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January 6, 2017

貓胰臟炎


Feline Pancreatitis: Signs of Trouble
貓胰臟炎
 
Last Updated on Saturday, January 23, 2016 08:29 PM
Published on Saturday, September 06, 2014 08:25 PM
Written by Guillermo Díaz, MV
 
最近更新:2016年1月23日
原始刊出日:2014年9月6日
作者:獸醫基勒摩.迪亞茲(Guillermo Diaz, MV)

原文出處連結:http://feline-nutrition.org/health/feline-pancreatitis-signs-of-trouble
 
Pancreatitis can be a frustrating disease in cats. The cause often can't be definitively determined and the symptoms can be vague. Pancreatitis can range from low-grade with mild symptoms to severe, which can be fatal. Most often, treatment is supportive, alleviating symptoms and keeping the cat comfortable.
 
貓胰臟(腺)炎是一個麻煩的疾病。成因常常無法確定,而且症狀可能不是很明確。胰臟炎的嚴重程度從症狀輕微的輕度到重度都有,重度可能會致命。大部分病例是採取支持療法,舒緩症狀,盡量讓貓舒服。
 
The pancreas is a lobulated gland located along a portion of the small intestine in mammals. The pancreas has two types of tissue, each one of them synthesizing a different type of secretion. The exocrine portion, or acinar cells, produce enzymes utilized in the digestion of food and the endocrine portion, or islets of Langerhans, produce vital hormones such as insulin. Insulin is involved in the absorption and metabolism of glucose.
 
胰臟是一個葉狀腺體,位在哺乳動物的小腸附近。胰臟有兩種組織,每一種都會合成不同的分泌物。外分泌的部分(外分泌腺),或稱腺泡細咆,分泌消化酶(消化酵素)以消化食物;而內分泌部分(內分泌腺),或稱胰島腺,製造重要的荷爾蒙(激素),例如胰島素。胰島素參與了葡萄糖的消化和代謝。
 
There are several diseases that can affect the normal functioning of the pancreas. In this article we're going to talk about inflammation of the pancreas, which is called pancreatitis. Pancreatitis happens when the enzymes produced and stored in the exocrine portion of the organ get activated inside it. This event causes the progressive autodigestion of the gland and the surrounding tissues. Normally, these digestive enzymes are encased in droplets while inside the pancreas and only become activated after travelling to the small intestine. Pancreatitis is the most common exocrine pancreatic disorder in cats.¹ Pancreatitis may be more common in cats than previously thought; a study that examined the pancreases of deceased cats found evidence of chronic pancreatitis in 45% of them.²
 
有數種疾病會影響胰臟的正常功能。本文針對胰臟發炎而討論,即胰臟炎。胰臟炎是因為胰臟的外分泌腺所製造和貯存的消化酵素被活化,造成胰臟和其週圍的組織進行自體消化。正常的情況下,胰臟內的消化酵素是呈水滴狀被鎖住,只有在前進到小腸時才會被活化。外分泌腺失調的胰臟炎是最常見的貓胰臟炎(註1)。貓得到胰臟炎的比例可能高於我們以前的認知;一份針對已死亡的貓胰臟所做的研究顯示,其中百分之四十五的貓有慢性(長期)胰臟炎(註2)。
 
From the medical point of view, pancreatitis is divided into two categories, acute pancreatitis and chronic pancreatitis, which is the more common of the two. Each one of them has its own characteristics and clinical manifestations and each have different effects on the prognosis of the disease and the life of our patient. Both acute and chronic pancreatitis can cause scarring in the pancreas, which can impair its ability to function normally. Scarring can also affect the endocrine portion and insulin production, leading to diabetes.
 
