Feline pancreas disease Flashcards
What are the different forms of pancreatitis in cats
Pancreatitis is an inflammatory disease of the exocrine pancreatic tissue and can be divided into acute and chronic types based on histological findings
- acute pancreatitis is characterised by neutrophilic inflammation and varying amounts of pancreatic acinar cell and peripancreatic fat necrosis
- chronic non-suppurative pancreatitis is characterized by lymphocytic inflammation, fibrosis and acinar atrophy
What is the most frequent cause of pancreatitis in cats
Several studies have shown a strong association between pancreatitis, IBD and cholangitis in cats
The common insertion of the common bile duct and the major pancreatic duct into the duodenal papilla may favour reflux of bile or luminal contents, including bacteria, into the pancreatic ducts
- vomiting, a clinical sign commonly observed in cats with IBD or cholangitis, may raise the intraluminal pressure and further increase the risk of pancreaticobiliary reflux
It is also possible that all three organs (i.e., pancreas, liver, gut) may be affected by a similar immune-mediated disease process
The gold standard for ante-mortem diagnosis of pancreatitis in cats is histopathological analysis of pancreatic biopsies. Explain why most authors agree that histopathology is not perfect for evaluating the presence of feline pancreatitis
Pancreatic biopsy is often complicated by the sensitivity of the pancreas to hypoxemia, whether induced by hypotension during anesthesia or by pancreatic blood flow impairement following manipulations of other organs during surgery
Most cats with severe pancreatitis are poor candidates for anesthesia
Results of pancreatic biopsy rarely alter patient management
Histological accuracy is limited by frequent multifocal distribution of lesions in cats with AP or CP
As a consequence, pancreatic biopsy should be considered if laparotomy or laparoscopy are being performed for other reasons
What are the main aspects of pancreatitis management
The general recommendations are centered on:
- nutrition and antiemetic treatment
- correction of fluid and electrolyte imbalances
- analgesia
What is the nutritonal recommendation for cats with pancreatitis
It is generally suggested that affected cats are fed a diet that is:
- low in carbohydrate
- high in protein
- contains a moderate amount of fat
in order to avoid the development of malnutrition and hepatic lipidosis
Nutrition should be reintroduced gradually over a few days to avoid refeeding syndrome
What is the pathomechanism for acute pancreatitis
Premature activation of pancreatic digestive enzymes within acinar cells, leading to activation of other zymogens and resulting in pancreatic autodigestion, is assumed to play an important role in the pathogenesis of pancreatitis
Hypoperfusion and thrombosis also may serve as triggers for the development of peripancreatic necrosis
What is the suspected pathomechanism for chronic pancreatitis
when chronic pancreatitis occurs independently of acute pancreatitis, trypsin activation is not considered the inciting event
- studies suggest that cholecystokinin and oxidative stress synergistically sensitize pancreatic acinar cells to injury and necrosis, independent of trypsin activation
- this occurs via calcium ion signaling and collapse of the mitochondrial membrane potential
What are the main differentials for increased serum fTLI
Trypsin-like immunoreactivity (TLI) measures trypsinogen, trypsin, and likely some trypsin that has been bound by protease inhibitors and is measured using a species-specific immunoassay
- it is not a sensitive test for pancreatitis
Increased serum fTLI concentrations have been associated with chronic enteropathy and gastrointestinal lymphoma, and may occur in cats with a decreased glomerular filtration rate
What is the mechanism of action of maropitant
Maropitant is the most commonly used antiemetic in cats
Maropitant is a neurokinin 1 receptor antagonist and acts both centrally and peripherally by inhibing the binding of substance P to the NK1 receptor located in the vomiting center, chemoreceptor trigger zone, and the gastrointestinal tract
Maropitant may have additional benefits, such as visceral analgesia and anti-inflammatory activity
What is the mechanism of actionn of ondansetron
Ondansetron is a 5-hydroxytryptamine 3 receptor antagonist that inhibitis serotonin-induced stimulation of vagal afferent activity
What would be the consequences of a lack of nutritional support in an anorectic cat
Lack of enteral nutrition may lead to:
- impaired gastrointestinal motility
- intestinal villous atrophy
- compromised intestinal blood flow
- altered barrier function
- disruption of the normal intestinal microbiota
What are considered poor prognostic factors in acute pancreatitis
Low plasma ionized calcium concentration
Hypoglycemia
Azotemia
