Diagnosis and treatment of feline pancreatitis - Veterinary Practice
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Diagnosis and treatment of feline pancreatitis

Though clinical signs may not be severe, it is important to take a proactive approach in the treatment of chronic feline pancreatitis

According to cat specialist Susan Little, pancreatitis
in cats can be classified into three forms: 1. acute
necrotising, 2. acute suppurative, which is unique
to cats, and 3. chronic non-suppurative, which is the most
common, and differs slightly from the canine variety.

While often idiopathic, on rare occasions the cause can
be identified as trauma, organophosphate poisoning or viral
infection. Another important point to note, particularly with
regards to management of the patient, is that unlike dogs,
no link between high-fat foods or obesity and pancreatitis
has been made (Little, 2016).

The acute condition is generally associated with high mortality, but the chronic version causes gradual deterioration of exocrine and endocrine functionality while also causing pain and reducing quality of life for the patient. One necropsy study of 115 cats (De Cock et al., 2007) found that 67 percent of pancreatic tissue examined showed signs of chronic pancreatitis, even though 45 percent of the cats had not shown any clinical signs. This could mean that despite pancreatitis having been established as an important and significant disease in cats, it may remain undetected and therefore appear clinically irrelevant in some animals.

Making a diagnosis

Diagnosis can be tricky and presenting signs are generally
fairly non-specific, including anorexia, lethargy and weight
loss, with vomiting and diarrhoea being more variably
present. Abdominal pain is not often reported in cats, but the reason for this is thought to be more that cats are very good at hiding discomfort; it would be safe to assume that
if you suspect pancreatitis, some degree of discomfort will
be present. No particular age or sex of cat has been found
to be more at risk, although some retrospective studies
showed that domestic short-haired and Siamese breeds
might have an increased risk (Ferreri et al., 2003).

When working up a suspected case, a complete blood
count, serum biochemistry profile and urinalysis should
always be performed because even though findings
would not be specific for pancreatitis, this will identify
other concurrent conditions, such as hepatic lipidosis or diabetes mellitus. A SNAP fPLI test is generally considered
the best test to use for pancreatitis, and diagnostic
sensitivity increases further with radiographs to rule
out other concurrent conditions, mentioned later. In
addition, on ultrasound, where thickening of the left limb
of the pancreas, severely irregular pancreatic margins or
hyperechoic peripancreatic fat are seen in cats would be
highly indicative of pancreatitis. An ultrasound-guided fine
needle aspirate is also useful; however, localised lesions
could be missed and lead to a false negative result.

A naso-oesophagal tube should be considered if the cat is anorexic

How to treat

Treatment of the feline pancreatic patient should include
replacing electrolytes lost through vomiting and diarrhoea
with crystalloids. The calculation for hydration de cit is
BW(kg) x % dehydration = loss (Davis et al., 2013) and
generalised supportive care. Analgesia should also be a
priority, particularly in acute cases, even when the clinician
is unable to detect abdominal pain because it should be
assumed that some degree of abdominal pain is present.

In terms of nutrition, it is not ideal to withhold food
from pancreatic patients that are not vomiting and when
controlled with antiemetics, food with a moderate fat level
and high-quality protein content should be offered. As is
usually the case, oral feeding is best, but it’s important
to consider tube feeding via a naso-oesophageal,
oesophagostomy or gastrostomy tube in cats that are
off food but not vomiting, and in the case of uncontrolled
vomiting, a jejunostomy tube could be considered.

Finally, many studies have reported a strong association
between chronic pancreatitis and the development of
other serious conditions such as hepatic lipidosis, diabetes
mellitus, inflammatory bowel disease or exocrine pancreatic
insufficiency. For this reason, we should always take a
proactive approach to feline pancreatitis, even when signs
are mild.

Nutritional support can be given via continuous rate infusion

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