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Feline Exocrine Pancreatic Disease

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Feline Exocrine Pancreatic Disease Feline Health Topics for veterinarians Volume 10, Number 4 Feline Exocrine Pancreatic Disease David A. Williams, M.A., Vet. MB, Ph.D., DACVIM and Jorg M. Steiner, med. vet., Dr. med. vet. Traditionally, the frequency of exocrine pancreatic bladder and pancreatic parasites (i.e., Eurytrema disease in cats has been considered to be low. How­ procyonis and Amphimerus pseudofelineus). ever, a recent study has shown that the frequency of The following discussion focuses on pancreatitis significant pathologic lesions of the exocrine pan­ and exocrine pancreatic insufficiency. Limited evi­ creas at necropsy is almost as high in cats as it is in dence shows that while there are broad similarities dogs (1.4 % in cats and 1.7 % in dogs).1 Other studies between these diseases in cats and dogs, there are also report even higher frequencies.2,3 This is contrasted some important differences, particularly with regard by an infrequent clinical diagnosis of exocrine pan­ creatic diseases in cats. Cats suffer from various to etiology and diagnostic testing. exocrine pancreatic diseases. However, the most Pancreatitis common condition appears to be pancreatitis. Chronic forms of pancreatitis are more common than acute Recent reports have described that acute necrotizing forms. Exocrine pancreatic insufficiency and pan­ pancreatitis in cats is similar to that seen in dogs, as creatic neoplasia are less common than inflammatory well as a histologically distinct suppurative form.4 disease. Finally, other conditions have been reported This contrasts with traditional reports of chronic mild in the cat such as pancreatic pseudocyst, pancreatic interstitial pancreatic inflammation in cats, charac­ terized by inflammation of interstitial tissue appar­ ently spreading from the ducts, often accompanied by cholangiohepatitis, and sometimes by interstitial nephritis. Inside this issue... Etiology The inciting cause of spontaneous feline pancreatitis Feline Exocrine Pancreatic Disease page 1 is not determined in most cases. However, several cases of pancreatitis caused by trauma (i.e., high rise Research Briefs page 5 syndrome, traffic accidents and abdominal surgery) Cornell Appoints New Dean have been described. Also several infectious organ­ of Veterinary College page 6 isms, such as Toxoplasma gondii, feline Herpesvirus I, feline infectious peritonitis virus, and the feline Feline Behavior Seminar page 7 parvovirus have been named responsible for cases of pancreatitis. Rare cases of pancreatitis caused by organophosphate intoxication have also been de­ scribed. Coexistent interstitial pancreatitis and Feline Health Topics 2 cholangiohepatitis have been observed in cats, and iting during an experimental study.6 A survey of 40 although the relationship between the changes in cases of fatal feline pancreatitis revealed that nearly these two organs is not clear, convergence of feline all were severely lethargic and anorexic, and that biliary and pancreatic ducts may be a factor. more than 50% were dehydrated or hypothermic. Pancreatitis has also been reported in a high propor­ Vomiting was noted in 35% of cases and signs of tion of cats with hepatic lipidosis.5 Suspect drugs abdominal pain or an abdominal mass were apparent associated with pancreatitis in feline patients include in 25%of patients.4 furosemide, sulfonamides and tetracyclines. Finally, History and clinical signs associated with the infestation of pancreatic tissue by the hepatic pancreatitis are also non-specific and are common to parasite Amphimerus pseudofelineus has been iden­ numerous gastrointestinal and metabolic disorders. tified as a rare cause of pancreatitis in the cat. Abdominal radiographs may provide evidence lead­ In summary, as in other species, nutrition/ ing to one of these alternative diagnoses, or support hyperlipoproteinemia, drugs/toxins/hypercalcemia, a tentative diagnosis of pancreatitis by revealing duct obstruction, duodenal reflux, pancreatic trauma, ascites or local peritonitis in the anterior right quad­ pancreatic ischemia/reperfusion, viral, mycoplasmal rant. Ultrasonographic imaging is proving increas­ and parasitic infections, and uremia may all be incit­ ingly useful in identification of patients with ing or contributory causes of pancreatitis, but their pancreatitis. Nonhomogeneous masses and loss of exact role in feline pancreatitis is unknown. echogenicity have been reported.1 Until recently the usefulness of serum amylase D iagnosis and lipase, which serve as markers of pancreatitis in Clinical signs of pancreatitis in cats are non-specific. dogs and humans, was unknown. An experimental Fever, tachycardia and variable signs of abdominal study demonstrated that while serum lipase