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Cho H, Choi J. Pancreatic adenocarcinoma arising from an ectopic pancreas in a cat. Vet Radiol Ultrasound 2023; 64:E50-E54. [PMID: 37340693 DOI: 10.1111/vru.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/29/2023] [Accepted: 05/13/2023] [Indexed: 06/22/2023] Open
Abstract
An 8-year-old male neutered Korean shorthair cat presented with chronic vomiting. Radiographically, an oval-shaped soft tissue abdominal mass caudoventral to the left kidney was detected. On ultrasonography, the hypoechoic mass was well-defined with thick, irregular, and hyperechoic margins and had no continuity with the pancreas or other adjacent organs. The mass was surgically excised. Areas of atypical pancreatic acinar epithelial cells were identified histopathologically. Postoperative CT demonstrated a normal pancreas in the expected anatomical region. Based on diagnostic imaging, surgical and histopathology findings, the mass was diagnosed as a well-differentiated pancreatic acinar cell adenocarcinoma arising from ectopic pancreatic tissue.
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Affiliation(s)
- Hyun Cho
- Bien Animal Medical Center, Bucheon, South Korea
| | - Jihye Choi
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul, South Korea
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2
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Evaluation of Clinicopathological Data, the Specific Feline Pancreatic Lipase Assay, and Abdominal Ultrasound as Severity Determinants in Cats with Pancreatitis. Vet Sci 2023; 10:vetsci10030209. [PMID: 36977248 PMCID: PMC10051357 DOI: 10.3390/vetsci10030209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Limited data exist to predict the severity of pancreatitis in cats. In this retrospective case series, we reviewed the medical records of 45 cats with SP from June 2014 to June 2019. Case definition was based on an internist’s review of clinopathologic data, Spec fPL concentration, and AUS findings. Information extracted from the medical records included signalment, history, physical examination findings, selected clinicopathological data (total bilirubin, glucose, ALP, ALT, and total calcium), Spec fPL concentration, AUS images/clips, length of hospitalization, and survival data. Hazard ratios were used to evaluate the association between clinicopathological data, the Spec fPL assay, AUS findings, and the length of hospitalization. Clinicopathological abnormalities, the Spec fPL, and AUS abnormalities were not statistically associated with the length of hospitalization. Despite a lack of statistical significance, the hazard ratios suggest the potential that an elevated total bilirubin (hazard ratio (HR): 1.19), hypocalcemia (HR: 1.49), and an elevated Spec fPL concentration (HR: 1.54) could be associated with prolonged hospitalization, although additional studies would be needed to verify this. Additionally, hazard ratios suggest that AUS evidence of concurrent gallbladder (HR: 1.61) and gastric abnormalities (HR: 1.36) could be associated with prolonged hospitalization.
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Rudinsky AJ. Laboratory Diagnosis of Pancreatitis. Vet Clin North Am Small Anim Pract 2023; 53:225-240. [DOI: 10.1016/j.cvsm.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lederer KA, Hittmair KM, Tichy A, Zeugswetter FK. Comparison of ultrasonographic echogenicity and outcome in cats with suspected pancreatitis. J Feline Med Surg 2022; 24:1228-1237. [PMID: 35166136 PMCID: PMC10812350 DOI: 10.1177/1098612x221074921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether ultrasonographic pancreatic echogenicity, especially hypoechogenicity, has an impact on the prognosis of cats with suspected pancreatitis. We hypothesised that cats with a hypoechoic pancreas have a longer duration of hospitalisation, higher treatment costs and a higher mortality rate. METHODS This was a retrospective study, which included cats with clinical signs of pancreatitis, a SNAP fPL test result above the reference interval and ultrasonographic abnormalities consistent with pancreatitis. Medical records and follow-up information were retrieved from the local electronic database. Cases were assigned to one of three groups based on pancreatic echogenicity: hypoechoic, hyperechoic or mixed echogenicity. Statistical analysis aimed to assess differences in outcome, ultrasonographic abnormalities, historical features, physical examination findings, laboratory results, concurrent diseases or treatment costs. RESULTS Thirty-six (64%) cats with a hypoechoic, seven (13%) with a hyperechoic and 13 (23%) cats with a mixed echoic pancreas were included. Cats with a hypoechoic pancreas had a significantly lower median body weight (P = 0.010) and lower median body condition score (P = 0.004) compared with the other cats. Furthermore, they were presented as being lethargic significantly more often (P = 0.014), were more likely to have a homogeneously enlarged pancreas (P <0.001) and were less likely to have concurrent abnormalities or diseases, such as ultrasonographic enteric abnormalities (P = 0.020), triaditis (P = 0.013) and diabetes mellitus (P = 0.041). However, there was no difference in treatment costs (P = 0.961), duration of hospitalisation (P = 0.898), survival of hospitalisation (P = 0.419) or survival time (P = 0.256) between groups. CONCLUSIONS AND RELEVANCE In this study, echogenicity was of no prognostic value in cats with suspected pancreatitis. Cats with a hypoechoic pancreas were not associated with a poorer outcome than cats with a hyperechoic or mixed echoic pancreas.
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Affiliation(s)
- Kristina A Lederer
- Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Katharina M Hittmair
- Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Alexander Tichy
- Department of Biomedical Sciences, University of Veterinary Medicine, Vienna, Austria
| | - Florian K Zeugswetter
- Internal Medicine, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
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Cruciani B, Touzet C, Robin E, Bismuth C. Left pancreaticoduodenostomy after removal of the right lobe and the head of the pancreas in a cat. Vet Surg 2022; 51:1304-1310. [PMID: 36099343 DOI: 10.1111/vsu.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/21/2022] [Accepted: 08/07/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report a surgical technique for pancreaticoduodenostomy and its outcomes in a cat. ANIMALS A 14-year-old domestic cat. STUDY DESIGN Case report. METHODS A cat was referred to our hospital with a large abdominal mass. On ultrasonographic examination, this mass was identified as a large fluid-filled cavity in place of the right pancreatic duct and involved the pancreatic and accessory pancreatic ducts. A small echoic cavity was observed in the left pancreatic lobe. Serous fluid was collected from the large cavity. On cytology, the small cavity was consistent with an abscess. A partial left pancreatectomy was performed to remove the abscess. The large cavity was excised with the remnant of the right pancreatic lobe and body. After ligation of the pancreatic ducts, the left pancreatic duct was isolated and an end-to-side pancreaticoduodenostomy was performed. RESULTS The cat recovered without complications. Histological examination was consistent with chronic pancreatitis and peripheral inflammation. No evidence of postoperative pancreatic insufficiency was detected on clinical examination or laboratory findings. A focal ampulla-like dilation of the pancreatic duct was noted on ultrasonography, with no other complications at the anastomosis. The cat presented 225 days postoperatively with respiratory distress. Multiple nodules were identified throughout the lung parenchyma on radiographs. Abnormalities on ultrasonographic examination included an enlarged liver infiltrated with nodules. Due to poor prognosis, the cat was euthanized. Final histopathological diagnosis was diffuse carcinoma. CONCLUSION Pancreaticoduodenostomy restored pancreaticointestinal continuity after extensive pancreatectomy involving the pancreatic ducts and resulted in long-term survival in the cat reported here.
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Affiliation(s)
- Benoît Cruciani
- Department of Surgery, Small Animal, Veterinary Hospital Frégis, Arcueil, France
| | - Chloé Touzet
- Department of Surgery, Small Animal, Veterinary Hospital Frégis, Arcueil, France
| | - Elisabeth Robin
- Department of Surgery, Small Animal, Veterinary Hospital Frégis, Arcueil, France
| | - Camille Bismuth
- Department of Surgery, Small Animal, Veterinary Hospital Frégis, Arcueil, France
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Xenoulis PG, Fracassi F. Feline Comorbidities: Clinical perspective on diabetes mellitus and pancreatitis. J Feline Med Surg 2022; 24:651-661. [PMID: 35775305 PMCID: PMC11107984 DOI: 10.1177/1098612x221106355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PRACTICAL RELEVANCE Diabetes mellitus (DM) is one of the most common feline endocrine disorders. It has been shown by several studies that DM in cats frequently coexists with pancreatitis. CLINICAL CHALLENGES It has not been definitively established what the exact pathogenetic association between DM and pancreatitis is in the cat. However, the association between these two conditions is most likely bidirectional, with DM predisposing cats to pancreatitis and vice versa. Diagnosis of pancreatitis in cats with DM is crucial because concurrent pancreatitis commonly leads to difficulties in the management of DM. When pancreatitis is associated with diabetic ketoacidosis (DKA), therapeutic management is even more challenging. AIMS This review focuses on the concurrent presence of DM or DKA and pancreatitis in cats, mainly focusing on their clinical management. EVIDENCE BASE Information provided in this review is based on feline-specific clinical research when available. In addition, comparative and human research, as well as clinical experience, has been used to enrich knowledge in areas where feline-specific research is not yet available.
