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Name
Pancreatitis, Feline
Short Description
Feline pancreatitis
Affected Animals: Pancreatitis can occur in cats of all ages. It
can affect cats of both sexes and all breeds, but one study found a
relatively higher incidence of pancreatitis in Siamese cats.
Overview: Pancreatitis, or inflammation of the pancreas, is
difficult to diagnose. This is because cats with pancreatitis show
signs that are not specific. Since there are no non-invasive tests
that can confirm the presence of pancreatitis, the diagnosis is
often tentative at best. The most common symptoms reported with
pancreatitis are lethargy, loss of appetite, dehydration, vomiting,
and abdominal pain. Screening blood tests may be normal, but will
more often show non-specific changes including elevated white blood
cell count, mild anemia, elevated kidney and liver values, abnormal
glucose concentrations, and abnormal electrolyte concentrations. The
serum concentrations of amylase and lipase, the most commonly
measured pancreatic enzymes, are not reliable in the diagnosis of
pancreatitis in cats. X-ray and ultrasound findings also are not
specific. However, these studies may be helpful in raising the
suspicion for a diagnosis of pancreatitis. They may also help
eliminate other potential causes for similar symptoms in affected
cats. Biopsy of the pancreas is required for a definitive diagnosis.
However, because the risks associated with biopsy often outweigh the
benefits, it is seldom performed.
Treatment for pancreatitis is usually supportive and symptomatic in
nature. Therapeutic goals include allowing time for the inflammation
in the pancreas to resolve, preventing complications, and addressing
those complications when they occur. Surgery may be indicated if
abscess formation or bile duct obstruction occurs.
The outlook for pancreatitis depends on the severity of the disease.
Most cats survive with supportive treatment. Severely affected
animals may require intensive care for several days or weeks.
Nutritional support is critical for all feline patients with
pancreatitis since fatty liver syndrome frequently occurs. The most
severely affected cats may die despite all attempts at treatment.
Since it may take time for a clearer picture to emerge with an
individual cat, it may be best to start treatment when pancreatitis
is suspected, and to see how the condition progresses.
Clinical Signs:
The most common signs of pancreatitis in cats are non-specific, and
can include lethargy, anorexia, dehydration, hypothermia, vomiting,
abdominal pain, diarrhea, and weakness. In severely affected cats
shock, respiratory distress, and ascites may occur.
Symptoms: Cats with pancreatitis can show any of a number
of symptoms, but none of them are specific to the condition.
Commonly seen symptoms include decreased activity, depression,
reduced appetite, vomiting and diarrhea. Many cats with pancreatitis
will act as if they have abdominal pain. Cats with pancreatitis are
more likely to have an abnormally low body temperature than fever.
Cats with severe pancreatitis can develop respiratory difficulty,
abdominal fluid accumulation and, in some cases, shock-like states.
Description:
The pancreas is a small organ that sits in the
abdominal cavity adjacent to the stomach and the small intestine. It
has two main functions. As an endocrine gland, the pancreas produces
insulin, a vital hormone. The pancreas is also an exocrine gland
that produces digestive enzymes. Normally these digestive enzymes
are not activated until they reach the small intestine via the
pancreatic duct. The specific cause of pancreatitis in most cats is
never determined. However, all cases of clinically significant
pancreatitis involve inappropriate activation of digestive enzymes
within the pancreas. This results in their release into pancreatic
tissue and triggers a profound inflammatory response that is
responsible for the signs and complications that occur with
pancreatitis. Pancreatitis in cats may be classified as acute,
chronic-active, or chronic in nature.
The most common symptoms of cats with pancreatitis are not specific.
Most cats will show variable combinations of lethargy, decreased
appetite, vomiting, abdominal pain, and dehydration. Jaundice may be
seen if secondary changes in the liver are severe, or if bile duct
obstruction secondary to inflammation in the pancreas occurs.
Pancreatitis may be so severe that cats develop shock or die
suddenly because of the disease.
Diagnostic tests are helpful in assessing overall
health status, and for identifying additional complicating factors.
However, there are no non-invasive tests that are specific for the
diagnosis of pancreatitis in cats. Bloodwork, x-rays, and abdominal
ultrasound are the most commonly used non-invasive tests to evaluate
cases of suspected feline pancreatitis. Tissue biopsy is required
for confirmation of the diagnosis, but this is seldom done unless
other factors are present that require surgical attention.
Because the diagnosis is seldom definitive, the treatment for
pancreatitis in cats is usually supportive and symptomatic in
nature. Intravenous fluids, often with dextrose and potassium
supplementation, antibiotics, pain medications, anti-vomiting drugs,
and antacids are commonly used. Plasma transfusion may be given as
well, but its effect on outcome is unknown. If cats are not eating,
and vomiting is limited or absent, then nutritional support may be
provided with feeding tubes. Surgery may be indicated to address
abscess formation or bile duct obstruction if they occur.
The outlook for cats with pancreatitis depends on the severity of
the affected animal's disease. Cats with mild clinical signs recover
well with supportive care. Severely affected cats may require
prolonged and intensive hospitalization if they are to recover.
Hepatic lipidosis, or fatty liver syndrome, is a common sequela to
severe pancreatitis, so nutritional support is critical to a good
outcome. Even with aggressive diagnostics and supportive care, some
cats with pancreatitis are either too ill to survive, or they
develop life-threatening complications from their illness. Feline
patients with severe or chronic pancreatitis may develop diabetes
mellitus as a complication because inflammation of the exocrine
pancreas may damage the insulin secreting cells of the endocrine
pancreas.
