Pancreatitis in cats: is it acute, is it chronic, is it significant?

Abstract

Practical relevance: Pancreatitis is a frequent finding in cats, the chronic form being more common than the acute form. Despite the large number of diseases or conditions that may be associated with feline pancreatitis, in most cases no cause is diagnosed and the pancreatitis is said to be idiopathic. The chronic form can be mild and asymptomatic, and has a high prevalence in apparently healthy cats. This has generated debate concerning the clinical significance of chronic feline pancreatitis. However, several reports have demonstrated the severity of clinical signs in certain forms of acute feline pancreatitis, while other studies have reported a strong association between chronic pancreatitis and the development of comorbidities such as hepatic lipidosis, diabetes mellitus, inflammatory bowel disease or exocrine pancreatic insufficiency. This suggests that feline pancreatitis should not be overlooked.

Clinical challenges: Diagnosis of feline pancreatitis is complicated by the non-specific clinical signs and poor diagnostic value of basic biochemistry and haematology or imaging techniques. Development of a feline-specific pancreatic lipase immunoassay has improved our diagnostic ability in the past decade, but may have more limited application for mild and chronic forms of pancreatitis. Moreover, histopathology (the 'gold standard' diagnostic test) can be associated with false-negative results due to multifocal distribution of lesions or mild forms of the disease. With respect to treatment, it is important to take into account the idiosyncrasies of the feline species when considering medical therapies.

Evidence base: This article reviews the literature on feline pancreatitis, focusing on the different forms and their relative clinical significance, while explaining difficulties inherent in the diagnosis of this disease. An overview of current recommendations for the management of cats with pancreatitis is also provided.

Figure 1

Histological section of the pancreas of a cat with acute pancreatitis. Note the intense peripheral fat necrosis and infiltration by mononuclear cells. Haematoxylin and eosin (H&E) x 40

Figure 2

Histological sections of the pancreas of a cat with chronic pancreatitis, at x 10 (a) and x 40 (b) magnification. Note the extensive fibrous tissue (pale pink) surrounding and disrupting darker pink acinar tissue and clumps of lymphoplasmacytic inflammation (dark purple) at the top and bottom of section (a). H&E

Figure 3

Frequently nausea is not obvious in cats, but can be associated with hypersalivation or anorexia

Figure 4

Ultrasonographic findings in a cat with acute pancreatitis. Note the heterogeneous pancreatic parenchyma and surrounding hyperechoic mesentery (arrows). Courtesy of diagnostic imaging department, Queen’s Veterinary School Hospital, University of Cambridge, UK

Figure 5

Dilation of the pancreatic duct can be a normal finding in ageing cats. Courtesy of diagnostic imaging department, Queen’s Veterinary School Hospital, University of Cambridge, UK

Figure 6

Intraoperative view of a cat with severe acute pancreatitis. Note the areas of haemorrhagic parenchyma, and overall swollen and oedematous appearance of the pancreas. Courtesy of Jane Ladlow, Queen’s Veterinary School Hospital, University of Cambridge, UK

Figure 7

Gastrostomy feeding tubes allow administration of appropriate volumes of food and can be used for medication administration