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Affiliation(s)
- Panagiotis G Xenoulis
- Clinic of Medicine, Faculty of Veterinary Science, University of Thessaly, Karditsa, Greece
| | - Federico Fracassi
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
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Hammes K, Kook PH. Effects of medical history and clinical factors on serum lipase activity and ultrasonographic evidence of pancreatitis: Analysis of 234 dogs. J Vet Intern Med 2022; 36:935-946. [PMID: 35438226 PMCID: PMC9151483 DOI: 10.1111/jvim.16426] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 12/19/2022] Open
Abstract
Background Lipase measurements and ultrasonographic (US) evidence of pancreatitis correlate poorly. Objectives Identify explanations for discrepant lipase and pancreatic US results. Animals Two hundred and thirty‐four dogs with gastrointestinal signs. Methods A retrospective study was conducted, in which lipase activity and US were performed within 30 hours. Medical history, clinical examination results, lipase activity, and US results were recorded. Results Lipase and US results were weakly correlated (rs = .25, P < .001). At both evaluated time cut‐offs, median lipase activities were significantly higher with shorter durations of clinical signs before presentation (≤2 days, 334 U/L; >2 days, 118 U/L; P = .03; ≤7 days, 334 U/L; >7 days, 99 U/L; P = .004), but US was not significantly more frequently positive. For both cut‐offs (>216/≤216 U/L, >355/≤355 U/L; reference range, 24‐108 U/L), median disease duration was significantly shorter (3 vs 4 days) with higher lipases. Previous pancreatitis episodes were significantly associated with an US diagnosis of pancreatitis (P = .04), but median lipase activities were not significantly higher (386 U/L vs 153 U/L; P = .06) in these dogs. Pancreatic US was significantly more often positive when the request contained “suspicion of pancreatitis” (P < .001) or “increased lipase” (P = .01). Only changes in pancreatic morphology, echogenicity, and peripancreatic mesentery were significantly associated with a positive US diagnosis, and also had significantly higher lipase activities. Conclusions and Clinical Importance Duration of clinical signs before presentation differently affects laboratory and US evidence of pancreatitis. Previous pancreatitis episodes and information given to radiologists influence US results. These findings can be helpful for future studies on pancreatitis in dogs.
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Affiliation(s)
- Karen Hammes
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Peter H Kook
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Auger M, Fazio C, Steiner JM, Penninck DG, Levine GJ, Griffin JF, Springer CM. Abdominal ultrasound and clinicopathologic findings in 22 cats with exocrine pancreatic insufficiency. J Vet Intern Med 2021; 35:2652-2661. [PMID: 34596279 PMCID: PMC8692186 DOI: 10.1111/jvim.16267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/04/2021] [Accepted: 09/10/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Awareness of exocrine pancreatic insufficiency (EPI) in cats has increased since the development of an assay for feline trypsin-like immunoreactivity (fTLI). Ultrasound findings in cats with EPI have only been reported rarely and described as nonspecific. HYPOTHESIS/OBJECTIVES To describe the ultrasonographic findings, clinical signs, and concurrent diseases in cats with EPI. ANIMALS Twenty-two client-owned cats with EPI. METHODS Multicenter retrospective descriptive study including cats with serum fTLI concentration ≤8 μg/L and an abdominal ultrasound examination performed within 6 weeks of fTLI measurement. Sonographic measurements of maximal pancreatic thickness and maximal pancreatic duct diameter as well as ratios of pancreatic duct diameter to pancreatic thickness were obtained. Additional sonographic findings, concurrent conditions, and clinical signs were recorded. RESULTS The most common clinical sign was weight loss (15/22 cats). Chronic enteropathy was the most common concurrent disease (13/22 cats). In 39% of cats, the pancreas had minimal or no sonographic alterations. Pancreatic duct dilatation (>2.5 mm), pancreatic duct tortuosity with variable diameter, or both were seen in 6/13 cats. The pancreatic parenchyma was subjectively thin in 6 cats. A significant relationship was found between subjectively thin pancreatic parenchyma and increased pancreatic duct size : pancreatic thickness ratio (P = .004). Diffuse gastrointestinal dilatation with echogenic content was observed in 8/22 cats. CONCLUSION Exocrine pancreatic insufficiency often causes minimal to no sonographic pancreatic changes. Nonetheless, the findings of thin pancreatic parenchyma, pancreatic duct dilatation, or diffuse small intestinal dilatation with echogenic contents in cats with unexplained weight loss or unformed feces should raise clinical suspicion for EPI.
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Affiliation(s)
- Mylène Auger
- Animages, Longueuil, Quebec, Canada.,Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee, USA
| | - Constance Fazio
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee, USA
| | - Joerg M Steiner
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Dominique G Penninck
- Foster Hospital for Small Animals, Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Gwendolyn J Levine
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - John F Griffin
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Cary M Springer
- Research Computing Support, University of Tennessee, Knoxville, Tennessee, USA
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Gaitan-Cobo AL, Griffin LR, Kruckman-Gatesy CR. Use of stereotactic body radiation therapy for treatment of a pancreatic tumor in a cat. J Am Vet Med Assoc 2021; 259:184-189. [PMID: 34227865 DOI: 10.2460/javma.259.2.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 16-year old castrated male domestic shorthair cat was evaluated at a veterinary teaching hospital because of polyuria, polydipsia, and weight loss of 2 months' duration. CLINICAL FINDINGS Hematologic and biochemical examination results were within respective reference ranges except for moderately high pancreas-specific lipase concentration. Ultrasonographic and cytologic evaluation revealed a hepatic mass with findings consistent with mild cholestasis and inflammation and a pancreatic mass that was initially identified as a neuroendocrine tumor. TREATMENT AND OUTCOME The cat underwent additional CT assessment and stereotactic body radiation therapy (SBRT; 3 fractions of 8 Gy, administered every other day) for treatment of the pancreatic tumor. Follow-up ultrasonographic and CT examinations indicated a partial response to SBRT, with a maximum CT-measured size reduction from 3.6 × 4.8 × 4.0 cm at the time of treatment planning to 2.0 × 2.0 × 1.9 cm 8 months later. Increased pancreatic tumor size and signs of carcinomatosis were detected 15 months after SBRT treatment; the initial cytologic diagnosis was changed to exocrine pancreatic carcinoma on reevaluation of the slides by another veterinary pathologist. Carboplatin treatment was elected, and signs of carcinomatosis resolved. The cat was euthanized without further testing because of weakness 589 days after SBRT was started. CLINICAL RELEVANCE To the authors' knowledge, this is the first report of SBRT for suspected exocrine pancreatic carcinoma in a cat. Further investigation is needed to determine optimal fractionation schedules for SBRT of pancreatic tumors and utility of SBRT of exocrine pancreatic carcinoma in cats.
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Forman MA, Steiner JM, Armstrong PJ, Camus MS, Gaschen L, Hill SL, Mansfield CS, Steiger K. ACVIM consensus statement on pancreatitis in cats. J Vet Intern Med 2021; 35:703-723. [PMID: 33587762 PMCID: PMC7995362 DOI: 10.1111/jvim.16053] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022] Open
Abstract
Background Pancreatitis in cats, although commonly diagnosed, still presents many diagnostic and management challenges. Objective To summarize the current literature as it relates to etiology, pathogenesis, diagnosis, and management of pancreatitis in cats and to arrive at clinically relevant suggestions for veterinary clinicians that are based on evidence, and where such evidence is lacking, based on consensus of experts in the field. Animals None. Methods A panel of 8 experts in the field (5 internists, 1 radiologist, 1 clinical pathologist, and 1 anatomic pathologist), with support from a librarian, was formed to assess and summarize evidence in the peer reviewed literature and complement it with consensus clinical recommendations. Results There was little literature on the etiology and pathogenesis of spontaneous pancreatitis in cats, but there was much in the literature about the disease in humans, along with some experimental evidence in cats and nonfeline species. Most evidence was in the area of diagnosis of pancreatitis in cats, which was summarized carefully. In contrast, there was little evidence on the management of pancreatitis in cats. Conclusions and Clinical Importance Pancreatitis is amenable to antemortem diagnosis by integrating all clinical and diagnostic information available, and recognizing that acute pancreatitis is far easier to diagnose than chronic pancreatitis. Although both forms of pancreatitis can be managed successfully in many cats, management measures are far less clearly defined for chronic pancreatitis.
