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Pancreatitis: acute

icanis

Introduction

  • Edematous and necrotic/hemorrhagic forms.
  • Signs: acute abdominal pain, vomiting, depression and anorexia.
  • Diagnosis: biochemistry, hematology, ultrasonography.
  • Treatment: intravenous fluid support, antiemetics, analgesics, parenteral nutrition, plasma.
  • Prognosis: recurrence common.
    Print off the owner factsheet on Pancreatitis Pancreatitis to give to your client.Follow the management tree for vomiting/anorexia Vomiting in suspected pancreatitisDiagnostic tree: Vomiting.

Pathogenesis

Etiology

  • Potential risk factors - cause usually unknown.
  • Unknown - predisposing factors:
    • Obesity.
    • High nutritional plane - high fat diets; high fat protein restricted diets.
    • Dietary indiscretion.
  • Hyperlipoproteinemia - primarily in:
  • Ischemia: hypotension, general anesthesia, compression of the pancreatic vessels during abdominal surgery.
  • Drugs, eg thiazides, furosemide, tetracyclines, azathioprine, high dose of corticosteroids (controversial and steroids may be indicated in some cases), particularly in patients with spinal trauma.
  • Infection - bacterial, viral, protozoal.
  • Duodenal reflux - not documented clinically.
  • Duct obstruction - edematous form, eg bile stones - rare.
  • Hypercalcemia Hypercalcemia: overview - particularly acute after IV calcium.
  • Trauma.
  • Uremia Uremia.
  • Auto-immune pancreatitis: suspected in English Cocker spaniel.
  • Idiopathic.

Predisposing factors

General

  • Obesity/high plane of nutrition.
  • High dietary fat.
  • Diet indiscretion, eating table scraps.

Pathophysiology

  • Activation of zymogen granule enzymes within the pancreas, eg trypsinogen → trypsin.
  • Activation may be a consequence of hyperstimulation of pancreas → enzyme activation → pancreatic autodigestion.
  • Oxygen free radicals → damage to cell membranes → increased capillary permeability → edema.
  • Increased levels of cytokines, chemokines, proteases and phospholipase:
    • Locally increased permeability, thrombosis and necrosis.
    • Also have systemic effects.
  • Multisystem involvement includes disseminated intravascular coagulopathy (DIC), hypoalbuminemia Hypoproteinemia , vasculitis, pulmonary edema, acute renal failure Kidney: acute kidney injury (AKI) , cardiac arrhythmia Heart: dysrhythmia , liver damage.
  • Serum antiproteases help but rapidly used up, resulting in progression of enzymatic damage.

Timecourse

  • Acute progression - 24-48 h; consequently - may develop bile duct obstruction 5-10 d after acute bout or pseudocyst/abscess - variable time of onset 2-10 days? (DIC most common multi-system consequence).