從醫學觀點來看,胰臟炎被分成兩類,急性和慢性,比較常見的是慢性。這兩種胰臟炎有不同的特性和臨床症狀,對預後和病貓的生活也有不同程度的影響。急性和慢性都會造成胰臟傷害,可能影響胰臟正常功能。受損的胰臟可能會影響內分泌腺和胰島素分泌,造成糖尿病。
 
The most common causes of pancreatitis in cats are:
 
以下是造成貓胰臟炎最常見的原因:
 
  • Damage to the pancreas from inflammation of the intestine 腸炎對胰臟造成破壞
  • Abdominal trauma 腹部創傷
  • Infectious diseases such as toxoplasmosis, FIP, herpesvirus or parasites 弓形蟲(弓獎蟲)、傳染性腹膜炎、皰疹病毒和寄生蟲
  • Hepatic lipidosis 脂肪肝
  • Colangitis /colangiohepatitis 膽管炎/膽管肝炎
  • Drugs such as phenobarbital, catabolic steroids and diuretics苯巴比妥、異化類固醇和利尿劑等藥物
  • Ascending infections of small intestine³ 小腸的上行感染(註3)
 
The association of pancreatitis with inflammatory bowel disease or IBD is frequently mentioned.⁴ One study found 30% of IBD cases to have histologic evidence of pancreatic involvement.⁵ Many cases of pancreatitis recognized with IBD have no specific clinical signs attributable to pancreatitis and should therefore be diagnosed as intestinal disease.⁶
 
胰臟炎和炎症性腸病(IBD)之間的關聯常被提及(註4)。有一份研究發現百分之三十的炎症性腸病病患中,存在著和胰臟有關的組織學證據(註5)。許多和炎症性腸病一起出現的胰臟炎,並沒有特定的臨床症狀可以將其歸類於胰臟炎,因此而被診斷為腸的疾病(註6)。
 
Although clinical signs of pancreatitis are variable and non-specific, acute lethargy and anorexia are present in most of the cases.⁷ If your cat has a sudden episode of lethargy and is reluctant to eat, take her to the vet immediately. Clinical signs in cats with acute pancreatitis are:
 
雖然胰臟炎的臨床症狀很多而且不明確,但是大部分的病例會非常的沒有精神以及厭食(註7)。如果你的貓突然顯得無精打采的,而且不願進食,立刻帶貓就醫。急性胰臟炎有以下臨床症狀;
 
  • Lethargy 沒有精神
  • Anorexia 厭食
  • Dehydration 脫水
  • Hypothermia體溫降低
  • Vomiting 嘔吐
  • Abdominal pain 腹部疼痛
  • Palpable abdominal mass 觸診可摸到腹部硬塊
  • Diarrhea 腹瀉
  • Dispnea呼吸困難
  • Weight loss 體重減輕
  • Peritoneal effusion 腹水
  • Jaundice 黃疸
 
The diagnosis of feline pancreatitis can be challenging because the physical examination findings are non-specific, requiring a high amount of clinical suspicion and the combination of diagnostics tests.⁸
 
診斷貓胰臟炎可能會很困難,因為體檢時症狀可能並不明確,令人度極存疑,進而需要結合不同的檢驗以確診(註8)。
 
Your veterinarian will do hematology tests, also called blood work. The doctor will look for anemia, increased or decreased white cell count. Also, serum biochemistry will be performed to determine the levels of liver enzymes, bilirubin, cholesterol, urea and creatinine.
 
你的獸醫會進行血檢。檢查有沒有貧血,白血球上升還是下降。此外也會進行血清生化檢驗,瞭解肝臟酵素、膽紅素、膽固醇、尿素和肌酸酐的數值。
 
The ordinary measurement of pancreatic enzymes such as lipase and amylase are not definitive for pancreatitis. For example, an increase in lipase levels only indicates a pancreatic pathology is present, this is the reason it must only be used as a screening test. More recently, better screening tests such as Spec fPL and Snap fPL have become available, although they are not always good at detecting mild pancreatitis. A combination of methods is a must.
 