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Affiliation(s)
- Marnin A Forman
- Cornell University Veterinary Specialists, Stamford, Connecticut, USA
| | - Joerg M Steiner
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - P Jane Armstrong
- College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA
| | - Melinda S Camus
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Lorrie Gaschen
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Louisiana, USA
| | - Steve L Hill
- Flagstaff Veterinary Internal Medicine Consulting, Flagstaff, Arizona, USA
| | | | - Katja Steiger
- Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
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Černá P, Kilpatrick S, Gunn-Moore DA. Feline comorbidities: What do we really know about feline triaditis? J Feline Med Surg 2020; 22:1047-1067. [PMID: 33100169 PMCID: PMC10814216 DOI: 10.1177/1098612x20965831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PRACTICAL RELEVANCE Feline triaditis describes concurrent pancreatitis, cholangitis and inflammatory bowel disease (IBD). The reported prevalence is 17-39% in ill referral patients. While the aetiology is poorly understood, it is known to include infectious, autoimmune and physical components. What is not known is whether different organs are affected by different diseases, or the same process; indeed, triaditis may be part of a multiorgan inflammatory disease. Feline gastrointestinal tract anatomy plays its role too. Specifically, the short small intestine, high bacterial load and anatomic feature whereby the pancreatic duct joins the common bile duct before entering the duodenal papilla all increase the risk of bacterial reflux and parenchymal inflammation. Inflammation may also be a sequela of bowel bacterial translocation and systemic bacteraemia. DIAGNOSTIC CHALLENGES Cholangitis, pancreatitis and IBD manifest with overlapping, vague and non-specific clinical signs. Cholangitis may be accompanied by increased serum liver enzymes, total bilirubin and bile acid concentrations, and variable ultrasonographic changes. A presumptive diagnosis of pancreatitis is based on increased serum pancreatic lipase immunoreactivity or feline pancreas-specific lipase, and/or abnormal pancreatic changes on ultrasonography, though these tests have low sensitivity. Diagnosis of IBD is challenging without histopathology; ultrasound findings vary from normal to mucosal thickening or loss of layering. Triaditis may cause decreased serum folate or cobalamin (B12) concentrations due to intestinal disease and/or pancreatitis. Triaditis can only be confirmed with histopathology; hence, it remains a presumptive diagnosis in most cases. EVIDENCE BASE The literature on feline triaditis, pancreatitis, cholangitis and IBD is reviewed, focusing on histopathology, clinical significance and diagnostic challenges. Current management recommendations are provided. Further studies are needed to understand the complex pathophysiology, and in turn improve diagnosis and treatment.
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Affiliation(s)
- Petra Černá
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, and Small Animal Clinic, The University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | | | - Danielle A Gunn-Moore
- The Royal (Dick) School of Veterinary Studies, and The Roslin Institute, University of Edinburgh, UK
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Abstract
In recent years, increased awareness of feline pancreatitis by the veterinary profession and improved diagnostic modalities have led to an increased frequency of diagnosis of pancreatitis in this species. Consequently, pancreatic diseases, especially chronic pancreatitis, are considered highly prevalent, even in populations of apparently healthy individuals. This prevalence has led to the suspicion that the condition may be overdiagnosed. This article summarizes the difficulties of diagnosis of acute and chronic pancreatitis, assesses the reasons why this is a challenging disease to recognize, and considers whether these difficulties could result in either overdiagnosis or underdiagnosis.
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Lee C, Kathrani A, Maddison J. Retrospective study of the diagnostic utility of Spec fPLin the assessment of 274 sick cats. J Vet Intern Med 2020; 34:1406-1412. [PMID: 32452547 PMCID: PMC7379029 DOI: 10.1111/jvim.15797] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 04/17/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background Serum feline pancreatic lipase immunoreactivity (fPL) commonly is used in the assessment of sick cats suspected to have pancreatitis but its diagnostic utility is debated. Objectives To evaluate the diagnostic utility of the Spec fPL test and selected serum biochemistry tests in the diagnosis of pancreatitis in cats. Animals Two hundred seventy‐four client‐owned cats presented to a university teaching hospital in the United Kingdom, from April 2013 to May 2017, in which Spec fPL was measured. Methods Cats were classified into 1 of 4 groups based on clinical signs (all cats), ultrasonographic findings (all cats) and histopathological or cytological assessment of the pancreas where available (9 cats) regardless of Spec fPL concentration. The groups were (a) definite pancreatitis (n = 9), (b) probable pancreatitis (n = 49), (c) possible pancreatitis (n = 139), and (d) unlikely pancreatitis (n = 77). Spec fPL and selected serum biochemistry test results were compared among groups. Results Serum fPL concentrations >5.3 μg/L were classified as positive and concentrations <3.5 μg/L were classified as negative. There was a significantly (P = .03) lower proportion of false‐positive results (cats unlikely to have pancreatitis, n = 77, with a positive fPL, n = 8, 10%) than false‐negative results (cats with definite or probable pancreatitis, n = 58, with a negative fPL result, n = 14, 24%). None of the selected biochemical tests were helpful diagnostically. Conclusion and Clinical Importance A positive Spec fPL result indicates that pancreatitis is a probable diagnosis, but the test cannot be used to rule the diagnosis out.
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Affiliation(s)
- Cherrie Lee
- The Royal Veterinary College, Hatfield, United Kingdom
| | | | - Jill Maddison
- The Royal Veterinary College, Hatfield, United Kingdom
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14
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Chen H, Dunaevich A, Apfelbaum N, Kuzi S, Mazaki-Tovi M, Aroch I, Segev G. Acute on chronic kidney disease in cats: Etiology, clinical and clinicopathologic findings, prognostic markers, and outcome. J Vet Intern Med 2020; 34:1496-1506. [PMID: 32445217 PMCID: PMC7379052 DOI: 10.1111/jvim.15808] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 12/31/2022] Open
Abstract
Background Chronic kidney disease (CKD) and acute decompensation of CKD (ACKD) are common in cats. Objectives To characterize the etiology, clinical and clinicopathologic findings, and the short‐ and long‐term prognosis of feline ACKD. Animals One hundred cats with ACKD. Methods Retrospective study, search of medical records for cats with ACKD. Results Common clinical signs included anorexia (85%), lethargy (60%), weight loss (39%), and vomiting (27%). Suspected etiologies included ureteral obstruction (11%), renal ischemia (9%), pyelonephritis (8%), others (6%), or unknown (66%). Hospitalization duration was longer in survivors versus nonsurvivors (median = 7 days, range = 2‐26 versus median = 3 days, range = 2‐20, respectively, P < .001). The survival rate to discharge was 58%. Age, serum creatinine, urea, and phosphorous concentrations were higher and venous blood pH was lower in nonsurvivors. However, only serum phosphorus remained associated with the short‐term outcome in the multivariable model (P = .02; 95% confidence interval = 1.03‐1.39). Survivors had a median survival time of 66 days after discharge. Serum creatinine concentrations at presentation as well as at discharge were associated with long‐term survival (P < .002 for both). Conclusions The short‐term prognosis of ACKD is comparable to acute kidney injury, while the long‐term prognosis is guarded.
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Affiliation(s)
- Hilla Chen
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Asia Dunaevich
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Naama Apfelbaum
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Sharon Kuzi
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Michal Mazaki-Tovi
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Itamar Aroch
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Gilad Segev
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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15
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Berman CF, Lobetti RG, Lindquist E. Comparison of clinical findings in 293 dogs with suspect acute pancreatitis: Different clinical presentation with left lobe, right lobe or diffuse involvement of the pancreas. J S Afr Vet Assoc 2020; 91:e1-e10. [PMID: 32370532 PMCID: PMC7203193 DOI: 10.4102/jsava.v91i0.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/29/2019] [Accepted: 02/12/2020] [Indexed: 12/13/2022] Open
Abstract
Pancreatitis is a common clinical condition seen in companion animals. The correlation of the region of the pancreas affected to the presentation of clinical signs has not been previously described. A retrospective study on the clinical findings in 293 client-owned dogs diagnosed with suspect pancreatitis based on history, clinical signs, laboratory testing and abdominal ultrasonography was performed. Based on ultrasonography, dogs were divided into three groups: group 1: 41 dogs with ultrasonographic changes consistent with pancreatitis within the left lobe of the pancreas; group 2: 105 dogs with ultrasonographic changes compatible with pancreatitis within the right lobe of the pancreas; and group 3: 147 dogs with ultrasonographic evidence of diffuse pancreatitis. No significant differences regarding age, breed and sex were evident. Furthermore, statistical significance was demonstrated with the presence of pain in group 3; poor appetite in groups 2 and 3; and vomiting and diarrhoea in group 3. Pain is expected to occur with a higher frequency in diffuse pancreatitis, but it is not a common clinical sign. This may represent a more severe form of the disease when the pancreas is diffusely affected. Vomiting was more common than diarrhoea with both clinical signs more prevalent in dogs with diffuse pancreatitis, and this could be ascribed to gastric and intestinal tract involvement. Poor appetite occurred more frequently in dogs with diffuse and right lobe pancreatitis. A possible explanation can be attributed to the fact that the duodenum has many receptors and is referred to as the 'organ of nausea'.
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Affiliation(s)
- Chad F Berman
- Bryanston Veterinary Hospital, Johannesburg, South Africa; and, Department of Companion Animal and Clinical Studies, Onderstepoort.
