pancreatitis in dogs and cats two different animals wendy blount, dvm nacogdoches, tx

Pancreatitis in Dogs and Cats

Two Different Animals

Wendy Blount, DVM

Nacogdoches, TX

Two types of pancreatitis

Acute1/2

Chronic1/2

Acute Pancreatitis

• Abrupt onset• often reversible after

treatment• May lead to chronic

pancreatitis• Acute necrotizing (cell death)

pancreatitis is a life-threatening condition

Chronic Pancreatitis

• Continuing inflammatory disease

• Irreversible pathology• Relapsing acute

pancreatitis• Exocrine pancreatic

insufficiency (EPI) can result

• Diabetes mellitus can result• Triaditis can result in cats

Pancreatitis - Predispositions

Chronic liver Disease – Why?•Bile reflux into the pancreas•Especially in cats – why?•Because bile & pancreatic duct merge

Diabetes mellitus

Intestinal disease


Hyperlipidemia – Why?•Blood sludging - pancreatic ischemia•Lipase and other enzymes released•Hydrolysis of TG in ECF by lipase releases free fatty acids (FFA)•FFA cause microthrombi and bind to calcium to cause further damage (saponification)•More lipase is released•Positive feedback vicious cycle

Pancreatitis - PredispositionsObesity

Hypercalcemia

Pancreatitis - PredispositionsObesity

Hypercalcemia

Hyperadrenocorticism

Hypothyroidism

High fat meal – How much is too much?•>50% calories as fat•Careful of U/D in Schnauzers

Refeeding after prolonged anorexia


Pancreatic neoplasia•If you are treating one of the worst cases of pancreatitis you have ever seen, rule out pancreatic adenocarcinoma

Infectious•Toxoplasma gondii•Feline liver flukes Amphimerus pseudofelinus•Feline pancreatic flukes Eurytrema procyonis•FIP


Drugs•Corticosteroids•Chemotherapeutics/immunosuppressives

–L-asparaginase–Azathioprine (Imuran)

•Estrogens•Others


Toxins•Organophosphates•Scorpion stings•Uremic toxins

Vaccines



Vaccines

Gerald Crump

Lufkin TX



Vaccines

Pancreatitis - PredispositionsTrauma to the pancreas•Abdominal surgery•Ischemia (post-GDV, anesthesia, hypotension, shock)•Bile duct obstruction

Protracted and severe vomiting – why?•Bile reflux into the pancreatic duct•Especially in the cat


Dog vs. Cat - QuizHyperlipidemia

dogs

Hypercalcemia

Both

Hyperadrenocorticism

both

Hypothyroidism

dogs

High fat meal

dogs

Refeeding after anorexia

dogs

Pancreatic neoplasia

both

Pancreatitis - PredispositionsCorticosteroidsdogsOrganophosphatesbothUremiaboth

Trauma to the pancreas

dogs >> cats

Bile duct obstruction

cats > dogs

Protracted severe vomiting

cats > dogs

Vaccines

?????

Breed PredispositionDogs•Miniature Schnauzer•Sheltie•Briard•Small dogs (yorkies, poodles)

Cats•Siamese•Himalayan

Common Concurrent Diseasesespecially in cats

Cholangiohepatitis

Inflammatory bowel disease

Triaditis

Nephritis

Hepatic lipidosis – cats only

Most Common Clinical SignsDogs

Most Common Clinical SignsDogs•95% of dogs with pancreatitis vomit•Anorexia (91%)•Abdominal pain (58%)

Cats•Anorexia/weight loss – 97%

–Only 35% of cats with pancreatitis vomit•Dehydration – 92%

Most Common Clinical SignsDogs•95% of dogs with pancreatitis vomit•Anorexia (91%)•Abdominal pain (58%)

Cats•Anorexia/weight loss – 97%

–Only 35% of cats with pancreatitis vomit•Dehydration – 92%•Constipation

Clinical Signs – Dogs and Cats

Lethargy

Icterus

Diarrhea – with or without blood

Fever (hypothermia more common in cats – 68%)

Abdominal pain, cranial abdominal mass

Hunched stance or praying position

Clinical Signs – Dogs and Cats

Lethargy

Icterus

Diarrhea – with or without blood

Fever (hypothermia more common in cats – 68%)

Abdominal pain, cranial abdominal mass

Hunched stance or praying position

Elevated respiratory rate

Necrotic skin lesions or red skin – why?