Diagnosis: Because the signs are not specific, pancreatitis
is seldom diagnosed unless it is suspected to be present. Bloodwork
test results may range from normal to profoundly abnormal. On the
complete blood count, possible abnormalities include an elevated
white blood cell count, low red blood cell count, and reduced
platelet count. Biochemistry profile abnormalities may include
unusually high or unusually low blood glucose levels, elevated liver
enzymes, elevated kidney values, and abnormal sodium, potassium,
chloride, and calcium concentrations. The two most commonly measured
pancreatic enzymes, amylase and lipase, which are helpful in
diagnosing pancreatitis in the dog, have been shown to be of minimal
value in diagnosing the disease in cats. Another blood test called
trypsin-like immunoreactivity, or TLI, may be sensitive for
diagnosing feline pancreatitis. However, studies have shown that it
is not always reliable in predicting the severity of the disease.
Furthermore, obtaining TLI results requires several days; therefore
this test can seldom be useful in the initial evaluation of a cat
with possible pancreatitis. Additionally, serum TLI can be
abnormally elevated in conditions other than clinically significant
pancreatitis.
Abdominal x-rays and ultrasound may help to rule out other causes
for symptoms in cats with pancreatitis. However, results of these
tests are seldom specific for the diagnosis. X-rays may show reduced
structural detail in the abdomen or a mass effect in the area of the
pancreas. Abdominal ultrasound studies may reveal unremarkable
findings, non-specific changes in the area where the pancreas is
normally seem, mass lesions in the area of the pancreas, or
abdominal fluid accumulation. Yet none of the positive findings are
specific to the diagnosis of pancreatitis in cats. If abdominal
fluid is present, measurement of amylase and lipase concentrations
in the fluid may help in the diagnosis.
Ultimately, tissue biopsy is the most definitive way to diagnose
pancreatitis in cats. However, many cats are so ill that surgical
biopsy is too high-risk for diagnostic purposes alone. If other
tests suggest the presence of abnormalities that are best addressed
surgically, the diagnosis can be confirmed during exploratory
abdominal surgery. Surgery may also allow for feeding tube placement
into the small intestine for nutritional support in cats with severe
pancreatitis.
Prognosis: The outlook for cats with pancreatitis is
unpredictable, especially since the diagnosis of the condition is
often tentative at best. Relatively stable cats without serious
underlying diseases may do well. Those that respond quickly to
supportive care may never have another occurrence, but repeated
bouts are possible. Cats with severe signs like shock, low body
temperature, low blood glucose concentrations, or other serious
complicating factors like kidney failure may not survive the initial
attack of pancreatitis. Cats with enough damage from a single bout
of pancreatitis, or with multiple recurrent bouts of pancreatitis,
may eventually develop diabetes mellitus if the endocrine portion of
the pancreas is affected by chronic inflammation
Transmission or Cause: Infections with parasites, viruses, or
toxoplasmosis have been suggested as possible causes in some cats.
Bile reflux from the small intestine into the pancreatic tissue may
also trigger pancreatitis in cats. A connection may also exist
between kidney disease and the development of pancreatitis. Despite
these possibilities, the cause of pancreatitis in most cats remains
unknown.
Treatment:
There is no established, uniform way to treat
pancreatitis, even when tissue biopsy confirmation of the diagnosis
is available. Treatment is generally supportive, with attention
focused on meeting fluid needs with intravenous support, preventing
infection, providing nutritional support, and treating symptoms
while waiting for the signs to resolve.
Intravenous fluids are used first to correct shock or dehydration,
and then to meet the maintenance fluid needs of cats with
pancreatitis. Fluids can be supplemented as needed with dextrose and
potassium to correct abnormally low blood sugar readings, and
abnormalities in potassium concentrations, respectively. Vitamin
B-12 is often added to the fluids. Plasma transfusion may help to
support good blood flow to the pancreas.
The use of antibiotics in cats with pancreatitis is controversial.
Most veterinarians use antibiotics to treat complications from
secondary infections. However, there is no data that either supports
or detracts from their use in this disease. Similarly,
corticosteroids may be given to animals in shock, but their value in
more stable cats with pancreatitis is unknown.
Cats may not show obvious signs of abdominal pain. If abdominal pain
appears to be present, analgesic medications are often given. Pain
medications can have side effects that complicate the management of
seriously ill cats, and should be used cautiously and with close
supervision for unexpected changes.
If vomiting is a problem, cats with suspected pancreatitis may be
treated with anti-vomiting medications administered by injections
under the skin or in the intravenous fluids. Antacid medications are
also frequently used in vomiting patients.
Nutritional support is another controversial
point for cats with pancreatitis. If vomiting is present, it is
generally agreed that cats should not be fed. In dogs with
pancreatitis, all oral food and water is usually suspended for
several days once the diagnosis is made. However, cats may do better
with more aggressive nutritional support early on, as long as
vomiting is not present. Since many cats with pancreatitis refuse to
eat on their own, nutritional support may be provided through a
feeding tube placed into the nose or directly into the stomach.
Nutritional support may be provided intravenously to patients that
are vomiting, but parenteral nutrition is cumbersome and of limited
availability.
Surgery is usually not a primary treatment for pancreatitis.
However, abscess formation, bile duct obstruction, and other
complications may require surgery. Surgery also enables biopsy
confirmation of pancreatitis. In cats with persistent vomiting,
feeding tubes may be placed into the small intestine at the time of
surgery to allow for nutritional support.
Prevention: Since the cause of pancreatitis in cats is
usually obscure, there is no known means of prevention of its
occurrence.
