A severity score for spontaneous canine acute pancreatitis

OBJECTIVE

To derive a severity score for spontaneous canine acute pancreatitis applicable to general practice.

DESIGN

Cohort study of canine pancreatitis cases.

PROCEDURE

Cases (n = 68) of spontaneous canine acute pancreatitis presented to general practitioners were identified among accessions to Veterinary Pathology Services Brisbane. The primary veterinarian was surveyed by telephone to ascertain the outcome of each case. Scores were assigned for extent of hyperamylasaemia, hyperlipasaemia and number of organ systems other than the pancreas compromised. The probability of mortality with each score of each analyte was calculated. The strength of interaction between scores for each analyte and mortality rate was assessed by chi-square analysis where appropriate. Relationships between the organ system score, other physiological variables and likelihood of euthanasia were analysed.

RESULTS

Scores derived mathematically from analysis of enzyme activities had poor abilities to predict mortality. The score based upon the number of organ systems compromised showed good ability to predict mortality and the interaction between the organ system score and mortality rate was significant by chi-square analysis (P < 0.01). Distribution of data within the amylase and lipase scores was not compatible with chi-square analysis.

CONCLUSION

Assessment of severity of spontaneous canine acute pancreatitis using pancreatic enzyme activities is potentially inaccurate. The use of a severity score based upon organ system compromise was more accurate in determining the likelihood of mortality in spontaneous canine acute pancreatitis. This is compatible with the hypothesis that severe canine acute pancreatitis is a multiple organ failure syndrome.

Endoscopic ultrasonographic findings of the pancreas after pancreatic duct ligation in the dog

Endoscopic ultrasonographic evaluation and gray-scale histogram analysis of pancreatic atrophy after pancreatic duct ligation were performed in four normal adult dogs. Using endoscopic ultrasonography, markedly dilated pancreatic ducts were visualized, and the pancreas became gradually atrophied with a hyperechoic parenchyma. In gray-scale histogram analysis of the pancreas, mean brightness increased gradually until 8 weeks, then decreased temporally. Standard deviation of the histogram increased markedly and then fluctuated until the 4th week, after which the mean brightness and standard deviation became stable. At 4 weeks postoperatively, collapse of most pancreatic acinar structures were observed, and each atrophic lobule was associated with a significantly large amount of interstitial fibrous tissue at histopathology. At 12 weeks postoperatively, most exocrine tissue had decreased and was partly replaced by fibrous and fatty tissue. These changes of mean brightness and standard deviation reflected the histologic analysis. These findings indicated that endoscopic ultrasonography is a useful technique to image such atrophic disorders of the pancreas as chronic pancreatitis. Furthermore, gray-scale histogram analysis provides helpful information for ultrasonographic tissue characterization of the pancreas.

Acute pancreatitis in chickens due to non-virulent Newcastle disease virus

A non-virulent Newcastle disease virus (strain APMV-1 96/89 VB) was isolated from a broiler chicken from a backyard flock. Using monoclonal antibodies, the virus was shown to be different from the vaccinal virus strains Hitchner, La Sota and Ulster. The virus was shown to replicate in the pancreas of one-day-old specific pathogen-free chickens infected orally, and the histological lesions observed in the pancreas of chickens inoculated with the fourth chicken passage of the virus five to nine days after infection were consistent with an acute pancreatitis.

Clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in dogs with fatal acute pancreatitis: 70 cases (1986-1995)

OBJECTIVE

To determine clinical, clinicopathologic, radiographic, ultrasonographic, and coagulation abnormalities in dogs in which acute pancreatitis was fatal.

DESIGN

Retrospective study.

ANIMALS

70 dogs.

PROCEDURE

History, clinical signs, and physical examination findings at the time of initial evaluation at the veterinary teaching hospital; results of pretreatment laboratory tests, abdominal radiography, and ultrasonography; and histologic abnormalities were obtained from medical records.

RESULTS

Clinical signs included anorexia, vomiting, Weakness, diarrhea, polyuria and polydipsia, neurologic abnormalities, melena, weight loss, hematemesis, and passage of frank blood in feces. At the time of initial examination at the veterinary teaching hospital, 68 (97%) dogs were dehydrated, 18 (26%) were icteric, 22 (32%) were febrile, 40 (58%) had signs of abdominal pain, and 30 (43%) were classified as overweight or obese. Most dogs had leukocytosis, neutrophilia with a left shift, and thrombocytopenia. Various serum biochemical abnormalities were identified, including hypoglycemia, azotemia, hypercalcemia and other electrolyte abnormalities, hypoalbuminemia, high hepatic and pancreatic enzyme activities, hypercholesterolemia, and lipemia. For 17 of 28 (61%) dogs, results of coagulation function tests were abnormal. Results of abdominal ultrasonography and radiography were consistent with a diagnosis of acute pancreatitis in 23 of 34 (68%) and 10 of 41 (24%) dogs, respectively. For 2 dogs, results of abdominal ultrasonography were not suggestive of acute pancreatitis, but results of abdominal radiography were.