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16
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Abstract
PRACTICAL RELEVANCE Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the pancreas is a vital part of the investigation into feline pancreatic disease. CLINICAL CHALLENGES Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings such as nodular hyperplasia and pathological changes such as neoplasia can be challenging. AIM This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination and appearance of the normal and diseased pancreas. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. EQUIPMENT Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience. EVIDENCE BASE Information provided in this article is drawn from the published literature and the author's own clinical experience.
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Affiliation(s)
- Sally Griffin
- Radiology Department, Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull B90 4NH, UK
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17
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Palermo SM, Newman AW, Koch MW. Candida albicans cholecystitis with associated hepatitis in a cat. JFMS Open Rep 2019; 5:2055116919854165. [PMID: 31218075 PMCID: PMC6563395 DOI: 10.1177/2055116919854165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Case summary A 3-year-old male neutered domestic shorthair cat was presented for vomiting, inappetence and icterus. Biochemical results and ultrasonographic findings were consistent with cholestasis and possible biliary obstruction. A diagnosis of Candida albicans cholecystitis with associated hepatitis was made following cytologic examination and fungal culture. Progressive hyperbilirubinemia and hepatic encephalopathy were ultimately fatal. Relevance and novel information To our knowledge, this is the first report of biliary candidiasis diagnosed by cytologic examination of a cholecystocentesis sample in a domestic animal with no evidence of immunodeficiency. Additionally, this is the first reported case of fungal cholecystitis with associated white bile syndrome due to obstructive cholestasis, without an overt gall bladder mucocele.
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Affiliation(s)
| | | | - Michael W Koch
- Veterinary Specialists and Emergency Services, Rochester, NY, USA
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Nivy R, Kaplanov A, Kuzi S, Mazaki-Tovi M, Yas E, Segev G, Ben-Oz J, Lavy E, Aroch I. A retrospective study of 157 hospitalized cats with pancreatitis in a tertiary care center: Clinical, imaging and laboratory findings, potential prognostic markers and outcome. J Vet Intern Med 2018; 32:1874-1885. [PMID: 30315665 PMCID: PMC6271303 DOI: 10.1111/jvim.15317] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 08/03/2018] [Accepted: 08/09/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pancreatitis in cats (FP) has been increasingly diagnosed in recent years, but clinical studies of large numbers of affected cats are scarce. OBJECTIVES To describe a large cohort of cats with FP requiring hospitalization. ANIMALS One hundred and fifty-seven client-owned cats. METHODS Retrospective study, including cats diagnosed with pancreatitis based on sonographic evidence, positive SNAP feline pancreatic lipase immunoreactivity test results, increased 1,2-o-dilauryl-rac-glycerol-glutaric Acid-(6'-methylresorufin ester)-lipase activity, histopathology, or some combination of these. RESULTS One-hundred and twenty-two cats (77.7%) survived to discharge. Median time from onset of clinical signs to presentation was longer (P = .003) in nonsurvivors. Causes of FP included recent general anesthesia, trauma, hemodynamic compromise, and organophosphate intoxication, but most cases (86.6%) were idiopathic. Ultrasonographic findings consistent with pancreatitis were documented in 134 cats, including pancreatomegaly (81.3%), decreased (31.3%), or increased (14.9%) pancreatic echogenicity, extra-hepatic biliary tract dilatation (24%), and increased peri-pancreatic echogenicity (13%). Lethargy (P = .003), pleural effusion (P = .003), hypoglycemia (P = .007), ionized hypocalcemia (P = .016), azotemia (P = .014), parenteral nutrition administration (P = .013), and persistent anorexia during hospitalization (P = .001) were more frequent in nonsurvivors, whereas antibiotics were more frequently administered to survivors (P = .023). Nevertheless, when Bonferroni's correction for multiple comparisons was applied, none of the variables was statistically significant. CONCLUSIONS AND CLINICAL IMPORTANCE Previously unreported, clinically relevant, potential prognostic factors, including hypoglycemia, azotemia, parenteral nutrition, and withholding antibacterial treatment were identified in this exploratory study. These preliminary results should be examined further in confirmatory studies.
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Affiliation(s)
- Ran Nivy
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Alina Kaplanov
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Sharon Kuzi
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Michal Mazaki-Tovi
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Einat Yas
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Gilad Segev
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Jennifer Ben-Oz
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Eran Lavy
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Itamar Aroch
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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19
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Abstract
OBJECTIVES Pancreatitis is a frequent disease in cats for which the ante-mortem diagnosis remains challenging. Feline pancreatic lipase immunoreactivity (fPLI) has been reported to have a high sensitivity for the diagnosis of pancreatitis. The aim of this study was to compare the rapid in-house test SNAP fPL with the standard test Spec fPL and to evaluate the use of SNAP fPL to diagnose pancreatitis in an emergency setting. METHODS fPLI of 111 cats with a clinical suspicion of pancreatitis was measured with both SNAP fPL and Spec fPL. Furthermore, clinical signs, haematological and biochemical changes, and abdominal ultrasound findings were recorded. RESULTS Seventy-eight of 111 cats (70.3%) were tested below the cut-off level for pancreatitis with SNAP, as well as Spec fPL, whereas 21/111 (18.9%) were tested with values above the cut-off level with both tests. In 12/111 (10.8%) cats the results were discordant. The comparison of both tests revealed an agreement of 78/80 (97.5%) when Spec fPL was ⩽3.5 μg/l (negative) and 18/20 (90%) when Spec fPL was ⩾5.4 μg/l (positive). The most common clinical signs in cats with suspected pancreatitis (n = 21) were lethargy (95.2%), reduced appetite and vomiting (90.5% each), dehydration (81.0%), diarrhoea (57.1%), abdominal pain and weight loss (47.6% each). Hyperglycaemia and hyperbilirubinaemia (85.7% each), increased aspartate transaminase (76.2%) and alanine transaminase (47.6%), leucocytosis (61.9%), lymphopenia (57.1%), decreased sodium and chloride (57.1% each), and increased urea (52.4%) were the most common abnormalities in blood work. CONCLUSIONS AND RELEVANCE Clinical signs, as well as routine blood-work changes, were non-specific and thus proved to be insufficient to diagnose pancreatitis. The combination of SNAP fPL and subsequent Spec fPL, if indicated, provided the opportunity to rule out or to diagnose pancreatitis with a higher certainty than previously known test methods. This study proved SNAP fPL to be a valuable tool to exclude or include pancreatitis in an emergency setting.
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Affiliation(s)
- Fanny Schnauß
- 1 Small Animal Clinic, Division of Small Animal Internal Medicine, University of Leipzig, Leipzig, Germany
| | - Franziska Hanisch
- 1 Small Animal Clinic, Division of Small Animal Internal Medicine, University of Leipzig, Leipzig, Germany
| | - Iwan Anton Burgener
- 2 Department of Small Animals and Horses, Division of Small Animal Internal Medicine, VetMedUni Vienna, Vienna, Austria
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Köster LS, Shell L, Ketzis J, Rajeev S, Illanes O. Diagnosis of pancreatic disease in feline platynosomosis. J Feline Med Surg 2017; 19:1192-1198. [PMID: 28094661 PMCID: PMC11104183 DOI: 10.1177/1098612x16685676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives Platynosomum species are cat-specific parasitic trematodes that parasitize the biliary ducts and gall bladder. Due to the common connection to the major duodenal papilla of the pancreas and common bile ducts in addition to the periductal proximity of the pancreas, it is possible that platynosomosis could cause pancreatitis. The objective of this study was to determine whether platynosomosis, a commonly diagnosed parasitic disease in cats on St Kitts, has any association with pancreatic disease. Methods To investigate this possibility, the pancreas of free-roaming cats with naturally acquired platynosomosis were evaluated via ultrasound, serum concentrations of feline pancreatic lipase (fPL), cobalamin, folate and feline trypsin-like immunoreactivity (fTLI) and histopathology. Twenty free-roaming, young adult, feral cats, positive for feline immunodeficiency virus, and diagnosed with Platynosomum species infection via fecal analysis were recruited. The liver, biliary system and pancreas were evaluated via ultrasonography during a short duration anesthesia. Serum concentrations of fPL, fTLI, folate and cobalamin were measured. Sections of the right limb, left limb and body of the pancreas were evaluated histopathologically using hematoxylin and eosin (H&E) stain. Results None of the cats had sufficient criteria to fulfill the ultrasonographic diagnosis of pancreatitis. One cat had an elevated fPL concentration in the range consistent with pancreatitis. Four cats had cobalamin deficiencies and 11 had abnormal folate concentration. The fTLI concentration was equivocal for the diagnosis of exocrine pancreatic insufficiency in one cat. With a single exception, histopathology changes, when present (n = 12), were mild, non-specific and predominantly characterized by lymphocytic infiltrates and fibrosis. The exception was a cat that presented a chronic interstitial and eosinophilic pancreatitis of slightly increased severity, likely the result of platynosomosis. Conclusions and relevance The results of this study suggest that platynosomosis rarely induces pancreatic damage in cats. With only one exception, chronic pancreatitis diagnosed in cats with fluke-induced cholangitis and cholangiohepatitis was subtle and interpreted as an incidental background lesion unrelated to platynosomosis.
