Pancreatitis of the Dog and Cat

Question 1

why doesn’t the pancreas digest itself?

Answer 1

intracellular compartmentalization (enzymes separate from lysosomal hydrolases), proteases made in inactive form (zymogens), PTSI is secreted in parallel with trypsinogen

Question 2

what do duct cells produce and why?

Answer 2

bicarb to neutralize the acid-sodium-chloride fluid from acinar cells

Question 3

what do pancreatic cells release along with enzymes?

Answer 3

trypsin inhibitor

Question 4

what is critical to the process of activating zymogens?

Answer 4

calcium

Question 5

describe the mechanism of zymogen activation

Answer 5

enterokinase (brush border enzyme) converts trypsinogen to trypsin which in turn activates zymogens by cleaving amino acids off the polypeptide chain

Question 6

describe the pathogenesis of pancreatitis

Answer 6

pancreas starts to digest itself, lysosomal granules, trypsinogen, and zymogens are all released through the apical side of pancreatic cell into duct

apical block = build up of zymogens and lysosomes leading to activation of enzymes by hydrolases in lysosomes

Question 7

what are the risk factors for pancreatitis?

Answer 7

• high fat diet (not sure if its a cause, makes it worse)
• dietary indiscretion
• pancreatic ischemia
• reflux of duodenal contents (bile, more in cats)
• drugs (used to think steroids but not believed so much anymore)
• duct obstruction: tumors, occasionally stones
• genetic factors: yorkies, poodles, schnauzers
• idiopathic: majority

Question 8

what are the differential diagnoses for pancreatitis?

Answer 8

• acute gastroenteritis
• hemorrhagic gastroenteritis
• intestinal obstruction
• acute peritonitis
• inflammatory bowel disease
• renal failure

Question 9

what are the clinical signs of pancreatitis in dogs?

Answer 9

mostly vomiting, weakness, abdominal pain

often get large bowel diarrhea because transverse colon runs underneath

Question 10

what are the clinical signs of pancreatitis in cats?

Answer 10

not so dramatic, hypothermia, very lethargic, not eating, dehydration, maybe abdominal pain

keep triaditis in mind

Question 11

what are the lab findings with pancreatitis in dogs?

Answer 11

neutrophilia with left shift, thrombocytopenia, anemia

Question 12

what are the lab findings with pancreatitis in cats?

Answer 12

anemia, maybe hemoconcentration if dehydrated, bloodwork mostly normal

Question 13

what studies can be used to diagnose pancreatitis?

Answer 13

canine and feline pancreatic lipase (high, cPLI and fPLI)

Question 14

how is a diagnosis of pancreatitis made?

Answer 14

• combo of history, clinical signs, lab findings and imaging
• leukocytosis with left shift, azotemia, increased liver enzymes, hyperbilirubinemia, hyperglycemia, hypocalcemia, hyperlipidemia

Question 15

what is the gold standard for diagnosis that is not often performed?

Answer 15

pancreas biopsy, don’t want to make pancreatitis worse so that’s not done unless removing a piece on purpose

Question 16

how is pancreatitis treated?

Answer 16

• analgesics (fentanyl patch, buprenorphine, epidural)
• anti-emetics (metoclopramide, maropitant, ondansetron)
• blood plasma or a plasma expander: efficacy is questionable, may be more helpful if hypovolemic
• fluid therapy
• +/- parenteral antibiotics (turns into enteritis)
• avoid surgery unless necessary

Question 17

what are the nutritional considerations for pancreatitis treatment?

Answer 17

• Traditional:
  
  • fast 3-5 days or until vomiting stops for a day, feed then watch for vomit, if vomit, fast even more
• total parenteral nutrition is possible
• early enteral nutrition?

Question 18

what kind of diet should be used for food reintroduction?

Answer 18

• dogs: low fat diet, can gradually return to normal diet (unless repeat pancreatitis patient)
• cats: no idea what to do with diet, keep on normal food until they get better, still try low fat food, find and treat underlying disease