Ascites

Pancreatitis - SequellaSIRSSystemic Inflammatory Response can Precipitate:•Thromboembolic disease

–Pulmonary thromboembolism•DIC•Pancreatic encephalopathy•Arrhythmia•Metabolic acidosis•Respiratory Distress

Diagnosis: Clues in the Bloodwork

CBC – nonspecific•Thrombocytopenia•Neutrophilia with left shift•Anemia

Serology•Lipemia after a prolonged fast (TG, chol)

–Can present for opaque eyes or anterior uveitis•Hypocalcemia – why?

–Calcium consumed by saponification of fat•Hypoalbuminemia – why?

–Massive inflammation, vasculitis, + sepsis


Serology – Dogs and Cats•Nonspecific changes

–Elevated liver enzymes–Elevated bilirubin–Azotemia–Hyperglycemia (cause or effect)–Hypoglycemia–Hypophosphatemia – why?–Hypochloridemia – why?


Serology – Dogs only•Amylase

–normal in 47%

•Lipase–Normal in 61%

Serology – Cats only•Elevated cholesterol (not as often triglycerides)•Amylase and lipase not at all useful


GI Serology – Dogs and Cats•B12 may be low – why?

–Intrinsic factor from the pancreas is required for absorption (cats)–concurrent distal small intestinal disease (ileum)–Concurrent dysbiosis–Concurrent EPI–SUBNORMAL B12 NOT DUE TO DIETARY INSUFFICIENCY


GI Serology – Dogs and Cats•B12 therapy – once weekly for 6 weeks, then every 30 days

–<10 lbs – 250 mcg–10-20 lbs – 400 mcg–20-40 lbs – 600 mcg–60-80 lbs – 1000 mcg–80-100 lbs – 1200 mcg–>100 lbs – 1500 mcg


GI Serology – Dogs and Cats•Folate may be high if dysbiosis•Folate may be low if proximal small intestinal disease•Not usually supplemented•More of an indicator for further diagnostics


GI Serology – Dogs and Cats

•TLI (trypsin like immunoreactivity)–Highly specific for EPI–Increased in SOME dogs and cats with pancreatitis


GI Serology – Dogs and Cats•What is the BEST blood test to diagnose pancreatitis??

–cPLI (canine Pancreatic Lipase Immunoreactivity)•97% sensitive for pancreatitis•82% specific for pancreatitis

–fPLI (feline Pancreatic Lipase Immunoreactivity)–Low confidence in this test amongst feline specialists

–Much more sensitive and specific for pancreatitisthan any blood test or imaging in dogs

–Antech and IDEXX–TAMU GI Lab (TVMDL sends to TAMU)

Diagnostic tools: A comparison

Susan Little, DVMLongview TX

Diagnostic tools: A comparison

SNAPR

cPLTM

Features

Reference Sample• 2 results: Normal or Abnormal • Read time: 10 minutes• Storage: Refrigeration• Sample type: Serum• Read: Visual; semi-quantitative

• <200 ug/L normal• 200-400 ug/L borderline• >400 ug/L pancreatitis

• Correlation to cPLI >95%• 96% of interpretations are

correct

Comparing Spec cPL values to SNAP results

Dog w/ Vomiting, Anorexia, Abdominal pain

CBCProfile/lytes

UASNAP cPL SNAP

Abnormal

Treat, Monitor, Retest; Continue to rule out

other differential diagnoses

SNAP Normal

Pancreatitis is unlikely – pursue other differential

diagnoses

SNAP cPL for Screening

Treat for pancreatitis,

Baseline cPLIAbdominal radiographs

Abdominal US

Baseline cPLImonitor w/ cPLI

200-399 >400

US/Rads confirmpancreatitis

Treat for pancreatitis,

Monitor with cPLI

US/Rads equivocal


Urinalysis – nonspecific

•Ketones–think diabetic with ketoacidosis (if glucosuria)–Or prolonged fasting/starvation

•Transient proteinuria–Enzyme mediated glomerular damage


Coagulation panel•Thrombocytopenia

–Vasculitis (enzyme mediated)•DIC

–PT, PTT, ACT–Elevated–FDP, d-Dimers (Cornell Coag Lab)–high


Electrolyte panel/blood gases (venous is fine)•HCO3,TC02, pH, pC02

–Low - Metabolic acidosis

What clue will your patient give you to check venous blood gases?

