Chronic feline pancreatitis treatment

RE: Chronic feline pancreatitis treatment

KMurphy — Mon, 19 Feb 2018 17:07:50 GMT

I don't know if anyone is interested but I thought I'd update you all on this cat. I discussed further investigation with the owners and they were happy to be referred. An ultrasound of his pancreas showed a 2.5cm lesion on the right limb of the pancreas. FNA suggested infection/inflammation but neoplasia wasn't ruled out. His owners decided they had nothing to lose and opted for surgery.

The cat had an exploratory laparotomy and the affected area of the pancreas was excised. Subsequent histopathology revealed "Pancreatitis, necrotising, neutrophilic, sub-acute, focally extensive, moderate to marked, with haemorrhage and granulation tissue formation".

The cat made a full recovery and is doing very well 6 weeks post-op.

Thank you again for all your input and help with this case.

RE: Chronic feline pancreatitis treatment

KMurphy — Wed, 13 Dec 2017 09:35:50 GMT

Thank you all for the very helpful information and replies!

I haven't scanned the cat because everything felt okay on abdominal palpation but it would be good to have that assessed a bit more objectively! I'll get that arranged soon.

I had always thought prednisolone was a good choice for pancreatitis in cats so thank you for that information. I will definitely keep it in mind in the future.

As for the triaditis - biochem and CBC were completely normal so I wasn't concerned about his liver at all. I will recommend a novel protein diet in case of IBD. I already have him on Lypex so that should address any EPI issues but I can add in a TLI and confirm if this is the case.

Thank you all again for your input.

Karen.

RE: Chronic feline pancreatitis treatment

Martin Atkinson — Wed, 13 Dec 2017 08:51:46 GMT

I recall reading some research that stated that something in the order of 50% of cats at post mortem examination for another disorder were found to have evidence of pancreatitis. I also believe that in dogs and cats it is a lot more common than is generally diagnosed and many odd sessions of vomiting and 'grumbly tummies' that recover with little or no treatment may well be recurrences of acute on chronic pancreatitis.

RE: Chronic feline pancreatitis treatment

gerard mclauchlan — Tue, 12 Dec 2017 23:10:42 GMT

Agreed - the increased PLI may be secondary to a local reaction resulting in weight loss such as a neoplastic process.

RE: Chronic feline pancreatitis treatment

gerard mclauchlan — Tue, 12 Dec 2017 23:09:58 GMT

Hi Martin

I am a big fan of bile culture but normally in cases of suspected neutrophilic cholangitis where I aspirate ultrasonographically. I would expect this case to have increased bilirubin, a neutrophilia and pyrexia plus in general more severe clinical signs if a bacterial infection was present in the biliary system but i guess not all cases read the txtbooks! :)

RE: Chronic feline pancreatitis treatment

gerard mclauchlan — Tue, 12 Dec 2017 23:07:03 GMT

Not sure what you mean - histologically there is clear evidence of multiorgan infiltration with inflammatory cells in cats (both ante and post mortem). In some studies infiltrates were also documented in organs other than pancreas, liver and GIT. If it always translates to clinical disease is less clear as some of the studies samples were taken in animals being neutered who had little to no clinical signs relating to the pancreas/GIT/hepatobiliary system.

RE: Chronic feline pancreatitis treatment

Kate Richardson — Tue, 12 Dec 2017 22:04:06 GMT

Have you scanned him?

RE: Chronic feline pancreatitis treatment

Judith Archbold — Tue, 12 Dec 2017 22:01:10 GMT

If I am treating a cat with “ triaditis” as an acute presentation I’ll give them a shot of dexafort and oral Famotidine tablets for a few days. Famoridine seems to be a great drug for these older vomitty cats too. ( I appreciate the cat in this case wasn’t vomitting though)

RE: Chronic feline pancreatitis treatment

David Mills — Tue, 12 Dec 2017 19:59:34 GMT

Does triaditis still exist?

RE: Chronic feline pancreatitis treatment

Martin Atkinson — Tue, 12 Dec 2017 19:13:12 GMT

I would go with Gerard's approach as pancreatitis in cats is often part of triaditis and secondary to liver disease and IBD so the novel protein diet would be a mainstay to control IBD. Also look at liver function and treat appropriately with SAMe and ursodiol. One patient I was treating also had cholestasis and cholecystitis, I drained its gall bladder while I was biopsying the pancreas, took a sample for culture and treated it with the appropriate antibiotics. I also added in some Lypex and it made a good recovery even with the owner being less than ideally compliant with the diet and the histo on the pancreas being suggestive of chronic disease/EPI but of course this was only a fraction of the pancreas and may not have been representative of its whole.

RE: Chronic feline pancreatitis treatment

gerard mclauchlan — Tue, 12 Dec 2017 18:17:22 GMT

Hi,

Worth considering the effects of prednisolone on your PLI results. Some conflicting reports in dogs but at least one study suggesting the use of steroids may increase the PLI values. I tend to not use steroids much in pancreatitis cases - in cats I would start normally with diet modification to either a novel protein or hydrolysed diet as many of these cases may be part of a triaditis complex often triggered by inflammatory bowel disease. Probably also worth checking a TLI also given that cats are now often thought to present without necessarily a ravenous appetite and diarrhoe even if they have EPI.