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Affiliation(s)
- Liza S Köster
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, West Indies
- Current address: School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Linda Shell
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, West Indies
| | - Jennifer Ketzis
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, West Indies
| | - Sreekumari Rajeev
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, West Indies
| | - Oscar Illanes
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, West Indies
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21
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Kuzi S, Segev G, Kedar S, Yas E, Aroch I. Prognostic markers in feline hepatic lipidosis: a retrospective study of 71 cats. Vet Rec 2017; 181:512. [PMID: 28978714 DOI: 10.1136/vr.104252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 06/24/2017] [Accepted: 08/13/2017] [Indexed: 11/04/2022]
Abstract
Feline hepatic lipidosis (HL) is a common, potentially life-threatening disease resulting from prolonged anorexia and increased catabolism. This retrospective study included cats diagnosed with HL based on liver cytology or histopathology (years 2004-2015), and aimed to identify clinical and laboratory parameters associated with mortality. The study included 71 cats (47 females and 24 males) and 85 control cats with non-HL diseases. Most HL cats (90 per cent) were mixed breed, neutered (70; 99 per cent), female (47; 66 per cent), indoor cats (56; 79 per cent), fed dry commercial diets (44 cats; 62 per cent), and with a median age of 7.5 years (range 1.5-16.0). Common primary conditions included gastrointestinal diseases, pancreatitis and cholangiohepatitis (31 cats; 44 per cent) and stressful events (14; 20 per cent). HL was idiopathic in 20 cats (28 per cent). The overall mortality was 38 per cent (27/71 cats). Older age, as well as dullness, weakness, ptyalism, hypoproteinaemia, hypoalbuminaemia, increased serum creatine kinase activity, hypocholesterolaemia and hepatic failure at presentation were significantly (P≤0.033) associated with mortality. The primary disease was unassociated with mortality. Worsening hypoalbuminaemia, hyperammonaemia, hyperbilirubinaemia, electrolyte disorders, and occurrence of cavitary effusions or hypotension during hospitalisation were significantly (P≤0.045) associated with mortality. A decrease of serum β-hydroxybutyrate during hospitalisation was significantly (P=0.01) associated with survival, likely reflecting improvement in the catabolic state. The identified risk factors may be therapeutic targets.
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Affiliation(s)
- Sharon Kuzi
- Koret School of Veterinary Medicine, Hebrew University Veterinary Teaching Hospital, Hebrew University of Jerusalem, Rehovot, Israel
| | - Gilad Segev
- Koret School of Veterinary Medicine, Hebrew University Veterinary Teaching Hospital, Hebrew University of Jerusalem, Rehovot, Israel
| | - Shay Kedar
- Koret School of Veterinary Medicine, Hebrew University Veterinary Teaching Hospital, Hebrew University of Jerusalem, Rehovot, Israel
| | - Einat Yas
- Koret School of Veterinary Medicine, Hebrew University Veterinary Teaching Hospital, Hebrew University of Jerusalem, Rehovot, Israel
| | - Itamar Aroch
- Koret School of Veterinary Medicine, Hebrew University Veterinary Teaching Hospital, Hebrew University of Jerusalem, Rehovot, Israel
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Cambournac M, Goy-Thollot I, Violé A, Boisvineau C, Pouzot-Nevoret C, Barthélemy A. Sonographic assessment of volaemia: development and validation of a new method in dogs. J Small Anim Pract 2017; 59:174-182. [PMID: 28960319 DOI: 10.1111/jsap.12759] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/11/2017] [Accepted: 06/20/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aims of this study were to describe a method for the sonographic assessment of volaemia, to determinate inter- and intra-operator variability and to assess the ability to detect blood loss after blood donation in healthy dogs. MATERIALS AND METHODS The left kidney was identified in a spleno-renal view, and transverse views of the caudal vena cava and aorta were obtained in 12 dogs. Vessel diameters were measured in B-mode, in duplicate by two operators, and the caudal vena cava:aorta ratio was calculated. Intra- and inter-operator variabilities were assessed using a Bland-Altman method by plotting the differences between the repeated measurements obtained from the same subject by the same operator and by the two operators against their means. Before and after blood donation measurements were compared using paired t-tests or one-sample t-tests, if appropriate. RESULTS Intra- and inter-operator variability was within the limit of agreement for the vast majority of measurements. After a blood donation of 9·8 ±2·2 mL/kg, the mean aorta measurements were not significantly different from those obtained before blood donation (1·11 versus 1·10, P=0·28), whereas the mean caudal vena cava measurements and caudal vena cava:aorta ratios were significantly lower (1·28 versus 1·01, P<0·0001; 1·17 versus 1·01, P=0·0001, respectively). CLINICAL SIGNIFICANCE The low intra- and inter-operator variabilities in the caudal vena cava, aorta and caudal vena cava:aorta ratio measurements support their reliability and operator independency. The sonographic assessment of volaemia appears to be a promising non-invasive, repeatable point-of-care ultrasound protocol for assessment and monitoring of blood loss. Further studies are needed to assess the sonographic assessment of volaemia protocol in spontaneously bleeding dogs.
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Affiliation(s)
- M Cambournac
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, APCSe, F-69280, Marcy l'Etoile, France
| | - I Goy-Thollot
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, APCSe, F-69280, Marcy l'Etoile, France
| | - A Violé
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, APCSe, F-69280, Marcy l'Etoile, France
| | - C Boisvineau
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, APCSe, F-69280, Marcy l'Etoile, France
| | - C Pouzot-Nevoret
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, APCSe, F-69280, Marcy l'Etoile, France
| | - A Barthélemy
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, APCSe, F-69280, Marcy l'Etoile, France
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23
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Zoia A, Drigo M. Association Between Pancreatitis and Immune-mediated Haemolytic Anaemia in Cats: A Cross-sectional Study. J Comp Pathol 2017; 156:384-388. [DOI: 10.1016/j.jcpa.2017.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/09/2017] [Accepted: 02/11/2017] [Indexed: 11/27/2022]
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24
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Fragkou FC, Adamama-Moraitou KK, Poutahidis T, Prassinos NN, Kritsepi-Konstantinou M, Xenoulis PG, Steiner JM, Lidbury JA, Suchodolski JS, Rallis TS. Prevalence and Clinicopathological Features of Triaditis in a Prospective Case Series of Symptomatic and Asymptomatic Cats. J Vet Intern Med 2016; 30:1031-45. [PMID: 27296565 PMCID: PMC5089651 DOI: 10.1111/jvim.14356] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/26/2016] [Accepted: 05/16/2016] [Indexed: 12/25/2022] Open
Abstract
Background The term triaditis designates the concurrent presence of idiopathic inflammatory bowel disease (IBD), cholangitis, and pancreatitis in cats. Hypothesis/Objectives The histopathology of concurrent, but often subclinical, inflammatory processes in the small intestine, liver, and pancreas of cats is poorly described. We aimed to investigate the frequency of enteritis, cholangitis, pancreatitis, or some combination of these in symptomatic and asymptomatic cats, compare clinicopathological features, and correlate histopathological with laboratory findings. Animals Domestic cats (27 symptomatic, 20 asymptomatic, and 8 normal). Methods Prospective study. Physical examination, laboratory variables (CBC, serum biochemistry profile, serum thyroxine concentration, serum feline trypsin‐like immunoreactivity [fTLI], feline lipase immunoreactivity [fPLI, as measured by Spec fPL®], urinalysis, and fecal analysis), imaging, and histopathological examinations were conducted. Feline liver, pancreas, and small intestine were biopsied during laparotomy. Results Inflammatory lesions were detected in 47 cats (27 symptomatic, 20 asymptomatic). In total, 20 cats had histopathologic lesions of IBD (13/47, 27.7%), cholangitis (6/47, 12.8%), or pancreatitis (1/47, 2.1%) alone, or inflammation involving >1 organ (27/47, 57.4%). More specifically, 16/47 cats (34.0%) had concurrent lesions of IBD and cholangitis, 3/47 (6.4%) of IBD and pancreatitis, and 8/47 cats (17%) of triaditis. Triaditis was identified only in symptomatic cats (8/27, 29.6%). A mild, positive correlation was detected between the severity (score) of IBD lesions and the number of comorbidities (rho = +0.367, P = .022). Conclusions and Clinical Importance Histopathological evidence of IBD or IBD with comorbidities was detected in both symptomatic and asymptomatic cats. The possibility of triaditis should be considered in symptomatic cats with severe IBD.