CLINICAL IMPLICATIONS

Clinical signs and results of clinicopathologic tests are inconsistent. Abdominal ultrasonography may be valuable in the diagnostic evaluation of dogs suspected to have acute pancreatitis.

Endoscopic and transcutaneous ultrasonographic findings and grey-scale histogram analysis in dogs with caerulein-induced pancreatitis

Endoscopic ultrasonography (EUS), grey-scale histogram analysis of EUS images, and transcutaneous ultrasonography (TUS) were done in four dogs with caerulein-induced pancreatitis. One other dog was subjected to laparotomy and biopsy specimens were collected for histopathology. By EUS, the pancreatic lesions were first detected at 60 minutes after the start of caerulein infusion. They were detected after 120 to 150 minutes when using TUS. EUS findings included swelling, a more distinct lobular pattern, subcapsular hypoechoic areas, and anechoic stripes through the pancreatic tissue. No marked changes in the histogram analysis was seen until 30 minutes. From 30 to 60 minutes, a decrease in the mean brightness of the pancreatic tissue was observed. These changes in mean brightness reflected histopathological findings showing vacuolization of acinar cells and interstitial oedema of the pancreas. These findings indicated that EUS can detect slight and diffuse changes in pancreatic tissue. Furthermore, grey-scale histogram analysis detects histopathological changes more sensitively than endoscopic ultrasound images.

Pericolonic mass containing chyle as a presumed sequela to chronic pancreatitis in a dog

A 9-year-old dog was admitted because of recurrent episodes of chronic pancreatitis. Ultrasonography revealed a multiloculated, fluid-filled cystic mass at the caudal portion of the stomach. Guided fine-needle aspirates yielded a fluid consistent with chyle. The dog underwent surgery during which a 6- to 8-cm mass was found adhered to the mesocolon and serosa of the transverse colon. Intraoperative lymphangiography revealed lymphangiectasia, but contrast medium did not accumulate within the mass. The mass and a portion of transverse colon were removed en bloc. Results of histologic examination were consistent with an abscess. Pancreatic enzymatic digestion may allow abscesses to extend beyond pancreatic parenchyma, cause severe local inflammation, and encapsulate and incorporate adjacent abdominal lymphatics. Subsequent lymphatic leakage can result in chyle within the abscess. Inflammatory masses of the pancreas are a rare, but serious, complication of pancreatitis in dogs. Familiarity with these types of lesions can aid in selection of appropriate treatments.

Diabetic ketosis and ketoacidosis in cats: 42 cases (1980-1995)

OBJECTIVE

To determine clinical signs, clinicopathologic abnormalities, prevalence of concurrent disease, treatment, complications of treatment, and outcome in cats with diabetic ketosis (DK) or diabetic ketoacidosis (DKA).

DESIGN

Retrospective study.

ANIMALS

42 cats with DK or DKA.

PROCEDURE

Medical records of diabetic cats with ketonuria were reviewed.

RESULTS

In 26 cats, diabetes was newly diagnosed; in 16, diabetes had been diagnosed previously and cats had been treated with insulin (n = 14) or sulfonylurea drugs (2). Common clinical findings were lethargy, anorexia, polyuria, polydipsia, and weight loss. Common laboratory findings were hyperglycemia, hyponatremia, hypochloremia, hypokalemia, hypocalcemia, hypophosphatemia, low total CO2 content, hyperosmolality, high serum alanine transaminase activity, azotemia, glycosuria, and ketonuria. Concurrent disorders were identified in 39 cats and included hepatic lipidosis, cholangiohepatitis, pancreatitis, chronic renal failure, urinary tract infection, and neoplasia. Treatment of DK and DKA included administration of regular crystalline (34 cats), NPH (6), or ultralente (2) insulin, intravenous (38) or subcutaneous (4) administration of fluids, and enterall parenteral or administration of antibiotics (42). Complications during treatment included abnormalities in serum electrolyte concentrations (27 cats), hemolytic anemia (4), hypoglycemia (3), and neurologic abnormalities unrelated to hypoglycemia (2). Eleven cats died or were euthanatized during the initial hospitalization period for treatment of DK or DKA. Azotemia, metabolic acidosis, and hyperosmolality were more severe in cats that died than in cats that survived. Differences in regard to treatment or complications were not apparent between cats that died and cats that survived. The 31 cats that survived were discharged 1 to 16 days (median, 5 days) after initiation of insulin treatment. Diabetic ketosis or ketoacidosis recurred in 13 (42%) of these cats.

