Pancreatitis: acute

Introduction

• Edematous and necrotic/hemorrhagic forms.
• Signs : acute abdominal pain, vomiting, depression and anorexia.
• Diagnosis : biochemistry, hematology, radiography, ultrasonography.
• Treatment : intravenous fluid support, antiemetics, nothing per osfor 3-4 days, analgesics, parenteral nutrition, plasma.
• Prognosis : recurrence common.
  Print off the owner factsheet on Pancreatitis to give to your client.

Diagnosis

Clinical signs

• Cranial abdominal pain.

• Signs of shock , ie tachycardia, weak pulse, pallor.
• Petechial/bleeding due to disseminated intravascular coagulopathy (DIC).

• Cardiac arrhythmia.
• Icterus.
• Abnormal lung sounds and tachypnea due to pulmonary edema.

Diagnosis

Differential diagnosis

• Vomiting - many causes:
  • Primary gastrointestinal tract disease:
    • Obstructive disease.
    • Inflammatory disease.
    • Ischemic disease
  • Secondary causes of vomiting:
    • Hypoadrenocorticism .
    • Renal failure/uremia .
    • Hepatic disease.
    • Pyometra .
    • Diabetic ketoacidosis .

• Nephritis/pyelonephritis.
• Hepatitis .
• Gastritis .
• Gastrointestinal obstruction , acute gastroenteritis .
• Peritonitis .

• Hepatitis .
• Cholangitis , other gall bladder disease .
• Bile duct obstruction.
• Hemolytic disease .

Sequelae

Prognosis

• Fair prognosis in short-term unless necrotizing, then prognosis is very poor.
• Recurrence common.

Expected response to treatment

• No vomiting within 24 h.
• Appetite returns and improvement in general demeanor in 3-4 days.
• Able to cope with normal diet within 4-5 days.

Reasons for treatment failure

• Severe necrotizing pancreatitis.
• Failing to maintain dietary restriction for 3-4 days; no food or fluid should be given orally in this period.
• Development of disseminated intravascular coagulation, sepsis or other systemic complications.
• Development of bile duct obstruction.
• Development of pancreatic phlegm (solid benign mass) → pancreatic pseudocyst → sterile necrosis and pancreatic abscess → poor prognosis.
• Rule out pancreatic cancer where recurrent/unresponsive.

Sources

Publications

Refereed papers

• Recent references from PubMed.
• Lem K Y, Fosgate G T, Norby B, Steiner J M (2008) Association between dietary factors and pancreatitis in dogs. JAVMA 233 , 1425-1431 PubMed.
• Mansfield C S, James F E, Robertson I D (2008) Development of a clinical severity index for dogs with acute pancreatitis. JAVMA 233 , 936-944 PubMed.
• Holm J L, Chan D L & Rozanski E A (2003) Acute pancreatitis in dogs. J Vet Emerg Crit Care. 13 (4), 201-213. Review.
• Steiner J M, Broussard J, Mansfield C S, Gumminger S R & Williams D A (2001) Serum canine pancreatic lipase immunoreactivity (cPLI) concentrations in dogs with spontaneous pancreatitis. JVIM 15 , 274.
• Mansfield C S & Jones B R (2000) Plasma and urinary trypsinogen activation peptide in healthy dogs, dogs with pancreatitis and dogs with other systemic diseases. Aust Vet J 78 , 416-422.
• Hess R et al(1998) Clinical, clinicopathologic, radiographic and ultrasonographic abnormalities in dogs with fatal acute pancreatitis: 70 cases. JAVMA 213 , 665-670.
• Ruaux C & Atwell R B (1998) A severity score for spontaneous canine acute pancreatitis. Aust Vet J 76 , 2-6.
• Williams D (1994) Diagnosis and management of acute pancreatitis. JSAP 35 , 445-454.
• Simpson et al(1989) Circulating concentrations of TLI and activities of serum amylase and lipase after pancreatic duct ligation in dogs. Am J Vet Res 50 , 629-632.

Other sources of information

• Mansfield C (2004) New directions in diagnosing and treating canine pancreatitis. Proceedings of the ACVIM Forum 2004, Minneapolis, June 9-12, 2004.
• Williams D & Steiner J (2000) Canine pancreatitis. In: Current Veterinary Therapy XIII.J Bonagura (ed), W B Saunders. pp 687-701.