increased pain were observed with only rare episodes of vom- ----------------------------- significantly in cats following induction of pan­ creatitis, amylase activity was never increased above normal, but rather decreased significantly during the Feline Health Topics course of the disease.6 A recent study reported serum amylase and lipase concentrations of 12 cats with A publication for veterinary professionals pancreatitis. These cats did not have elevations or The ultimate purpose of the Cornell Feline Health Center is to decreases in either serum amylase or serum lipase improve the health of cats everywhere, by developing methods to prevent or cure feline diseases, and by providing continuing concentrations.8 Hence, serum amylase or serum education to veterinarians and cat owners. All contributions are lipase seems to be of little help in the diagnosis of tax-deductible. pancreatitis in the cat. The same study evaluated the Director: Fred W. Scott, D.V.M., Ph.D Assistant Director: James R. Richards, D.V.M. use of feline trypsin-like immunoreactivity (fTLI) in Editor: June E. Tuttle Secretaries: Gwen Frost serum. The reference range for fTLI has been re­ Marsha J. Leonard ported to be 17-49 |ig/L.9 The mean serum fTLI Sheryl A. Thomas concentration was significantly higher in the group of ©1995 by Cornell University on behalf of 12 cats suffering from pancreatitis compared with the Cornell Feline Health Center, College of Veterinary Medicine, Ithaca, NY 14853. healthy cats or cats suffering from other diseases. Phone: (607) 253-3414 Fax: (607) 253-3419 Thus fTLI is the first serum marker for pancreatitis All rights reserved. Permission to reprint se­ lected portions must be obtained in writing. which has shown any promise in the cat. Cornell University is an equal opportunity, affirmative action educator and employer. V Printed on recycled paper. 3 Hyperglycemia is common in cats with necrotizing The value of other therapeutic agents including anti­ pancreatitis, probably as a result of hypergluca- biotics, glucococorticoids, and antisecretory drugs is gonemia and stress-related increases in the concen­ highly questionable. trations of catecholamines and cortisol. Some af­ fected animals are diabetic following recovery from Exocrine Pancreatic Insufficiency acute episodes of pancreatitis. In contrast, cats with suppurative pancreatitis often develop hypogly­ Etiology cemia.4 The most common cause of feline EPI is chronic The concentration of trypsinogen activation pep­ pancreatitis. Since both endocrine and exocrine pan­ tides (TAP) in plasma or urine creatic cells are destroyed in provides a specific marker for ( \ pancreatitis, feline EPI is often pancreatitis, since in the absence TLI Assay accompanied by diabetes mellitus. of pancreatitis only free trypsi­ Other, less commonly reported nogen is present in the plasma.10 Submissions causes of EPI in the cat are ob­ TheTAPconcentration correlates struction to the flow of pancreatic with the disease severity and clini­ Assay of feline TLI is pres­ juice secondary to pancreatic adenocarcinoma or other tumors, cal course of pancreatitis in rats ently only available from Dr. or secondary to the infestation of and human beings. Recent re­ Williams* laboratory. Addi­ search has confirmed that the the pancreas with pancreatic tional information and (Asp)4-Lys-peptide sequence, flukes. EPI has also been reported common toTAPin all vertebrates, sample submission forms as a complication of proximal is also preserved in the cat.11 can be obtained from Dr. duodenal resection. Dual pancre­ Therefore, immunoassays for David A. Williams, Cl Lab, atic ducts are usually absent in the TAP may also prove to be of Purdue University, West cat and therefore damage to the major duodenal papilla blocks practical value in the cat. Lafayette IN 47907-1248. Fax (317) 496-1796, Tele­ pancreatic secretion. There are no Treatm ent phone (317) 494-0331. well documented reports of idio­ Supportive care is the mainstay pathic pancreatic acinar atrophy in cats. However, the authors are of therapy for pancreatitis in the L J cat. In the very few cases in which aware of at least three cases in a cause can be identified, the specific cause should be which this diagnosis was con­ eliminated if possible. The importance of withhold­ firmed by direct examination of the pancreas. ing all oral intake in cats with pancreatitis is question­ able, especially given the reported high prevalence of Pathophysiology concurrent hepatic lipidosis and the attendant desir­ There are no reports of studies in cats, but naturally ability of aggressive nutritional support. These cats occurring and experimental EPI in several other perhaps should ideally be fed via a jejunostomy tube, species leads to abnormal activities of intestinal and perhaps total parenteral nutrition may
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