CLINICAL IMPLICATIONS

A thorough diagnostic evaluation should be performed on cats with DK or DKA to identify concurrent disorders, formulate an appropriate treatment plan, and provide prognostic information to the owner.

High feline trypsin-like immunoreactivity in a cat with pancreatitis and hepatic lipidosis

A 1.5-year-old domestic shorthair cat was examined because of vomiting and icterus. Clinicopathologic abnormalities included high alanine transaminase, alkaline phosphatase, and gamma-glutamyltransferase activities and high total bilirubin concentration. During abdominal ultrasonography, the left limb and body of the pancreas appeared hypoechoic, and a small quantity of peritoneal effusion was seen. The liver was diffusely hyperechoic, with echogenicity similar to that of the spleen, indicating hepatic lipidosis. Feline trypsin-like immunoreactivity was high, suggesting that the cat also had pancreatitis. The cat was treated with crystalloid fluids and was fed a protein-restricted diet via a percutaneous endoscopically placed gastrostomy tube. The cat's condition continued to deteriorate despite medical treatment, and it was euthanatized. Necropsy confirmed the clinical suspicion of acute pancreatitis and hepatic lipidosis. This case suggests that measurement of trypsin-like immunoreactivity may be useful in cats suspected of having pancreatitis.

Eikenella corrodens-caused botryomycosis-type pneumonia in a barbary ape (Macaca sylvanus)

An 18-year-old female barbary ape in a safari park died from a mixed bacterial infection. Staphylococus aureus was isolated from a purulent necrotic mastitis and from a chronic purulent granulomatous sialoadenitis of the sublingual glands, Eikenella corrodens from a botryomycosis-type pneumonia. As judged by histopathology, mixed infection of S. aureus and E. corrodens was present in the sialoadenitis, and E. corrodens botryomycosis-type bacterial colonies were also present in the pancreatic parenchyma, though here no bacteriological isolation was attempted. A generalized amyloidosis, and especially pancreatic islet amyloidosis, probably indicated an altered immunological competence.

Evaluation of three pancreas specific protein assays, TLI(trypsin-like immunoreactivity), PASP (pancreas specific protein) and CA 19-9 (glycoprotein) for use in the diagnosis of canine pancreatitis

Three radioimmunoassays (RIA) for the pancreas specific proteins TLI, PASP and CA 19-9 were evaluated in serum from normal control dogs (n = 40) and dogs with pancreatitis (n = 20). Statistically significant differences (P < 0.05) were found for serum TLI and PASP levels between the control and pancreatitis groups. However, only 3/20 dogs with pancreatitis had serum TLI concentrations greater than the highest concentration in control dogs. Concentrations of PASP in serum were higher in 15/20 dogs with pancreatitis than in the control dogs. The magnitude of the increase in concentrations of PASP in pancreatitis was small in the majority of cases. Thus these assays are of limited clinical value in the diagnosis of pancreatitis. There was no cross-reactivity with dog serum in the CA 19-9 assay.

Complications and concurrent disease associated with canine hyperadrenocorticism

In untreated hyperadrenocorticism, clinical problems may result from metastasis of an adrenocortical carcinoma, growth of a pituitary tumor, or complications associated with sustained hypercortisolemia itself, such as hypertension, cardiovascular disease, thromboembolism, glucose intolerance, and increased susceptibility to infection. This article discusses the origin, diagnosis, and treatment of the many complications associated with hyperadrenocorticism.

Avian influenza A virus induced stunting syndrome-like disease in chicks

Two-day-old specific-pathogen free chicks were inoculated with type A influenza virus (A/whistling swan/Shimane/499/83 (H5N3) through the air sac. Inoculated chicks showed mild to severe diarrhea and lesions of pancreatitis and atrophy of the pancreas, thymus and bursa of Fabricius. One chick died on each of days 4, 6 and 14 postinoculation (PI). Reduced weight gain was conspicuous from day 22 PI. Positive immunoreaction to the virus antigen was detected in the pancreas, kidneys, liver, lungs and air sacs, and cecal lamina propria. Virus recovery persisted longer in the pancreas. Some of these findings conformed to those of stunting syndrome.

DNA in situ hybridization for the rapid diagnosis of massive necrotizing avian adenovirus hepatitis and pancreatitis in chicks

The present study describes the use of DNA in situ hybridization for the rapid diagnosis of massive necrotizing adenovirus hepatitis and pancreatitis in broiler chicks. A light microscope and DNA probes were used to identify avian adenovirus in replicate sections of formalin-fixed paraffin-embedded liver and pancreas from field and experimental chicks. Avian adenovirus infection was confirmed by transmission electron microscopy and virus isolation.

Relationship between inflammatory hepatic disease and inflammatory bowel disease, pancreatitis, and nephritis in cats

OBJECTIVE

To determine whether cats with inflammatory hepatic disease had concurrent inflammatory bowel disease (IBD), pancreatitis, or chronic interstitial nephritis.

