DM3 Pt3-5 Pancreatitis

Question 1

What is pancreatitis in cats?

Answer 1

Pancreatitis is inflammation of the pancreas due to activation of pancreatic enzymes within the pancreas, leading to both pancreatic and systemic inflammation.

Question 2

Why are cats with biliary disease prone to developing pancreatitis?

Answer 2

Cats have one pancreatic duct, which enters the intestine with the common bile duct at the major duodenal papilla, making them susceptible to biliary tract disease.

Question 3

What are the classifications of pancreatitis in cats?

Answer 3

Pancreatitis is classified as acute necrotising, acute suppurative, and chronic non-suppurative based on the histological findings in the pancreas.

Question 4

What are the common clinical signs of pancreatitis in cats?

Answer 4

Common signs include lethargy, anorexia, dehydration, and less frequently vomiting and abdominal pain compared to dogs.

Question 5

What is ‘triaditis’ in cats, and how is it linked to pancreatitis?

Answer 5

Triaditis is a combination of pancreatitis, inflammatory bowel disease (IBD), and cholangitis/hepatitis, often seen together due to the anatomical connection of organs.

Question 6

What are common biochemical abnormalities in cats with pancreatitis?

Answer 6

Biochemical abnormalities include hyperglycaemia, hypocalcaemia, elevated liver enzymes, hyperbilirubinaemia, and sometimes azotaemia.

Question 7

Which diagnostic test is most sensitive and specific for diagnosing feline pancreatitis?

Answer 7

Feline pancreatic lipase immunoreactivity (fPLI) is currently the most sensitive and specific test for diagnosing pancreatitis in cats.

Question 8

What are the limitations of amylase and lipase tests in cats with pancreatitis?

Answer 8

Amylase and lipase are not reliable for diagnosing pancreatitis in cats as they are usually normal or even decreased in affected cats.

Question 9

How useful is abdominal ultrasound for diagnosing pancreatitis in cats?

Answer 9

Abdominal ultrasound can be helpful but is dependent on operator skill. It may show subtle changes like pancreatic enlargement or echogenicity, and is more useful in dogs.

Question 10

What is the treatment approach for feline pancreatitis?

Answer 10

Treatment focuses on supportive care with fluid therapy, nutritional support, analgesia, and addressing any underlying causes or complications like triaditis.

Question 11

What type of fluid therapy is recommended for cats with severe pancreatitis?

Answer 11

Crystalloids such as Lactated Ringers or 0.9% NaCl are recommended for initial replacement. Cats prone to hypovolaemia may require an initial bolus of fluids, but care is needed to avoid fluid overload.

Question 12

Why should plasma administration be considered in pancreatitis management?

Answer 12

Plasma provides protease inhibitors to reduce activation of pancreatic enzymes. However, availability is limited and its effectiveness in cats has not been extensively studied.

Question 13

What electrolyte imbalances should be addressed in pancreatitis cases?

Answer 13

Common imbalances include hypocalcaemia and hypokalaemia. Calcium gluconate can be used for hypocalcaemia, while potassium chloride can be added to fluids for hypokalaemia (max rate: 0.5 mmol/kg/h).

Question 14

When should enteral nutrition be initiated in cats with pancreatitis?

Answer 14

Enteral nutrition should be started early, especially since cats are prone to hepatic lipidosis. If vomiting is not a major issue, naso-oesophageal or oesophagostomy tubes can be used for feeding.

Question 15

What type of analgesia is recommended for managing pain in pancreatitis?

Answer 15

Opioid analgesia is recommended. Options include pethidine (3-10 mg/kg q4-6h), morphine (0.1-0.5 mg/kg IM/SC q6-8h), buprenorphine (0.01-0.02 mg/kg IM/SC q8h), or fentanyl patches for up to 72 hours of relief.

Question 16

Should NSAIDs be used for pain management in severe pancreatitis?

Answer 16

NSAIDs should generally be avoided in severe pancreatitis due to the risk of renal toxicity, particularly in dehydrated or hypovolaemic cats.

Question 17

Which anti-emetics are commonly used in pancreatitis treatment?

Answer 17

Maropitant (Cerenia) and metoclopramide are commonly used. Metoclopramide can be administered via injection or continuous rate infusion (1-2 mg/kg/24h), protecting the fluids from light to maintain drug efficacy.

Question 18

What is the role of H2 blockers in pancreatitis management?

Answer 18

H2 blockers (e.g., ranitidine, cimetidine, famotidine) are used to reduce gastric acid secretion. Ranitidine is preferred due to its prokinetic effects and minimal impact on the hepatic P450 enzyme system.

Question 19

Are antibiotics recommended for pancreatitis in cats?

Answer 19

Although pancreatitis in cats is usually sterile, antibiotics like potentiated amoxicillin are often used in severe cases due to the risk of bacterial translocation from the intestine.

Question 20

Why is vitamin B supplementation important in pancreatitis?

Answer 20

Vitamin B (e.g., B12) supplementation is beneficial in cats with prolonged anorexia or concurrent GI/liver disease, as these patients commonly develop B12 deficiency.

Question 21

What is the key aspect of therapy for mild pancreatitis?

Answer 21

The treatment of concurrent diseases such as IBD, cholangitis/hepatitis, or diabetes mellitus is crucial, as there are no treatments to prevent ongoing inflammation or fibrosis in chronic pancreatitis.

Question 22

What are the signs of pain in cats with mild pancreatitis?

Answer 22

Pain is difficult to recognize and may manifest as lethargy and/or inappetance. Trial treatment with buprenorphine is recommended to exclude pain as the cause of clinical signs.

Question 23

How is buprenorphine administered in cats with pancreatitis?

Answer 23

Buprenorphine can be administered intramuscularly (IM) or subcutaneously (SC) at 0.01-0.02 mg/kg every 8 hours. It is also effective sublingually for home administration.

Question 24

What appetite stimulants are recommended for mild pancreatitis?

Answer 24

Cyproheptadine (0.1-0.5 mg/kg PO BID or TID) and mirtazapine (1/8-1/4 of a 15 mg tablet every 72 hours) are used. Mirtazapine is preferred due to its anti-emetic properties and less frequent administration.

Question 25

When should enteral feeding be considered in pancreatitis cases?

Answer 25

Enteral assisted feeding (via oesophagostomy or gastrotomy tube) is recommended for severely anorexic or persistently inappetant cats.

Question 26

When should antibiotics be used in the treatment of pancreatitis?

Answer 26

Antibiotics should be used only if there is a suspected infection, an infectious complication, or if there is concurrent cholangitis/hepatitis.

Question 27

Are corticosteroids indicated for mild pancreatitis?

Answer 27

Corticosteroids are generally not indicated unless required for concurrent IBD. In chronic cases, they may help prevent ongoing inflammation and fibrosis, especially with IBD.

Question 28

Is obesity or a high-fat diet linked to pancreatitis in cats?

Answer 28

Unlike dogs, obesity and high-fat diets are not associated with pancreatitis in cats. Cats with pancreatitis are often underweight and need high-calorie, palatable diets.

Question 29

Should pancreatic enzyme extracts be used in cats with pancreatitis?

Answer 29

Pancreatic enzyme extracts are used in humans to reduce pain, but in cats, there is no evidence of their benefit for pancreatitis.

Question 30

What type of diet is recommended for cats with pancreatitis?

Answer 30

High-calorie, palatable diets are recommended, and novel protein or hypoallergenic diets may be required if the cat has underlying IBD.