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Affiliation(s)
- F C Fragkou
- Medicine Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K K Adamama-Moraitou
- Medicine Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - T Poutahidis
- Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N N Prassinos
- Surgery and Obstetrics Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M Kritsepi-Konstantinou
- Diagnostic Laboratory, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P G Xenoulis
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX, USA
| | - J M Steiner
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX, USA
| | - J A Lidbury
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX, USA
| | - J S Suchodolski
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX, USA
| | - T S Rallis
- Medicine Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ultrasound Imaging of the Hepatobiliary System and Pancreas. Vet Clin North Am Small Anim Pract 2016; 46:453-80, v-vi. [DOI: 10.1016/j.cvsm.2015.12.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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26
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Oppliger S, Hilbe M, Hartnack S, Zini E, Reusch CE, Kook PH. Comparison of Serum Spec fPL(™) and 1,2-o-Dilauryl-Rac-Glycero-3-Glutaric Acid-(6'-Methylresorufin) Ester Assay in 60 Cats Using Standardized Assessment of Pancreatic Histology. J Vet Intern Med 2016; 30:764-70. [PMID: 26968865 PMCID: PMC4913568 DOI: 10.1111/jvim.13924] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 01/11/2016] [Accepted: 02/18/2016] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Feline pancreas-specific lipase (Spec fPL) is considered a useful test for the antemortem diagnosis of pancreatitis in cats. A recent study found good agreement between the results of the Spec fPL and catalytic 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester (DGGR) lipase assay. Prospective studies evaluating their sensitivity and specificity are lacking. OBJECTIVES To compare the results of the Spec fPL and the DGGR assays with a standardized histologic assessment of the pancreas. ANIMALS Sixty client-owned cats presented for necropsy. METHODS PROSPECTIVE STUDY Spec fPL concentrations and serum DGGR lipase activity were measured from the same blood sample. The pancreas was removed within 3 hours after euthanasia; serial transverse sections were made every 0.5 cm throughout the entire pancreas and reviewed using a histologic grading scheme. Sensitivity and specificity for the Spec fPL and DGGR assay results were determined. RESULTS The sensitivity and specificity for the Spec fPL assay (cutoff value ≥5.4 μg/L) was 42.1 [95% confidence interval (95% CI), 29.4-55.9%] and 100% (95% CI, 31.0-100.0%). The sensitivity and specificity for the DGGR assay (cutoff value >26 U/L) was 36.8 (95% CI, 24.7-50.7%) and 100% (95% CI, 31.0-100.0%). When lymphocytic inflammation up to 10% of a section was considered normal, the sensitivity and specificity for Spec fPL assay (cutoff value ≥5.4 μg/L) was 61.1 (95% CI, 36.1-81.7%) and 69.0% (95% CI, 52.8-81.9%) and the sensitivity and specificity for the DGGR assay (cutoff value >26 U/L) was 66.7 (95% CI, 41.2-85.6%) and 78.6% (95% CI, 62.8-89.2%). CONCLUSIONS AND CLINICAL IMPORTANCE Both lipase assays performed similarly well, but their agreement with histologic pancreatic inflammation was limited.
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Affiliation(s)
- S Oppliger
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - M Hilbe
- Institute for Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - S Hartnack
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - E Zini
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Department of Animal Medicine, Production and Health, University of Padova, Legnaro, PD, Italy.,Istituto Veterinario di Novara, Granozzo con Monticello, NO, Italy
| | - C E Reusch
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - P H Kook
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Crain SK, Sharkey LC, Cordner AP, Knudson C, Armstrong PJ. Safety of ultrasound-guided fine-needle aspiration of the feline pancreas: a case-control study. J Feline Med Surg 2015; 17:858-63. [PMID: 25371007 PMCID: PMC11112200 DOI: 10.1177/1098612x14557910] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
The safety of fine-needle aspiration (FNA) of the feline pancreas has not been reported. The incidence of complications following ultrasound-guided pancreatic FNA in 73 cats (pancreatic aspirate [PA] cats) with clinical and ultrasonographic evidence of pancreatic disease was compared with complications in two groups of matched control cats also diagnosed with pancreatic disease that either had abdominal organs other than the pancreas aspirated (control FNA, n = 63) or no aspirates performed (control no FNA, n = 61). The complication rate within 48 h of the ultrasound and/or aspirate procedure did not differ among the PA cats (11%), control FNA (14%) or control no FNA (8%) cats. There was no difference in rate of survival to discharge (82%, 84% and 83%, respectively) or length of hospital stay among groups. The cytologic recovery rate for the pancreatic samples was 67%. Correlation with histopathology, available in seven cases, was 86%. Pancreatic FNA in cats is a safe procedure requiring further investigation to establish diagnostic value.
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Affiliation(s)
- Sarah K Crain
- Tufts University Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Leslie C Sharkey
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, St Paul, MN, USA
| | | | | | - P Jane Armstrong
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, St Paul, MN, USA
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28
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Xenoulis PG. Diagnosis of pancreatitis in dogs and cats. J Small Anim Pract 2015; 56:13-26. [PMID: 25586803 DOI: 10.1111/jsap.12274] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 04/13/2014] [Accepted: 06/09/2014] [Indexed: 12/23/2022]
Abstract
Pancreatitis is the most common disorder of the exocrine pancreas in both dogs and cats. Ante-mortem diagnosis of canine and feline pancreatitis can be challenging. The clinical picture of dogs and cats with pancreatitis varies greatly (from very mild to severe or even fatal) and is characterised by non-specific findings. Complete blood count, serum biochemistry profile and urinalysis should always be performed in dogs and cats suspected of having pancreatitis, although findings are not-specific for pancreatitis. Serum amylase and lipase activities and trypsin-like immunoreactivity (TLI) concentrations have no or only limited clinical value for the diagnosis of pancreatitis in either dogs or cats. Conversely, serum pancreatic lipase immunoreactivity (PLI) concentration is currently considered to be the clinicopathological test of choice for the diagnosis of canine and feline pancreatitis. Abdominal radiography is a useful diagnostic tool for the exclusion of other diseases that may cause similar clinical signs to those of pancreatitis. Abdominal ultrasonography can be very useful for the diagnosis of pancreatitis, but this depends largely on the clinician's experience. Histopathological examination of the pancreas is considered the gold standard for the diagnosis and classification of pancreatitis, but it is not without limitations. In clinical practice, a combination of careful evaluation of the animal's history, serum PLI concentration and abdominal ultrasonography, together with pancreatic cytology or histopathology when indicated or possible, is considered to be the most practical and reliable means for an accurate diagnosis or exclusion of pancreatitis compared with other diagnostic modalities.
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Affiliation(s)
- P G Xenoulis
- Clinic of Medicine, Faculty of Veterinary Medicine, University of Thessaly, Karditsa 43100, Greece; Animal Medical Center of Athens, Athens, Greece
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Lee M, Kang JH, Chang D, Na KJ, Yang MP. Pancreatic Abscess in a Cat with Diabetes Mellitus. J Am Anim Hosp Assoc 2015; 51:180-4. [DOI: 10.5326/jaaha-ms-6122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An 11 yr old spayed female Maine coon cat was referred with uncontrolled diabetes mellitus. The cat had a 2 mo history of weight loss and intermittent vomiting. An abdominal ultrasound identified the presence of a large cavity measuring a maximum of 4.6 cm in the pancreas that was filled with a homogeneous echogenic fluid. Cytological analysis and culture of the fluid obtained from the pancreatic mass indicated the presence of a bacterial abscess. The application of nonsurgical drainage and the administration of glargine insulin and antibiotics resolved the clinical signs. The size of the pancreatic abscess was reduced after 5 mo, and the cat achieved diabetic remission and remained healthy at the time this report was prepared. This case report describes the successful treatment of a pancreatic bacterial abscess concurrent with diabetes mellitus in a Maine coon cat.
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Affiliation(s)
- Minji Lee
- From the Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Ji-Houn Kang
- From the Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Dongwoo Chang
- From the Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Ki-Jeong Na
- From the Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Mhan-Pyo Yang
- From the Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
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Diana A, Linta N, Cipone M, Fedone V, Steiner JM, Fracassi F, Grandis A, Baron Toaldo M. Contrast-enhanced ultrasonography of the pancreas in healthy cats. BMC Vet Res 2015; 11:64. [PMID: 25879918 PMCID: PMC4367928 DOI: 10.1186/s12917-015-0380-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/27/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study describes the pattern of ultrasonographic contrast enhancement of the pancreatic body and left lobe using a second-generation commercial contrast medium (Sonovue) in 10 clinically healthy cats. RESULTS Following contrast medium administration, microbubbles were observed within the splenic artery. This was followed by an inflow of contrast medium into the pancreatic capillary beds, providing a uniformly contrast-enhanced pancreas at peak intensity (PI). At the time of PI, a replenishment of the splenic and portal veins started and increased progressively during the wash-out phase. During the wash-out phase, the echogenicity of the pancreatic parenchyma decreased progressively. Perfusion parameters included arrival time (4.69 ± 1.26 s), time to peak from injection (7.52 ± 1.88 s), time to peak from initial rise (2.84 ± 0.88 s), peak intensity (6.58 ± 2.66 a.u.), and wash-in rate (2.11 ± 1.79 a.u./s). CONCLUSIONS This perfusion pattern of normal pancreatic parenchyma may be useful for characterising cats with exocrine pancreatic disorders.
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Affiliation(s)
- Alessia Diana
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Via Tolara di Sopra 50, I-40064, Ozzano Emilia, Bologna, Italy.
| | - Nikolina Linta
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Via Tolara di Sopra 50, I-40064, Ozzano Emilia, Bologna, Italy.
| | - Mario Cipone
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Via Tolara di Sopra 50, I-40064, Ozzano Emilia, Bologna, Italy.
| | | | - Joerg M Steiner
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA.
| | - Federico Fracassi
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Via Tolara di Sopra 50, I-40064, Ozzano Emilia, Bologna, Italy.
| | - Annamaria Grandis
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Via Tolara di Sopra 50, I-40064, Ozzano Emilia, Bologna, Italy.
| | - Marco Baron Toaldo
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Via Tolara di Sopra 50, I-40064, Ozzano Emilia, Bologna, Italy.
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Makara M, Chau J, Hall E, Kloeppel H, Podadera J, Barrs V. EFFECTS OF TWO CONTRAST INJECTION PROTOCOLS ON FELINE AORTIC AND HEPATIC ENHANCEMENT USING DYNAMIC COMPUTED TOMOGRAPHY. Vet Radiol Ultrasound 2015; 56:367-73. [PMID: 25640846 DOI: 10.1111/vru.12239] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 11/19/2014] [Indexed: 11/28/2022] Open
Abstract
This prospective study compared aortic and hepatic enhancement achieved using a contrast injection protocol with a fixed rate of 5 ml/s vs. that achieved using a protocol with fixed injection duration of 20 s in eight cats. Cats were assigned into two groups (Group 1, rate 5 ml/s; Group 2, duration 20 s). The dose of contrast was the same in both groups (740 mgI/kg). Regions of interest (ROI) were drawn in the aorta and liver for transverse scans acquired at the hepatic hilus. Time to peak aortic enhancement occurred significantly earlier in Group 1 (M = 11s, SD = 1.63) than in Group 2 (M = 25.5 s, SD = 2.51). Peak aortic enhancement was significantly higher in Group 1 (M = 1906.51 HU, SD = 368.64) than in Group 2 (M = 745.08 HU, SD = 201.84). Duration of aortic enhancement equal to or above 300 HU was statistically longer in Group 2 (M = 24.5 s, SD = 8.39) than in Group 1 (M = 10 s, SD = 1.63). There were no significant differences in time to peak liver enhancement, peak liver enhancement, or duration of hepatic arterial phase between groups. Findings supported the hypothesis that longer injection duration results in a broader bolus geometry with a longer time to peak and a lower peak aortic enhancement in cat. This strong influence of injection duration on timing of aortic enhancement may help future users optimize protocols for CT angiography of the aorta and multiphasic evaluation of the liver, pancreas, and small intestine.
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Affiliation(s)
- Mariano Makara
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Jennifer Chau
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Evelyn Hall
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Heide Kloeppel
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Juan Podadera
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Vanessa Barrs
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
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32
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Simpson KW. Pancreatitis and triaditis in cats: causes and treatment. J Small Anim Pract 2015; 56:40-9. [DOI: 10.1111/jsap.12313] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 09/12/2014] [Accepted: 10/28/2014] [Indexed: 01/16/2023]
Affiliation(s)
- K. W. Simpson
- College of Veterinary Medicine; Cornell University; Ithaca NY 14850 USA
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33
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Stockhaus C, Teske E, Schellenberger K, Huisinga E, Konietschke U, Mangelsdorf S, Steiner JM. Serial serum feline pancreatic lipase immunoreactivity concentrations and prognostic variables in 33 cats with pancreatitis. J Am Vet Med Assoc 2014; 243:1713-8. [PMID: 24299542 DOI: 10.2460/javma.243.12.1713] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify factors significantly associated with prognosis in cats hospitalized because of pancreatitis. DESIGN Prospective case series. Animals-33 cats hospitalized for treatment of pancreatitis (diagnosis determined on the basis of clinical signs and serum feline pancreatic lipase immunoreactivity [fPLI] concentration ≥ 5.4 μg/L). PROCEDURES Cats were hospitalized (day 1) for 2 to 16 days and observed for 44 days or until they died or were euthanized. Results of physical examination and hematologic and serum biochemical analysis, including measurement of serum fPLI concentration, performed on the day of hospital admission were analyzed to determine whether they were associated with outcome (ie, survival to at least 44 days vs death or euthanasia). RESULTS On day 1, mean × SD serum fPLI concentration among the 33 cats was 22.0 × 16.4 μg/L. Mean age of the cats was 12.7 × 3.8 years (range, 4 to 19 years). Eleven of the 33 (33%) cats died or were euthanized before day 44. In univariate analyses, dyspnea, hypothermia, hypokalemia, hyperkalemia, and serum fPLI concentration were significantly associated with an adverse outcome. However, in a multivariate analysis, only severe dyspnea, hyperkalemia (potassium concentration > 5.5 mmol/L), and serum fPLI concentration at the time of hospital admission were found to be significantly associated with an adverse outcome. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that dyspnea, hyperkalemia, and serum fPLI concentration at the time of hospital admission were significant prognostic factors for cats hospitalized because of pancreatitis.
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Kim HW, Oh YI, Choi JH, Kim DY, Youn HY. Use of laparoscopy for diagnosing experimentally induced acute pancreatitis in dogs. J Vet Sci 2014; 15:551-6. [PMID: 24962411 PMCID: PMC4269598 DOI: 10.4142/jvs.2014.15.4.551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 06/19/2014] [Indexed: 11/20/2022] Open
Abstract
Diagnosis of acute pancreatitis in dogs remains a significant challenge despite the development of advanced diagnostic methodologies. Visual inspection and pancreas biopsy using laparoscopy are generally considered to be procedures free of complications when conducted on healthy animals. However, the usefulness of laparoscopy for diagnosing acute pancreatitis has not been assessed. In the present study, the efficacy of laparoscopy for diagnosing acute pancreatitis in dogs was evaluated in animals with experimentally induced acute pancreatitis. Gross appearance of the pancreatic area was examined by laparoscopy to survey for the presence of edema, adhesions, effusion, pseudocysts, hemorrhage, and fat necrosis. Laparoscopic biopsy was performed and the histopathologic results were compared to those of pancreatic samples obtained during necropsy. The correlation between laparoscopy and histopathologic findings of the pancreas was evaluated. The presence of adhesions, effusion, and hemorrhage in the pancreatic area observed by laparoscopy significantly correlated with the histopathologic results (p < 0.05). There was no significant relationship between the histopathologic and laparoscopic biopsy findings. Results of this study suggested that laparoscopic evaluation of gross lesions has clinical significance although the laparoscopic biopsy technique has some limitations. This method combined with additional diagnostic tools can be effective for diagnosing acute pancreatitis in dogs.
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Affiliation(s)
- Hyun-wook Kim
- Haemaru Referral Animal Hospital, Seongnam 463-050, Korea
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35
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Abstract
PRACTICAL RELEVANCE Pancreatitis is a frequent finding in cats, the chronic form being more common than the acute form. Despite the large number of diseases or conditions that may be associated with feline pancreatitis, in most cases no cause is diagnosed and the pancreatitis is said to be idiopathic. The chronic form can be mild and asymptomatic, and has a high prevalence in apparently healthy cats. This has generated debate concerning the clinical significance of chronic feline pancreatitis. However, several reports have demonstrated the severity of clinical signs in certain forms of acute feline pancreatitis, while other studies have reported a strong association between chronic pancreatitis and the development of comorbidities such as hepatic lipidosis, diabetes mellitus, inflammatory bowel disease or exocrine pancreatic insufficiency. This suggests that feline pancreatitis should not be overlooked. CLINICAL CHALLENGES Diagnosis of feline pancreatitis is complicated by the non-specific clinical signs and poor diagnostic value of basic biochemistry and haematology or imaging techniques. Development of a feline-specific pancreatic lipase immunoassay has improved our diagnostic ability in the past decade, but may have more limited application for mild and chronic forms of pancreatitis. Moreover, histopathology (the 'gold standard' diagnostic test) can be associated with false-negative results due to multifocal distribution of lesions or mild forms of the disease. With respect to treatment, it is important to take into account the idiosyncrasies of the feline species when considering medical therapies. EVIDENCE BASE This article reviews the literature on feline pancreatitis, focusing on the different forms and their relative clinical significance, while explaining difficulties inherent in the diagnosis of this disease. An overview of current recommendations for the management of cats with pancreatitis is also provided.