DESIGN

Prospective case series.

SAMPLE POPULATION

78 tissue sections of liver, intestine, pancreas, and kidney from cats that had previous necropsy examinations at the teaching hospital.

PROCEDURE

We reviewed histologic sections of liver, intestine, pancreas, and kidney from cats that had previous necropsy examinations and determined the prevalence of lymphocytic portal hepatitis, cholangiohepatitis, IBD, pancreatitis, and chronic interstitial nephritis, and the relationship among them.

RESULTS

36 cats had lymphocytic portal hepatitis, 18 had cholangiohepatitis, and 24 did not have inflammatory hepatic disease. The prevalence of IBD (10/36; 28%) and pancreatitis (5/36; 14%) in cats with lymphocytic portal hepatitis was not significantly different from cats without inflammatory hepatic disease. The prevalence of IBD (15/18; 83%) and pancreatitis (9/18; 50%) was greater (P < 0.05) for cats with cholangiohepatitis, compared with cats without inflammatory hepatic disease. Thirty-nine percent of cats (7/18) with cholangiohepatitis had IBD and pancreatitis. Evidence of IBD in association with cholangiohepatitis was characterized by infiltration of lymphocytes and plasma cells into the lamina propria; however, neutrophilic infiltrates also were found in 6 of 15 (40%) cats with cholangiohepatitis. Pancreatitis was mild in all cats.

CLINICAL IMPLICATIONS

Cats with a diagnosis of cholangiohepatitis should be evaluated for IBD and pancreatitis.

Sonographic evaluation of the common bile duct in cats

Ultrasound is an excellent imaging tool in the evaluation of the biliary tract in cats. Extrahepatic obstruction could be diagnosed by the presence of dilated common bile duct (CBD), which was measured ventral to the portal vein in the porta hepatis. At this level, the diameter of the CBD in 6 healthy cats and in 22 cats with nonsurgical jaundice was < or = 4 mm. Six of 7 cats with a CBD > 5 mm had extrahepatic biliary obstruction.

Molecular phylogeny and in situ detection of the etiologic agent of necrotizing hepatopancreatitis in shrimp

Necrotizing hepatopancreatitis (NHP) is a severe disease of farm-raised Penaeus vannamei that has been associated with mortality losses ranging from 20 to 95%. NHP was first recognized in Texas in 1985 (S. K. Johnson, p. 16, in Handbook of Shrimp Diseases, 1989) and is an economically important disease that has limited the ability to culture shrimp in Texas. The putative cause of NHP is a gram-negative, pleomorphic, intracellular, rickettsia-like bacterium that remains uncultured in part because of the absence of established shrimp cell lines. The inability to culture the NHP bacterium necessitated the use of molecular methods for phylogenetic placement of the NHP bacterium. The gene encoding the 16S rRNA (16S rDNA) of this shrimp pathogen was amplified by PCR, cloned, and sequenced. Sequence analysis of the cloned 16S rDNA indicates that the NHP bacterium is a member of the alpha subclass of the Proteobacteria. Within the alpha subclass, the NHP bacterium is shown to be most closely related to bacterial endosymbionts of protozoa, Caedibacter caryophila and Holospora obtusa. Also, the NHP bacterium is distinct from but related to members of the typhus group (Rickettsia typhi and R. prowazekii) and spotted fever group (R. rickettsii) of the family Rickettsiaceae. Fluorescently labeled oligonucleotide DNA probes that bind to variable regions (V2, V6, and V8) of 16S rRNA of the NHP bacterium were used to detect the bacterium in infected shrimp by in situ hybridization. This technique provided direct visual evidence that the 16S rDNA that was amplified, cloned, and sequenced was derived from the intracellular bacterium that infects the hepatopancreas of farm-raised P. vannamei shrimp.

Pancreatic pseudocyst associated with chronic-active necrotizing pancreatitis in a cat

A 13-year-old, neutered female domestic shorthair was referred for evaluation of chronic, intermittent vomiting of approximately two years' duration. On physical examination, a fluctuant mass was palpated in the left cranial abdominal quadrant. Significant laboratory findings included neutrophilia, hyperglycemia, hyperlipasemia, and proteinuria. A distinct mass within the left cranial quadrant was noted on abdominal radiographs. Ultrasonographically, the pancreas appeared slightly hyperechoic with a hypoechoic mass arising from its left lobe. A cystic mass in the left lobe of the pancreas was identified during an exploratory celiotomy. The mass and affected areas of the pancreas and a portion of the spleen were resected. The cat recovered completely. Cytological, histological, and laboratory evaluations of the mass were consistent with pancreatic pseudocyst formation, which has been reported in dogs and humans but has not yet been reported in cats.