Gerard

Feline Exocrine Pancreatic Insufficiency: A Retrospective Study of 150 Cases

P.G. Xenoulis, D.L. Zoran, G.T. Fosgate, J.S. Suchodolski, and J.M. Steiner

Background:

Little information is available about the clinical presentation and response to treatment of cats with exocrine

pancreatic insufficiency (EPI).

Objectives:

To describe the signalment, clinical signs, concurrent diseases, and response to treatment of cats with EPI.

Animals:

One hundred and fifty cats with EPI.

Methods:

Retrospective case series.

Results:

Questionnaires were sent to 261 veterinarians, and 150 (57%) were returned with data suitable for statistical

analysis. The median age of the cats with EPI was 7.7 years. The median body condition score was 3 of 9. Ninety-two of

119 cats (77%) had hypocobalaminemia, and 56 of 119 cats (47%) had increased and 6 of 119 cats (5%) had decreased

serum folate concentrations. Clinical signs included weight loss (91%), unformed feces (62%), poor hair coat (50%), anor-

exia (45%), increased appetite (42%), lethargy (40%), watery diarrhea (28%), and vomiting (19%). Eighty-seven cats

(58%) had concurrent diseases. Treatment response was reported to be good in 60%, partial in 27%, and poor in 13% of

121 cats. Trypsin-like immunoreactivity <4lg/L was associated with a positive response to treatment (OR, 3.2; 95% CI,

1.5–7.0;P=.004). Also, cobalamin supplementation improved the response to treatment (OR, 3.0; 95% CI, 1.4–6.6;P=.006).

Conclusions and Clinical Importance:

Exocrine pancreatic insufficiency in cats often has a different clinical presentation than in dogs. The age range for EPI in cats is wide, and many cats can be ≤ 5 years of age. Most cats respond well to appropriate treatment for EPI, and cobalamin supplementation appears to be necessary for a good response

Stability of canine pancreatic lipase immunoreactivity concentration in serum samples and effects of long-term administration of prednisone to dogs on serum canine pancreatic lipase immunoreactivity concentrations.

Steiner JM¹, Teague SR, Lees GE, Willard MD, Williams DA, Ruaux CG.

Author information

Abstract

OBJECTIVE:

To evaluate stability of canine pancreatic lipase immunoreactivity (cPLI) in serum samples and to determine the effect of long-term administration of prednisone on serum cPLI concentrations.

SAMPLE POPULATION:

8 canine serum samples for the stability evaluation and serum samples obtained from 6 healthy young adult heterozygous (carrier) dogs with X-linked hereditary nephritis for determining the effect of prednisone administration.

PROCEDURES:

To evaluate stability of serum cPLI concentration, an aliquot of each serum sample was stored at each of 4 temperatures between -80 degrees and 24 degrees C; samples were analyzed on days 0, 3, 7, 14, and 21. To determine the effect of long-term prednisone administration, pretreatment serum samples were obtained (days 0 and 14) and prednisone was administered (2.2 mg/kg, q 24 h, PO) on days 15 through 42, with serum samples obtained on days 28 and 42. Additional serum samples were obtained on days 56 and 70.

RESULTS:

Mean serum cPLI concentrations did not change significantly from day 0 to day 21 regardless of storage temperature. Serum cPLI concentrations in dogs after prednisone administration were within the reference range for all dogs at all time points, and results of repeated-measures ANOVA revealed that serum cPLI concentrations did not change significantly over time.

CONCLUSIONS AND CLINICAL RELEVANCE:

Serum cPLI concentrations measured in canine serum samples stored at room temperature, in a refrigerator, or in a freezer at -20 degrees or -80 degrees C were stable for at least 21 days. Also, long-term prednisone administration to dogs did not significantly affect serum cPLI concentrations.

Serial measurement of pancreatic lipase immunoreactivity concentration in dogs with immune-mediated disease treated with prednisolone.

Ohta H¹, Morita T¹, Yokoyama N¹, Osuga T¹, Sasaki N¹, Morishita K², Nakamura K², Takiguchi M¹.

Author information

Abstract

OBJECTIVES:

In this pilot study, serum canine pancreatic lipase immunoreactivity was measured repeatedly in dogs with various immune-mediated diseases that were treated with immunosuppressive doses of prednisolone.

METHODS:

Ten client-owned dogs with newly diagnosed immune-mediated disease that had normal canine pancreatic lipase immunoreactivity concentrations (≤200 µg/l) were treated with 2 to 2.2 mg/kg prednisolone orally once daily as the initial treatment. Serum samples were obtained from each of the dogs prior to treatment and at 1- to 4-week intervals during immunosuppressive treatment. The highest canine pancreatic lipase immunoreactivity concentration detected during immunosuppressive treatment was defined as the peak canine pancreatic lipase immunoreactivity.

RESULTS:

Peak canine pancreatic lipase immunoreactivity concentrations were classified as normal in two dogs, questionable (201 to 399 µg/l) in three dogs, and abnormal (≥400 µg/l) in five dogs. Peak canine pancreatic lipase immunoreactivity concentrations were significantly higher than baseline canine pancreatic lipase immunoreactivity concentrations but there was no evidence of clinical pancreatitis.

CLINICAL SIGNIFICANCE:

It remains unclear whether the five of 10 dogs with elevated canine pancreatic lipase immunoreactivity during prednisone treatment had subclinical pancreatitis or whether the abnormal results were a consequence of prednisolone administration.