–Panting


Electrolyte panel/blood gases (venous is fine)•HCO3,TC02, pH, pC02

–Low - Metabolic acidosis

What clue will your patient give you to check venous blood gases?

–Panting•Potassium

–Low – why?–H+ outside the cell exchanged for K+ inside the cell–K+ lost in the urine–Especially a problem with diabetics – why?–Insulin is required to get potassium into the cell where it is needed and stored

Diagnosis: Abdominal Ultrasound

BEFORE PLI, WAS THE BEST TEST FOR DIAGNOSIS OF PANCREATITIS•Highly specific, but not that sensitive•60% of cats with pancreatitis have normal US


BEFORE PLI, WAS THE BEST TEST FOR DIAGNOSIS OF PANCREATITIS•Highly specific, but not that sensitive•60% of cats with pancreatitis have normal US•Pancreatitis (> 1 cm thick)

–Enlarged pancreas–Hypoechoic–May have cavitary lesions–Fluid accumulation around the pancreas–Hyperechoic ring around the fluid–Pancreatic duct may be tortuous and dilated


BEFORE PLI, WAS THE BEST TEST FOR DIAGNOSIS OF PANCREATITIS•Highly specific, but not that sensitive•60% of cats with pancreatitis have normal US•Pancreatitis (> 1 cm thick)

–Enlarged pancreas–Hypoechoic–May have cavitary lesions–Fluid accumulation around the pancreas–Pancreatic duct may be tortuous and dilated


•Duodenum–Dilated and hypomotile (<5 waves per minute)–Sometimes “corrugated”

•Common Bile Duct–Dilated and tortuous




Ronnie Nye, DVM

Floresville TX




•Gall bladder–Enlarged, wall edema/hyperechoic, sludge





•Ascites





•Ascites (fluid analysis chart)•Peripancreatic fat and omentum

–hyperechoic


•Ultrasound truly IS for everyone• Time-consuming

–30 minutes to warm up reagants–10 minutes to run the test

• Expensive–Diagnostic Quality US $12K-15K–3 US a week x $150 x 50 weeks = $22.5K

• Subject to user experience–No more subjective than x-rays–Oncura can provide help if your buy their ultrasound–GCVS does telemedicine with your US

Diagnosis: Radiographs

Abdominal radiographs•Often normal (sensitivity 24%)•Ascites – generalized or localized•Peritonitis – loss of detail “ground glass”•Stomach – displaced left, dilation•Duodenum – displaced caudal and right, gas

–Dilated, thickened, corrugated

•Colon – displaced caudal


Abdominal radiographs•Often normal (sensitivity 24%)•Ascites – generalized or localized•Peritonitis – loss of detail “ground glass”•Stomach – displaced left, dilation•Duodenum – displaced caudal and right, gas

–Dilated, thickened, corrugated

•Colon – displaced caudal•Calcification of fat


Upper GI Barium Series•Delayed emptying of stomach and duodenum•Corrugation of duodenal wallThoracic radiographs•Can be normal•Pleural effusion


Upper GI Barium Series•Delayed emptying of stomach and duodenum•Corrugation of duodenal wallThoracic radiographs•Can be normal•Pleural effusion•Pulmonary edema

–Severe vasculitis–if severe hypoalbuminemia–25-50% of cats have either pleural effusion or ascites

•Sometimes pneumonitis (interstitial pattern)

Diagnosis: Abdominocentesis, Thoracocentesis

Usually modified transudate

Occasionally exudative (suppurative)

Rarely hemorrhagic

Diagnosis: Diagnostic Laparotomy

Pancreas•Edematous, hemorrhagic, abscesses, cysts

Diagnosis: Exploratory Laparotomy


John Wood

Lufkin TX


Pancreas•Edematous, hemorrhagic, abscesses, cysts•Enlarged if acute•Very small, wasted, fibrotic if chronic•Can appear grossly normal in cats


