Lipemic

Biochemistry (non-specific)

Azotaemia: Dehydration; Hypovolaemia

↑ Cholesterol; ↑ Blood lipid

↑ Liver enzymes; ↑ Bilirubin: Hepatocellular injury; Ischaemia;

Cholestasis

Amylase & Lipase (low-specificity): Dggr-lipase

Other (non-specific)

§ ↑ Blood glucose

§ ↓ Blood calcium

§ ↓ Blood potassium

§ ↓ Blood sodium

§ Metabolic acidosis

Differential diagnosis

§ Gastritis § Ileus

§ Gastroenteritis § Pyometra

§ Peritonitis § Prostatitis

§ Acute renal insufficiency § Pyelonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment of acute Pancreatitis?

A

TREATMENT

Fluid therapy (essential)

The pancreas is susceptible to hypovolaemia; We aim to maintain

homeostasis and ↑ the pancreas’ microcirculation

Either:

§ Crystalloids

§ Colloids

§ Plasma transfusion (suggested in DIC cases)

Analgesia

Used even if there is no apparent abdominal pain

§ Opioids

§ FLK CRI (Fentanyl-ketamine-lidocaine)

§ Fentanyl patch

§ Ø NSAIDS (potential ulcerogenic/nephrotoxic effect)

Antiemetics

Given initially (or symptomatically); Even if there is no vomiting

§ Maropitant

§ Ondansetron

§ Metoclopramide

Management of complications

§ Gastric acid suppressants: Omeprazole

§ Antibiotics: Amoxiclav; Metronidazole

§ Glucocorticoids

§ Surgery (if unavoidable)

Special diet

Aims to prevent malnutrition, feed enterocytes & rest the pancreas

Feed ASAP – High digestibility; Low-fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Chronic Pancreatitis?

A

Chronic Pancreatitis

Recent studies show that chronic pancreatitis is more common than acute
Predisposed: Cats > Dog; Middle/old-aged

Types: Idiopathic; Autoimmune

§ Idiopathic pancreatitis: Toy breeds; Terriers; Spaniels;

Collie; Boxer; Sled dogs

§ Autoimmune pancreatitis: Cocker spaniel

Immunosuppressants may be beneficial

CLINICAL SIGNS

May be exhibited for months → years

§ Recurrent postprandial pain

§ Ø Appetite

§ Vomiting

§ Haematochezia/colitis

§ Severe acute peritonitis (recurring)

§ Most common cause of extrahepatic bile duct obstruction

§ End stage: DM; EPI

DIAGNOSIS

See acute pancreatitis

cPLI is the preferred test for chronic pancreatitis too

Definitive diagnosis: Histology (impractical)

§ Signs of irreversible morphological damage

§ Fibrosis; Atrophy; Lymphocytic infiltration

TREATMENT

§ Low-fat

§ Analgesics

§ Treatment of any acute pancreatitis, EPI or DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Feline Pancreatitis?

A

FELINE PANCREATITIS

Cause: Trauma; Ischaemia; Concurrent disorders

Aetiology: Bacterial translocation; Haematogenous spread

Clinical signs

Acute: Vomiting; Abdo. Pain; Anorexia; Lethargy; Hypothermia

Chronic: Weight loss; Signs of concurrent disorders

Diagnosis

§ fPL test

§ Blood work: See dog pancreatitis

Treatment

Acute: See dog pancreatitis; Give additional abx; Feeding tube

Chronic: See above; Improve appetite (B12); Steroids; Antioxidant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

EPI?

A

Exocrine Pancreas Insufficiency

AETIOLOGY

Occurs by two main pathomechanisms:

§ Pancreatic acinar atrophy (PAA)

§ Chronic pancreatitis

Pancreatic acinar atrophy

§ 60% of cases are German Shepherds; Collie; Chow-chow

§ Young > Old

§ Autoimmune cause; Ø DM

Chronic pancreatitis

§ Cats & spaniels (end stage/old > young)

§ DM is possible

SYMPTOMS

§ Acute: Polyphagia; Weight loss; Cachexia; Claylike faeces

§ Chronic: Alert; Good general state

DIAGNOSIS

↓ TLI (Trypsin-like immunoreactivity) (Highly specific for EPI)

§ Concentration of trypsin-like substances in the blood

§ cTLI in dogs; fTLI for cats

TREATMENT

§ Pancreatic enzyme substitution: Powder; Capsule;

Beef/pork pancreas

Dose dependent: Gastric acid suppression

§ Diet: High-digestibility; Moderate fat; Ø Fibre

§ Cobalamin supplementation

§ Antibiotic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly