Pancreatitis/hepatitis - to give steroids or not?

Re: Pancreatitis/hepatitis - to give steroids or not?

Edward Jones — Wed, 28 Mar 2012 11:58:28 GMT

Re: Hepatitis, you might find the following 'In Practise' articles helpful, if you can find them:

Bexfield, NH & Watson, PJ. (2009) Treatment of canine liver disease 2. Managing clinical signs and specific liver diseases. In Practice 31: 172-180.
Bexfield, NH & Watson, PJ. (2009) Treatment of canine liver disease 1. Drugs and dietary management. In Practice 31:130-135.

Re: Pancreatitis/hepatitis - to give steroids or not?

nikki — Wed, 28 Mar 2012 09:45:27 GMT

nothing to dislike about your answer re the steroids - that was what I was unsure about - whether there was ever any indiciation to use them in anything other than the immune mediated disease in Cockers.

liver looked fine on ultrasound - homogenous and uniform. repeated the scan yesterday and same findings - common bile duct still only moderately dilated.

Re: Pancreatitis/hepatitis - to give steroids or not?

Christopher Saul — Wed, 28 Mar 2012 00:22:26 GMT

Hi Nikki,

Firstly I'd want to be sure with your diagnostics; is there definately no evidence of other liver disease which may explain the jaindice? did the hepatic parenchyma look okay?

Assuming you are happy with the diagnosis and you are definately talking pancreatitis then I'd probably just continue as you are provided the dog is clinically improving. If he deteriorates futher it's worth remebering that in extreme cases pancreatitis can cause complete bilary obstruction necessating placement of a stent in the bile duct; is referral to a soft tissue surgeon an option?

You may not like my answer but with regard to the steroid can of worms; this is something in which I'm very interested as I am a (very lowly ranked) co-author in one of the cocker spaniel studies. We have had an abstract accepted at ACVIM but there's alot of work still to do....

In humans there is a form of chronic pancreatitis which is considered auto-immune, and this form of the disease is characterised by a predominence of IgG4+ plasma cells on immunohistochemistry. Chronic pancreatitis in a cohort of cocker spaniels has been demonstrated to also show a predominence of IgG4+ plasma cells, and the logic is that this disease is also probably autoimmune as in humans. It therefore seems logical to treat these cases with steroids; indeed I do myself, though we have yet to prove a clinical benefit to this.

Such a pattern of disease has ONLY been demonstrated in cocker spaniels, not in other spaniel breeds (let alone crosses) so I would say that with the current level of knowledge of pancreatitis, there is no reason to give steroids in this case.

I would suggest continuing with your standard pancreatitis treatment plan, you seem to be doing a good job so far!

Hope this helps

Chris

Re: Pancreatitis/hepatitis - to give steroids or not?

David Mills — Tue, 27 Mar 2012 23:59:45 GMT

Steroids only indication to prevent fibrosis or immune mediated disease, latter requires cytological/histological diagnosis, former usually of concern if widespread heterogenecity on US. Mostly steroids are contraindicated in liver disease. ALT/ALP don't give any indication of prognosis. If dog eating and bright, send home oral meds, jaundice can take days-weeks to resolve completely.