Pancreas•Edematous, hemorrhagic, abscesses, cysts•Enlarged if acute•Very small, wasted, fibrotic if chronic•Can appear grossly normal in cats

Peripancreatic tissues•Saponification of fat•Inflammation•Adhesions


Histopathology - pancreas•Definitive diagnosis in cats

–Chronic pancreatitis – fibrosis, inflammation, nodular hyperplasia–Acute pancreatitis – edema, hemorrhage, necrosis, inflammation

•Few side effects after Bx of cat pancreas


Histopathology - pancreas•Definitive diagnosis in cats

–Chronic pancreatitis – fibrosis, inflammation, nodular hyperplasia–Acute pancreatitis – edema, hemorrhage, necrosis, inflammation

•Few side effects after Bx of cat pancreas

Culture/Cytology any abscesses•Usually sterile (do cytology first)•Bacterial infection is not very common in dogs and cats

Pancreatitis Treatment: Dogs and Cats

PRIMARY THERAPIES•Fluid therapy•Colloids•Antibiotics•Analgesia•Antioxidants


Fluid therapy – why so crucial•Need to support pancreatic perfusion

–Pancreatitis + pancreatic ischemia = bad things

•35-45 ml/lb/day until eating well –less if low albumin, until colloids restored

•Supplement potassium according to the sliding scale

–One scale for animals with severe acidosis–One scale for animals with normal venous blood gases


Fluid therapy – why so crucial•Why do pets with acidosis need more potassium?

–In a state of acidosis, there are excess hydrogen ions (H+) in the extracellular fluid–As the acidosis is corrected by therapy, potassium that had left the cells in exchange for H+ goes quickly back into the cells–This can drop serum potassium precipitously, causing arrhythmia, weakness or even respiratory paralysis–Most common culprits are DKA and RTA


Fluid therapy – why so crucial•Why do pets with acidosis need more potassium?

–In a state of acidosis, there are excess hydrogen ions (H+) in the extracellular fluid–As the acidosis is corrected by therapy, potassium that had left the cells in exchange for H+ goes quickly back into the cells–This can drop potassium precipitously, causing arrhythmia, weakness or even respiratory paralysis–Most common culprits are DKA and RTA


Fluid therapy – why so crucial•Add glucose if hypoglycemic•Add bicarbonate if:

–Acidosis is immediately life threatening–Acidosis will not be corrected by treating other problems–See handout

•LRS won’t work if severe liver disease and needs alkalinizing – why??

–Liver must transform lactate to bicarbonate


“Flop”•Chief Complaint – Not doing well since treating abscess on a toe 1 week ago, vomiting blood

–3 days ago regular vet did a UA and blood glucose–UA showed ketones++ and glucose +++, blood glucose 296–Has been treating with IV fluids since, getting worse–Did not start insulin because cat not eating

•Exam - Dehydrated, lethargic, icteric, RR 56–vomited coffee grounds and collapsed on abdominal palpation, HR 65/bpm–Responded to atropine IV and fluid bolus


“Flop” - diagnostics•CBC – granulocytes 16,000•Profile – glucose 200, BUN 41

–TG 500, Chol 297–Bili 4.2, ALT 148, ALP normal–Ca 7.0, Phos 1.6

•UA – SG 1.027, ketones ++, glucose +++, inactive sediment•Electrolytes – K+ <2.0, Na+ 133, iCa++ 1.08

–pH 7.032, BE -24, HCO3 7, TCO2 8–pCO2 26.5,

•No chest rads or abdominal US done•Urine culture pending


“Flop” - diagnostics•CBC – granulocytes 16,000•Profile – glucose 200, BUN 41

–TG 500, Chol 297–Bili 4.2, ALT 148, ALP normal–Ca 7.0, Phos 1.6

•UA – SG 1.027, ketones ++, glucose +++, inactive sediment•Electrolytes – K+ <2.0, Na+ 133, iCa++ 1.08

