Pancreatitis

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Histological appearance of chronic pancreatitis in a Boxer[1]
An ultrasonographic image illustrating the left lobe of the pancreas (large arrow). The organ is viewed ventral to the gastric wall. The left branch of the pancreatic duct is visualized within its center (arrow heads). The lack of dilatation indicates that the duct is still patent and functionally draining near the head of the pancreas, where the lesions appear at their worst.[2]

Pancreatitis is an umbrella term for any infectious or inflammatory disease of the canine pancreas.

Pancreatitis results from auto digestion of the pancreatic tissue by premature activation of zymogen within the acinar cells. Activation of zymogen granules lead to eventual fusion with lysosomes that favors zymogen activation, leading to inflammatory changes.

Episodes of pancreatitis can range from mild to severe, where patients may exhibit a plethora of signs from mild lethargy to multiple organ failure or death[3].

The inciting cause of this chain reaction is often unknown, but a number of predisposing factors have been recognised, including:

Clinical symptoms include anorexia, vomiting, weakness, abdominal pain, diarrhoea, fever, dyspnoea or signs of shock. Abdominal pain has not been reported as frequently in canine patients as in human patients.

Chronic pancreatitis, or milder acute pancreatitis may have less specific clinical signs, and in some patients there may be no clinical signs at all.

Complications of pancreatitis include shock, fever, and portal vein thrombosis[14].

Diagnosis is based on a collections of clinical signs, suggestive pancreatic inflammation visible under echocardiography, supportive laboratory evidence of elevated lipase and exclusion of other differential diseases. On hematological analysis, a neutrophilia and left shift is a relatively common finding. Blood biochemistry often shows a mild hyponatremia and hyperkalemia.

Currently, the most sensitive test for dogs is canine pancreatic lipase immunoreactivity[15].

A definitive diagnosis usually requires pancreatic biopsy, to differentiate from neuroendocrine diseases such as pancreatic adenocarcinoma and insulinoma.

Trypsinogen activation peptide (TAP) has also been tested and has reasonable to high sensitivity for pancreatitis, but low specificity. Canine pancreatic elastase-1 (cPE-1) is accurate in cases of severe pancreatitis only[16].

Canine pancreatic-specific lipase (cPL) concentration has good specificity overall in dogs with acute pancreatitis[17] but shows a poor sensitivity with chronic pancreatitis cases[18].

Treatment usually requires intravenous fluid therapy and parenteral feeding for 1 - 3 days by naso-oesophageal or nasogastric tubes[19], followed by a low-fat, low-protein diet. Food restriction is not considered mandatory. Anitmicrobial therapy is not usually indicated as most cases are sterile.

Pain relief is considered essential, with fentanyl (continuous rate infusion or transdermal), methadone or buprenorphine considered drugs of choice. Anti-emetics such as metoclopramide are commonly used to control vomiting.

Recovery from acute pancreatitis is good in most cases with low to moderate clinical severity[20], although relapse is common.

References

  1. Cambridge University
  2. Hylands R (2006) Veterinary diagnostic imaging. Chronic pancreatitis resulting in marked infiltrative fibrosis and necrosis. Can Vet J 47(12):1214-1217
  3. Whittemore JC & Campbell VL (2005) Canine and feline pancreatitis. Compendium 27:766–776
  4. Lem KY et al (2008) Associations between dietary factors and pancreatitis in dogs. J Am Vet Med Assoc 233(9):1425-1431
  5. Shukla A (2010) Acute pancreatitis attributed to dietary indiscretion in a female mixed breed canine. Can Vet J 51(2):201-203
  6. Verkest KR et al (2012) Association of postprandial serum triglyceride concentration and serum canine pancreatic lipase immunoreactivity in overweight and obese dogs. J Vet Intern Med 26(1):46-53
  7. Xenoulis PG et al (2011) Serum triglyceride concentrations in Miniature Schnauzers with and without a history of probable pancreatitis. J Vet Intern Med 25(1):20-25
  8. Pápa K et al (2011) Occurrence, clinical features and outcome of canine pancreatitis (80 cases). Acta Vet Hung 59(1):37-52
  9. Watson PJ et al (2007) Prevalence and breed distribution of chronic pancreatitis at post-mortem examination in first-opinion dogs. J Small Anim Pract 48(11):609-618
  10. Kook PH et al (2009) Pancreatitis associated with clomipramine administration in a dog. J Small Anim Pract 50(2):95-98
  11. Schleis SE et al (2011) Asparaginase-associated pancreatitis in a dog. Can Vet J 52(9):1009-1012
  12. Kim HJ et al (2011) Sterile panniculitis in dogs: new diagnostic findings and alternative treatments. Vet Dermatol 22(4):352-359
  13. Weingart C & Kohn B (2009) Zinc intoxication in a Yorkshire Terrier due to Euro cent ingestion. Schweiz Arch Tierheilkd 151(2):75-81
  14. Respess M et al (2012) Portal vein thrombosis in 33 dogs: 1998-2011. J Vet Intern Med 26(2):230-237
  15. Steiner JM et al (2001) Serum canine pancreatic lipase immunoreactivity (cPLI) concentrations in dogs with spontaneous pancreatitis. J Vet Intern Med 15:274
  16. Mansfield CS et al (2011) Specificity and sensitivity of serum canine pancreatic elastase-1 concentration in the diagnosis of pancreatitis. J Vet Diagn Invest 23(4):691-697
  17. Trivedi S et al (2011) Sensitivity and specificity of canine pancreas-specific lipase (cPL) and other markers for pancreatitis in 70 dogs with and without histopathologic evidence of pancreatitis. J Vet Intern Med 25(6):1241-1247
  18. Mansfield CS et al (2012) Association between canine pancreatic-specific lipase and histologic exocrine pancreatic inflammation in dogs: assessing specificity. J Vet Diagn Invest 24(2):312-318
  19. Mansfield CS et al (2011) A pilot study to assess tolerability of early enteral nutrition via esophagostomy tube feeding in dogs with severe acute pancreatitis. J Vet Intern Med 25(3):419-425
  20. Mansfield CS et al (2008) Development of a clinical severity index for dogs with acute pancreatitis. J Am Vet Med Assoc 233(6):936-944