January 6, 2017
Feline Pancreatitis: Signs of Trouble
Last Updated on Saturday, January 23, 2016 08:29 PM
Published on Saturday, September 06, 2014 08:25 PM
Written by Guillermo Díaz, MV
作者：獸醫基勒摩．迪亞茲（Guillermo Diaz, MV）
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.
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.
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
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.
The most common causes of pancreatitis in cats are:
- 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
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:
- Lethargy 沒有精神
- Anorexia 厭食
- Dehydration 脫水
- Vomiting 嘔吐
- Abdominal pain 腹部疼痛
- Palpable abdominal mass 觸診可摸到腹部硬塊
- Diarrhea 腹瀉
- 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
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.
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.
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.
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
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:
- 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.
- 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。
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.
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.
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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