–pH 7.032, BE -24, HCO3 7, TCO2 8–pCO2 26.5,

•No chest rads or abdominal US done•Urine culture pending

Jeremy Finch

LaGrange TX


“Flop” - diagnosis•Initial life threatening problems

–Severe ketoacidosis

treatment – insulin, bicarbonate, IV fluids–Severe hypokalemia

treatment – IV KCl or K-phosphates–Severe hypophosphatemia

treatment – IV K-phosphates–(pancreatitis, hematemesis, abscess on toe)

(treatment – feed, antacids, sucralfate, antibiotics)


“Flop” - treatment•IV fluids – of course – 45 ml/lb/day

–Rehydrates and corrects acidosis – which fluids?–Buffered – LRS, Ringers, Normosol, Plasmalyte, etc.

•Potassium chloride – no disadvantage •Potassium phosphates – no disadvantage

(sliding scale) (IV drip rate calculator)•Insulin

–Advantage – corrects ketoacidosis–Disadvantage – makes hypokalemia and hyposphatemia worse

•Bicarbonate–Advantage – corrects acidosis–Disadvantage – will make hypokalemia worse

•Cefazolin 100 mg IV TID, famotidine 5 mg IV BID


“Flop” – reassess in 4 hours•Glucose - 99 (1 unit NPH SC)•PCV – 23%•pH 7.228, HC03 10, TCO2 11

•pC02 23.9,

•iCa++ 1.07, Na+ 130, K+ 2.3•Phosphorus 0.7•Red tinged urine, serum icteric•Hydration normal, general condition slightly improved, no vomiting, not eating


“Flop” – 2 days later•Glucose - 325•PCV – 20%•pH 7.403, HC03 18.8, TCO2 20

•pC02 30

•iCa++ 0.92, Na+ 134, K+ 3.7•Phosphorus 3.4•Urine clear, serum slightly icteric•Hydration normal, general condition greatly improved, eating small amounts, no vomiting


Colloids – why so crucial•Low albumin + vasculitis + fluid therapy = pulmonary edema•Hetastarch 5-10 ml/lb/day•Plasma 10 ml/lb/day, over 2-3 hours

–Premedicate with diphenhydramine–Can repeat daily until improved–Also treats DIC –Provides antiproteases and alpha-macroglobulins

•Whole blood if significantly anemic (hemolysis)


Antibiotics – controversial•Increased survival in people with pancreatitis who are treated with antibiotics•But bacterial pancreatitis is much less common in dogs and cats•Should prevent systemic infection from bacterial translocation across the gut•Treat concurrent infection, of course (UTI*)

–Penicillins (avoid Clavamox – it causes vomiting)–Cephalosporins–Quinolones alone aren’t the best choice – why?


Analgesia – THIS IS A PAINFUL DISEASE•Butorphanol (1 mg/10 lbs q2-4hrs PRN for pain)•Buprenorphine (0.015 mg/kg q6-12hrs)•Opiate pure agonists – what’s the catch?

–Oxymorphone–Morphine–Hydromorphone–Fentanyl injectable or patch

•Intraperitoneal lidocaine or bupivocaine•Cerenia (maropitant)•Be careful of NSAIDs – Why?


Antioxidants•Milk thistle•SAMe (Denosyl), Denamarin•VetriScience Cell Advance

Free radical damage is rampant in pancreatitis

People with recurring pancreatitis have fewer episodes when they take daily antioxidants


SECONDARY THERAPIES - As indicated

•Heparin–Questionable efficacy in cats–Some think it is primary therapy for dogs – why?

•Even if not in DIC, they are hypercoagulable•May promote pancreatic microcirculation•Preventing a thromboembolism is

Way better than treating one



•Antiemetics–Definitely make the patient more comfortable–May prevent death from vagal surge–Early return to alimentation



•Antiemetics–Metoclopramide, Cisapride–Ondansetron (Zofran), dolasetron (Anzemet) - 5HT3 antagonists – 0.3-0.6 mg/kg SID to BID–Maropitant (Cerenia) - neurokinin-1 receptor antagonist – 1 mg/kg SID–Careful of phenothiazines – why?