衡量胰臟酵素的數值,例如脂肪酵素(脂肪酶)和澱粉酵素(澱粉酶),無法明確判定胰臟炎。例如脂肪酵素(脂肪酶)數值上升,只能顯示胰臟有出現病理現象,所以只能拿來當作篩選(過濾)的檢驗。近年來已經有比較好的篩選檢驗,例如Spec fPL和Snap fPL,儘管在判斷輕度胰臟炎時這兩種檢驗並非總是很好用。因此同時使用不同的檢驗方式是必要的。
 
Radiography usually only indicates that something abnormal is going on inside the abdomen. Pancreatitis is generally located in the "cranial part" of the cat's belly. Radiography may be useful in ruling out other possible causes of the symptoms, such as a bowel obstruction.
 
X光通常只能看到貓的腹部有異常的現象在進行。胰臟炎通常位於貓的腹部前方。X光可以用來排除病因,例如腸阻塞。
 
Ultrasound tests can sometimes see pancreatic abnormalities when performed by a skilled ultrasonographer, but not always. They may be useful in spotting concurrent problems in other organs such as the liver and intestines.
 
超音波有時候也可以看出胰臟異常,如果是由解讀超音波影像經驗豐富的獸醫進行,但並非一定都可以看出異常。超音波或許可以發現身體其他器官也有病狀,例如肝臟和腸道。
 
Definitive diagnosis of pancreatitis can only be achieved by cytologic examination of pancreatic tissue, in other words, by doing a biopsy. Ultrasound-guided fine-needle aspiration of the pancreas is technically difficult due to the small dimension of this feline organ. Doctors may be very reluctant to perform biopsy of the pancreas because of the high risk of deleterious effects on the patient.⁹
 
要確診胰臟炎只能進行胰臟組織的細胞檢查,換句話說就是活體採樣。在超音波的引導下,使用細針抽吸術,抽吸胰臟組織在技術上是困難的,因為胰臟的體積小。醫生可能會不願意進行胰臟活體採樣,因為對病患造成傷害的風險是高的(註9)。
 
The therapy for pancreatitis must address supportive care and the treatment - if possible - of the underlying cause. As a rule of thumb, the treatment of pancreatitis should include:
 
治療胰臟炎務必採取支持療法,而且如果可能的話,找出造成胰臟炎的原因並加以治療。根據經驗法則,胰臟炎的治療必須包括:
 
  • Fluid therapy. Dehydration and electrolyte imbalances should be corrected within the first 12 to 24 hours.
  • Pain management. Pain contributes to anorexia, and an anorectic cat may develop secondary conditions, such as hepatic lipidosis, that can worsen the prognosis.
  • Nutritional support. Cats that have pancreatitis need careful nutritional support because in almost every case, they are inappetant.¹⁰ Lack of food can greatly increase the risk of concurrent hepatic lipidosis, making the situation even worse. Water should be reintroduced slowly, followed by small amounts of food. Some veterinarians recommend a low-fat diet, but high-fat diets are not viewed as a cause of pancreatitis.¹¹ Small, frequent feedings are preferable to large, single meals.¹² Enteral feeding may be needed temporarily for cats that will not eat.¹³
  • Drug therapy. Antiemetics are frequently used in cats that are vomiting. Some drugs used in feline medicine for this purpose are dolasetron, ondansetron and maropitant.
 
  • 補充液體。脫水和電解質不平衡的症狀,應該要在十二到二十四小時之內解除。
  • 疼痛管理。疼痛會讓貓不願進食,而不吃飯可能引起其他疾病,例如脂肪肝,或許會讓預後狀況更糟。
  • 養分支援。有胰臟炎的貓需要小心的給予養分支援,因為幾乎每一隻胰臟炎的貓都是沒有胃口食慾的(註10)。沒有進食會大大提高得到脂肪肝的風險,讓病況雪上加霜。少量多餐的進食,然後慢慢給予水分。有些獸醫建議低脂的食物,但是高脂食物並不是造成胰臟炎的原因(註11)。比起一次給予大份量的食物,小量多餐才是比較理想的餵食方式(註12)。暫時的腸道灌食有時也是必要的(註13)。
  • 藥物療程。有嘔吐症狀的貓常常會需要服用止吐藥,例如dolasetron、 ondansetron 和 maropitant。
 