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Harris J P, Parnell N K, Griffith E H, Saker K E (2017) Retrospective evaluation of the impact of early enteral nutrition on clinical outcomes in dogs with pancreatitis: 34 cases (2010-2013). J Vet Emerg Crit Care (San Antonio) 27(4), 425-433 PubMed.
  • Pratschke K M, Ryan J, McAlinden A & McLauchlan G (2015) Pancreatic surgical biopsy in 24 dogs and 19 cats: postoperative complications and clinical relevance of histological findings. J Small Anim Pract 56 (1), 60-66 PubMed.
  • Chartier M A, Hill S L, Sunico S, Suchodolski J S, Robertson J E & Steiner J M (2014) Pancreas-specific lipase concentrations and amylase and lipase activities in the peritoneal fluid of dogs with suspected pancreatitis. Vet J 201 (3), 385-389 PubMed.
  • Haworth M D, Hosgood G, Swindells K L & Mansfield C S (2014) Diagnostic accuracy of the SNAP and Spec canine pancreatic lipase tests for pancreatitis in dogs presenting with clinical signs of acute abdominal disease. J Vet Emerg Crit Care (San Antonio) 24 (2), 135-143 PubMed.
  • Paek J, Kang J H, Kim H S, Lee I, Seo K W & Yang M P (2014) Serum adipokine concentrations in dogs with acute pancreatitis. J Vet Intern Med 28 (6), 1760-1769 PubMed.
  • McCord K, Morley P S, Armstrong J, Simpson K, Rishniw M, Forman M A, Biller D, Parnell N, Arnell K, Hill S, Avgeris S, Gittelman H, Moore M, Hitt M, Oswald G, Marks S, Burney D & Twedt D (2012) A multi-institutional study evaluating the diagnostic utility of the spec cPL" and SNAP® cPL" in clinical acute pancreatitis in 84 dogs. J Vet Intern Med 26 (4), 888-896 PubMed.
  • Mansfield C (2012) Pathophysiology of acute pancreatitis: potential application from experimental models and human medicine to dogs. J Vet Intern Med 26 (4), 875-87 PubMed.
  • Trivedi S, Marks S L, Kass P H, Luff J A, Keller S M, Johnson E G & Murphy B (2011) Sensitivity and specificity of canine pancreas-specific lipase (cPL) and other markers of pancreatitis in 70 dogs with and without histopathologic evidence of pancreatitis. J Vet Intern Med 25 (6), 1241-1247 PubMed.
  • Mansfield C S, James F E, Steiner J M, Suchodolski J S, Robertson I D & Hosgood G (2011) A pilot study to assess tolerability of early enteral nutrition via esophagostomy tube feeding in dogs with severe acute pancreatitis. J Vet Intern Med 25 (3), 419-425 PubMed.
  • Weatherton L K & Streeter E M (2009) Evaluation of fresh frozen plasma administration in dogs with pancreatitis: 77 cases (1995-2005). J Vet Emerg Crit Care (San Antonio) 19 (6), 617-622 PubMed.
  • Lem K Y, Fosgate G T, Norby B & Steriner J M (2008) Associations between dietary factors and pancreatitis in dogs. J Am Vet Med Assoc 233 (9), 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 (6), 936-944 PubMed.
  • Flint RS & Windsor JA (2003) The role of the intestine in the pathophysiology and management of severe acute pancreatitis. HPB (Oxford) 5 (2), 69-85 PubMed.
  • Holm J L, Chan D L & Rozanski E A (2003) Acute pancreatitis in dogs. J Vet Emerg Crit Care 13 (4), 201-213 VetMedResource.
  • 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 Research Gate.
  • 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 (6), 416-422 PubMed.
  • Hess R et al (1998) Clinical, clinicopathologic, radiographic and ultrasonographic abnormalities in dogs with fatal acute pancreatitis: 70 cases. JAVMA 213 (5), 665-670 PubMed.
  • Ruaux C & Atwell R B (1998) A severity score for spontaneous canine acute pancreatitis. Aust Vet J 76 (12), 804-8 PubMed.
  • Williams D (1994) Diagnosis and management of acute pancreatitis. JSAP 35 (9), 445-454 VetMedResource.
  • 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 (5), 629-632 PubMed.

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.

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Biliary system: disease (cholestatic disease)

Biopsy: pancreas

Blood biochemistry: albumin

Blood biochemistry: alkaline phosphatase (ALP)

Blood biochemistry: amylase

Blood biochemistry: glucose

Blood biochemistry: lipase

Blood biochemistry: total bilirubin

Blood biochemistry: total calcium

Blood biochemistry: total lipid

Blood biochemistry: total protein

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Cocker Spaniel

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Diabetes mellitus

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Diabetes mellitus: management regimens

Diabetes mellitus: pathophysiology

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Gastrostomy: percutaneous tube 1 (endoscopic)

Glomerulonephritis

Heart: dysrhythmia

Hematology: activated clotting time

Hematology: activated partial thromboplastin time (APTT)

Hematology: leukocyte (WBC)

Hematology: platelet count

Hepatocutaneous syndrome

Hypercalcemia: overview

Hyperlipidemia

Hyperosmolar hyperglycemic state

Hypoadrenocorticism

Hypoglycemia

Hypoproteinemia

Hypothermia

Ileus

Intestine: linear foreign bodies

Intestine: obstruction

Intestine: rupture

Kidney: acute kidney injury (AKI)

Kidney: pyelonephritis

Laparoscopy

Laparotomy: exploratory

Laparotomy: midline

Liver: acute disease

Liver: cholangiohepatitis

Lung: pulmonary edema

Lung: pulmonary thromboembolism

Maldigestion

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Nasoesophageal intubation

Ondansetron

Pancreas: neoplasia

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Pancreas: neoplasia: gastrinoma

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Pleural: effusion

Poodle: Miniature

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Pre-renal azotemia

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Pyometra

Radiography: abdomen

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Shock

Shock: septic

Stomach: acute gastritis

Stomach: chronic gastritis

Stomach: lymphocytic plasmacytic gastritis

Therapeutics: antimicrobial drug

Ultrasonography: pancreas

Uremia

Urinalysis: specific gravity

Vomiting

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Vomiting

OWNER FACTSHEETS

Pancreatitis

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