•don’t want hypotension



•B vitamins (especially B12)•H2 blockers/H+ pump blockers, sucralfate/barium

–if blood in the stool or vomit–May prevent reflux esophagitis if vomiting

is severe–Famotidine, Ranitidine, omeprazole–There is some evidence cimetidine and ranitidine might aggravate pancreatitis in people



•Treat hyperlipidemia–Handout–Hyperlipidemia predisoposes to pancreatitis

•Calcium–Therapy rarely needed–Only if clinical signs, and calcium < 6.5 mg/dl

•Bicarbonate–Some cats with severe chronic pancreatitis need long term oral HC03

–these cats also tend to have EPI



•Surgery/laparoscopy–Biopsy to diagnose neoplasia in dogs and cats–Biopsy to diagnose pancreatitis in cats–Debridement–Restore bile flow (stent)–To treat abscesses or pseudocysts

That recur after US guided

drainage



•Antihelminthics–In the rare case of liver flukes or pancreatic flukes in cats–Fenbendazole–Praziquantel (high dose)


CONTROVERSIAL THERAPIES•Dopamine CRI

–Protective effect when administered to cats with experimental pancreatitis within 12 hours–No effect after 12 hours–Can cause vomiting, nausea, seizures in cats

•Peritoneal dialysis–To remove chemical irritants from the abdomen–When ascites (especially exudative)


CONTROVERSIAL THERAPIES

•Oral pancreatic enzymes–Reported to reduce pain in people with pancreatitis–Less likely to be effective in dogs because they do not have a protease negative feedback–Some have observed clinical benefits

in dogs who have pain associated

with chronic pancreatitis


Patient Monitoring

TPR, blood pressure BID or more–Low body temp indicates big trouble–High fever spikes might indicate infection–Increased heart rate??

•Pain•Hypovolemia (need more fluids)

–Increased respiratory rate??•Pain•Pulmonary edema, pleural effusion, pneumonitis•acidosis


Patient Monitoring•Electrolytes/blood gases, lactate

–SID-BID when critical–QOD when stable

•Weigh BID when concerned about kidney function–Why?–Increase in body weight 10% is the first sign

of fluid retention–If you catch this early, you can prevent

pulmonary edema, and give your patient

more time to start making urine








Royce SmathersKirbyville TX


Patient Monitoring•HCT

–SID if stable–BID if phosphorus low, especially if DKA

•Albumin–daily if <1.5–QOD if >2.0, as long as on fluid therapy

•Monitor for DIC–Platelets–If decreasing, do PT, PTT, FDP/d-dimers–No need for BMBT


Patient Monitoring•Glucose

–Every 2 hours when unstable–Give insulin ONLY as needed–Glucose can be very erratic in DKA–When stable enough, can do every 2 hours during the day, and not overnight–If you MUST spot check, then do so 6 hours

after insulin (glucose low)–Insulin nadir is much more important

than peak when deciding dose


Patient Monitoring•Urine ketones if diabetic – daily until stable•cPLI

–Long term, to monitor resolution of pancreatitis, and need for ongoing dietary therapy and antioxidant supplementation

•Abdominal US–To follow resolution of pancreatic abscesses or cysts

Treatment: Canine Pancreatitis

Glucocorticoids contraindicatedNPO•Offer water after no vomiting for 24 hours•Offer food when no vomiting for 8-12 hours with free choice water

–2-3 very small meals the first day (2 teaspoons to 2 tablespoons)

•Gradually work up to full feed over 3-5 days•If any vomiting, start over at the top•Use antiemetics for early alimentation


Nutrition•Low fat – Why?

–<15-20% of calories•Low fiber, at first – Why?

–Can go to higher fiber later •Low protein – Why?

–<25% of calories•Carbs stimulate amylase which has little to do with pathology of pancreatitis


Nutrition•Suitable commercial diets

–Hill’s I/D low fat canned and dry–Royal Canine GI Low Fat–Natura Ultra Low Fat

•Home made food–Fat free cottage cheese and white rice is ideal–Turkey breast (without skin) and potatoes


Nutrition

•Monomeric (elemental food)–Water soluble liquid foods in their simplest nutritional state–Should in theory minimally stimulate the pancreas–Some have added glutamine to support enterocyte recovery from disuse atrophy–Can cause diarrhea, as many are hyperosmolar