Most cases of pancreatitis begin as a sterile process and there's controversy amongst clinicians concerning the use of antibiotics. When pancreatic necrosis occurs the inflammatory process may predispose to bacterial colonization of the pancreas.¹⁴ The use of corticosteroids is of great help in cases of lymphocytic-type pancreatitis with or without concurrent IBD. Prednisolone given once or twice daily helps to reduce the inflammatory process. In cases of acute suppurative pancreatitis, the use of these drugs is contraindicated。
 
大部分的胰臟炎一開始時是沒有細菌的,要不要使用抗生素獸醫之間頗有爭議。當胰臟壞死發生時,發炎可能會導致胰臟細菌叢生(註14)。淋巴型胰臟炎,不管有沒有同時出現炎症性腸病,使用皮質類固醇極有幫助。一天給予一到二次的去氫可體醇錠(Prednisolone )幫助減緩發炎。這類型藥物不能拿來治療急性化膿性胰臟炎,會使病況惡化。
 
譯註:去氫可體醇錠(Prednisolone)為主要具有醣質皮質固醇(glucocorticoid)性質之合成腎上腺皮質類固醇
 
The prognosis for acute pancreatitis depends on the severity of the disorder and the presence of pancreatic and systemic complications such as pancreatic abscesses, infected necroses, pancreatic pseudocysts and especially hepatic lipidosis.¹⁵ Because many of these cats can be anorectic for prolonged periods of time, nutritional support has to be aggressive to prevent this often fatal complication.
 
胰臟炎的預後狀況視胰臟功能失調的嚴重程度而定,以及是否出現胰臟和相關系統的併發症,例如胰臟膿瘍、發炎壞死、胰臟假性囊腫,以及脂肪肝(註15)。胰臟炎的貓可能會有長時間的厭食,所以養分支援極為重要,以預防脂肪肝這個致命的併發症。
 
Cats with chronic pancreatitis may have damage or scarring of their pancreas and may not produce digestive enzymes in sufficient quantities and additional digestive enzymes may need to be added as supplements. A caution about probiotics; a study in humans with pancreatitis associated the use of probiotics with a doubling of the risk of death.¹⁶ While this is not a study on cats; please discuss the use of probiotics with your veterinarian. Feeding a high-protein, palatable diet is critical – your cat must want to eat. A high-protein, low-carbohydrate diet is essential and raw meat diets provide this high quality nutrition. Because IBD is frequently associated with pancreatitis, dealing with that underlying condition is beneficial. Work with your veterinarian on a diet that will be appropriate for your individual cat.
 
有慢性胰臟炎的貓胰臟可能有損傷或刮痕,無法分泌足夠的消化酵素,所以需要額外補充。使用益生菌要小心。一份人類胰臟炎的研究顯示,使用益生菌會讓死亡風險提高一倍(註16)。不過這並不是針對貓所做的研究。使用益生菌之前,請先和你的獸醫討論。餵貓吃高蛋白質的可口食物是必要的-貓一定要進食。高蛋白低碳水的食物是必要的,生肉可以提供高品質的養分。炎症性腸病常常引起胰臟炎,所以治療造成胰臟炎的起因對病情有益。和你的獸醫討論什麼食物最適合你的貓。
 

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祝大家週末愉快

Researcher Dr. Guillermo Díaz studied veterinary medicine at the Universidad Mayor de San Marcos in Lima, Perú. He currently practices in Lima and also provides veterinary services to a large number of local rescue organizations.
 
本文作者獸醫基勒摩.迪亞茲(Dr. Guillermo Diza) 就讀位於秘魯利馬的 Universidad Mayor de San Marcos 獸醫系。他目前在利馬執業,同時提供許多當地的動物救援組織獸醫服務。
 
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