Pancreatitis in cats

Abstract

Pancreatitis was considered a rare disease in the cat until a couple of decades ago when several retrospective studies of severe acute pancreatitis were published. It was apparent that few of the diagnostic tests of value in the dog were helpful in cats. With increasing clinical suspicion, availability of abdominal ultrasonography, and introduction of pancreas-specific blood tests of increasing utility, it is now accepted that acute pancreatitis is probably almost as common in cats as it is in dogs, although the etiology(s) remain more obscure. Pancreatitis in cats often co-exists with inflammatory bowel disease, less commonly with cholangitis, and sometimes with both. Additionally, pancreatitis may trigger hepatic lipidosis, while other diseases, such as diabetes mellitus, may be complicated by pancreatitis. Therapy is similar to that used in dogs, with added emphasis on early nutritional support to prevent hepatic lipidosis. Less is known about chronic pancreatitis than the acute form, but chronic pancreatitis is more common in cats than it is in dogs and may respond positively to treatment with corticosteroids.

Fig. 1

Serum concentrations (μg/L) of feline trypsin-like immunoreactivity (fTLI) and feline pancreatic lipase (fPLI) A, in a cat with mild transient acute pancreatitis B, induced experimentally by injection of oleic acid into the pancreatic duct. The horizontal line indicates the upper limit of the reference range for each enzyme. Although both enzymes are pancreas-specific in origin, the increase in serum fPLI is sustained for several days longer than that of serum fTLI. Edema is evident in the fissures between lobules of the pancreas (arrow) and areas of fat necrosis and hemorrhage can be seen in the adjacent peri-pancreatic tissue

Fig. 2

Ultrasonographic image of a normal feline pancreas (arrow).

Fig. 3

Ultrasonographic features of feline acute pancreatitis. The pancreas is diffusely and severely thickened and hypoechoic with an irregular margin; surrounding omentum is markedly hyperechoic.

Fig. 4

Ultrasonographic appearance of the pancreas in a 16-year-old cat diagnosed with chronic pancreatitis. There are numerous hypoechoic nodules of varying size throughout the pancreas. The margin of the pancreas is irregular secondary to the nodules. Fine-needle aspiration cytology results were consistent with hyperplastic nodules. At 9-month follow up, the cat remains clinically well on 2.5 mg prednisolone daily.

Fig. 5

A, Pancreatic cytology from a cat with necropsy confirmed pancreatitis. The bright pink extracellular material in the lower right corner is mineral, which is commonly observed. There is a cluster of pancreatic acinar cells in the upper left corner of the smear. The remainder of the smear consists of blood, lipid, and increased numbers of neutrophils and foamy macrophages. Wright Giemsa Stain, ×200. Photomicrograph courtesy of Dr. L. Sharkey, University of Minnesota. B, Pancreatic cytology from the same case of necropsy confirmed pancreatitis. There is a cluster of hyperplastic exocrine pancreatic acinar cells exhibiting mild disorganization, diminished cytoplasmic granularity with cytoplasmic vacuolization, and increased nuclear to cytoplasmic ratio that often characterize reactive hyperplasia in this cell population. The bright pink extracellular material may represent matrix material or amyloid, both of which were observed in histologic sections. Wright Giemsa Stain, ×500.

Fig. 6

A 25 μg/h fentanyl patch placed on a cat to provide analgesia transdermally.

Fig. 7

A nasoesophageal tube in place to provide enteral support by frequent small bolus or infusion feeding. A Chinese finger trap knot is usually placed at the lateral edge of the nostril in addition to a simple interrupted suture near the lateral canthus of the eye or on the cheek to secure the tube.