3-5-7 Rule–3 days with no food, and you should be formulating a nutritional plan–Never let a patient go more than 5 days without nutrition–7 days without nutrition has serious implications

After Recovery–2 weeks or more after recovery, consider switching to low fat, high fiber diet (use cPLI, fPLI)–May or may not eventually be able to go back to a maintenance type diet (use cPLI)


NutritionSuitable High Fiber Low Fat foods for long term

–Hill’s R/D and W/D–Purina CNM OM canned and dry–Purina CNM DCO dry, Purina CNM GL dry–Select Care Canine HiFactor Formula canned and dry–Royal Canin Canine High Fiber canned and dry–Royal Canin Gastrointestinal Low Fat

Dogs with persistently high triglycerides

will probably have to stay on this type diet

Treatment: Feline Pancreatitis

Glucocorticoids•Indicated for feline pancreatitis – why?

–Controlling concurrent IBD and cholangiohepatitis will remove predisposition to pancreatitis–Can be immune mediated per se in cats

•Prednisone 1 mg/lb/day•Dexamethasone 0.2 mg/kg every other day•Wean to lowest effective dose over 2-4 months, after clinical response

Treatment: Feline Pancreatitis

Nutrition – FEED!!!•Place feeding tube ASAP – why?

–Pancreatitis + fatty liver = disaster

•Place E-tube first•Place G-tube if E-tube can not be maintained due to uncontrollable vomiting•Why not place G-tube right away?

–10-25% are dislodged even with

proper placement–Can result in gastric perforation

Treatment: Feline PancreatitisNutrition•If vomiting becomes difficult to control:

–Drip liquid diet CRI if bolus feeding is not tolerated–Try Cerenia, Anzemet, Zofran–If all else fails, consider a jejunostomy tube

Treatment: Feline PancreatitisNutrition•As always, cats do best on a high protein,

low carb diet (especially diabetics)–No need to be concerned about fat content in cats–There are very few dry diets with >45% protein and <8% carbs

•Innova EVO (California Naturals), Wellness CORE•Purina DM and Hills Prescription Diet M/D have 15% carbs (protein is fine)•Studies used to market DM and M/D are on canned

Binky’s Page Dry Cat Foods Canned Cat Foods

Percent Calories Calculator

Treatment: Feline PancreatitisNutrition•Appetite stimulants can be used

–Cyproheptadine 2 mg per cat PO BID 30 min prior to feeding–Mirtazipine 3-4 mg per cat twice a week–Diazepam is risky with concurrent liver disease

Pancreatitis: Prognosis

Dogs – variable•Good if response to short term therapy•Guarded if severe pancreatitis•Better for lean dogs than fat dogs – why?

–Less necrosis of fat to deal with

•Clinical response is probably the best predictor•100% recovery is possible•Some dogs are prone to repeated episodes


Cats - variable•Tend to take longer than dogs to respond•Some cats can begin eating in days•Some have to be fed by tube for months•Worse if concurrent hepatic lipidosis•Worse if suppurative pancreatitis rather than mononuclear•Cats who have it once tend to get it again•Owners learn to catch it early and intervene



Mary Marble

Frankston TX


Things associated with poor prognosis:•Shock•Oliguria•Icterus•Hypocalcemia•Hypoglycemia•Hypoproteinemia•Acidosis•Falling hematocrit


Things associated with poor prognosis:•Thrombocytopenia•DIC

Handouts

•PowerPoint Presentation – behind the yellow tab•Bicarbonate Administration•Fluid Analysis Diagnostic Chart•Hyperlipidemia•IV Potassium Supplementation•Cornell Comparative Coagulation Lab Instructions, Submission Form and test list

Handouts

•Client Information Handouts•Canine Pancreatitis•Feline Pancreatitis•Canned Cat Food Content•Dry Cat Food Content•Fish Oil

•Web Resources•Cat Food Percent Calories Calculator•IV Fluid Rate Calculator

pancreatitis in dogs and cats two different animals wendy blount, dvm nacogdoches, tx

Documents

cat slide

types of pancreatitis

obesity hypercalcemia

worst cases of pancreatitis

prolonged anorexia slide

bile reflux

shock bile duct obstruction

fat careful of ud