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Affiliation(s)
- Julien Bazelle
- Willows Veterinary Centre and Referral Service, Shirley, Solihull, West Midlands, B90 4NH, UK
| | - Penny Watson
- Queen’s Veterinary School Hospital, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
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36
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Oppliger S, Hartnack S, Reusch CE, Kook PH. Agreement of serum feline pancreas–specific lipase and colorimetric lipase assays with pancreatic ultrasonographic findings in cats with suspicion of pancreatitis: 161 cases (2008–2012). J Am Vet Med Assoc 2014; 244:1060-5. [DOI: 10.2460/javma.244.9.1060] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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37
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Williams JM, Panciera DL, Larson MM, Werre SR. Ultrasonographic findings of the pancreas in cats with elevated serum pancreatic lipase immunoreactivity. J Vet Intern Med 2013; 27:913-8. [PMID: 23731243 DOI: 10.1111/jvim.12117] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 02/12/2013] [Accepted: 04/17/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Pancreatitis is a common disease in cats that is difficult to diagnose. HYPOTHESIS/OBJECTIVES To determine the sensitivity and specificity of ultrasonographic changes of the pancreas with serum feline pancreatic lipase immunoreactivity (fPLI) as the standard for diagnosis of pancreatitis. ANIMALS 35 cats with clinical signs consistent with pancreatitis with an abdominal ultrasound examination and serum fPLI concentration measured within 3 days of the ultrasound. METHODS Retrospective study: Pancreatic thickness, pancreatic margination, pancreatic echogenicity, and peripancreatic fat echogenicity were evaluated. Sensitivity and specificity were calculated with an elevated serum fPLI concentration indicative of pancreatitis as the standard for diagnosis. RESULTS Serum fPLI was elevated and diagnostic for pancreatitis in 19 of 35 cats. The single ultrasound characteristic with the highest sensitivity was hyperechoic peripancreatic fat at 68% (95% confidence interval = 44-87%), indicating a moderate probability that cats with pancreatitis will have this abnormality on ultrasonographic examination. Specificity was >90% for each of increased pancreatic thickness, abnormal pancreatic margin, and hyperechoic peripancreatic fat. The sensitivity and specificity of ultrasound were 84% (95% confidence interval = 60-97%) and 75% (95% confidence interval = 48-93%), respectively, in cats with elevated serum fPLI indicative of pancreatitis. CONCLUSIONS AND CLINICAL IMPORTANCE The presence of a thick left limb of the pancreas, severely irregular pancreatic margins, and hyperechoic peripancreatic fat in cats with appropriate clinical signs and elevated serum fPLI are highly supportive of pancreatitis.
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Affiliation(s)
- J M Williams
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
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38
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Zimmermann E, Hittmair KM, Suchodolski JS, Steiner JM, Tichy A, Dupré G. Serum feline-specific pancreatic lipase immunoreactivity concentrations and abdominal ultrasonographic findings in cats with trauma resulting from high-rise syndrome. J Am Vet Med Assoc 2013; 242:1238-43. [DOI: 10.2460/javma.242.9.1238] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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39
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Marolf AJ, Kraft SL, Dunphy TR, Twedt DC. Magnetic resonance (MR) imaging and MR cholangiopancreatography findings in cats with cholangitis and pancreatitis. J Feline Med Surg 2013; 15:285-94. [PMID: 23143839 PMCID: PMC10816759 DOI: 10.1177/1098612x12466084] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cholangiohepatitis/cholangitis is second only to hepatic lipidosis as the most common liver disease in cats and is often associated with concurrent pancreatitis. Magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) have developed into an accurate, highly sensitive and specific imaging tool for the diagnosis of biliary and pancreatic duct disorders in humans. In this prospective case series, 10 cats with suspected cholangitis and/or pancreatitis were enrolled based on clinical history, physical examination and appropriate diagnostic test results. MRI and MRCP sequences with secretin stimulation of the cranial abdomen were performed, and sonography and laparoscopic biopsies for histologic diagnosis were obtained for comparison. MRI detected pancreatic abnormalities in cats suspected of pancreatitis, including T1 pre-contrast hypointense and T2 hyperintense pancreatic parenchyma and a dilated pancreatic duct. The MRI findings of the liver were non-specific. Nine of 10 cats had biliary abnormalities, including gall bladder wall thickening, gall bladder wall moderate contrast enhancement and/or gall bladder debris. Eight of 10 cats had histologic evidence of pancreatitis, as well as hepatitis or cholangitis, with one cat diagnosed with hepatic lymphoma. The advantages of MRI/MRCP over sonography of these cats included the striking pancreatic signal changes associated with pancreatitis and the ability to comprehensibly assess and measure the pancreas and hepatobiliary structures without operator dependence or interference from bowel gas. MRI/MRCP imaging of the feline abdomen may be beneficial in cases with equivocal ultrasound imaging findings.
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Affiliation(s)
- Angela J Marolf
- Colorado State University, Veterinary Medical Center, Fort Collins, CO 80523, USA.
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41
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Abstract
Pancreatitis was considered a rare disease in the cat until a couple of decades ago when several retrospective studies of severe acute pancreatitis were published. It was apparent that few of the diagnostic tests of value in the dog were helpful in cats. With increasing clinical suspicion, availability of abdominal ultrasonography, and introduction of pancreas-specific blood tests of increasing utility, it is now accepted that acute pancreatitis is probably almost as common in cats as it is in dogs, although the etiology(s) remain more obscure. Pancreatitis in cats often co-exists with inflammatory bowel disease, less commonly with cholangitis, and sometimes with both. Additionally, pancreatitis may trigger hepatic lipidosis, while other diseases, such as diabetes mellitus, may be complicated by pancreatitis. Therapy is similar to that used in dogs, with added emphasis on early nutritional support to prevent hepatic lipidosis. Less is known about chronic pancreatitis than the acute form, but chronic pancreatitis is more common in cats than it is in dogs and may respond positively to treatment with corticosteroids.
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Affiliation(s)
- P Jane Armstrong
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota St. Paul, MN 55108, USA.
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42
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Histopathology. CANINE AND FELINE GASTROENTEROLOGY 2013. [PMCID: PMC7152035 DOI: 10.1016/b978-1-4160-3661-6.00029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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43
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Evaluation of fecal α1-proteinase inhibitor concentrations in cats with idiopathic inflammatory bowel disease and cats with gastrointestinal neoplasia. Vet J 2012; 196:189-96. [PMID: 23231864 DOI: 10.1016/j.tvjl.2012.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 07/24/2012] [Accepted: 09/25/2012] [Indexed: 11/23/2022]
Abstract
Idiopathic inflammatory bowel disease (IBD) and gastrointestinal lymphoma are common disorders in cats. The aim of this study was to evaluate fecal α(1)-PI concentrations, a marker of gastrointestinal protein loss, in cats with histopathological evidence of gastrointestinal inflammation or gastrointestinal neoplasia. Fecal and serum samples were obtained from 20 cats with chronic gastrointestinal disease in which endoscopic biopsies were performed. Two groups of cats were assembled based on histopathology: Group A (n = 8), mild to moderate IBD; Group B (n = 12), severe IBD or gastrointestinal neoplasia. Fecal α(1)-PI concentrations and serum concentrations of total protein, albumin, globulin, cobalamin, folate, pancreatic lipase immunoreactivity, and trypsin-like immunoreactivity were determined. Nineteen of the 20 diseased cats had elevated fecal α(1)-PI concentrations, ranging from 1.9 to 233.6 μg/g compared to 20 healthy control cats (normal range: ≤1.6 μg/g). Fecal α(1)-PI concentrations were statistically significantly different between healthy cats and cats of Group A (median: 3.9 μg/g, range: 1.3-9.2 μg/g, P < 0.001) or cats of Group B (median: 20.6 μg/g, 4.3-233.6 μg/g; P < 0.001), and between cats of Groups A and B (P < 0.01). Hypoalbuminemia, hypoproteinemia, and hypocobalaminemia were detected in 88%, 83%, and 56% of the diseased cats, respectively. This study suggests that increased fecal α(1)-PI concentrations in association with low serum albumin and total protein concentrations may be a common finding in cats with IBD or gastrointestinal neoplasia. Furthermore, fecal α(1)-PI concentrations appear to be higher in cats with severe IBD or confirmed gastrointestinal neoplasia when compared to cats with mild to moderate IBD.
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44
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The effect of naturally occurring renal insufficiency on serum pancreatic-specific lipase in cats. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s00580-012-1481-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Liehmann LM, Dörner J, Hittmair KM, Schwendenwein I, Reifinger M, Dupré G. Pancreatic rupture in four cats with high-rise syndrome. J Feline Med Surg 2012; 14:131-7. [PMID: 22314089 PMCID: PMC10822477 DOI: 10.1177/1098612x11431527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2011] [Indexed: 07/10/2024]
Abstract
Pancreatic trauma and rupture are rare after feline high-rise syndrome; however, should it happen, pancreatic enzymes will leak into the abdominal cavity and may cause pancreatic autodigestion and fatty tissue saponification. If not diagnosed and treated, it can ultimately lead to multiorgan failure and death. In this case series, 700 records of high-rise syndrome cats that presented between April 2001 and May 2006 were analysed, and four cats with pancreatic rupture were identified. Clinical signs, diagnosis using ultrasonography and lipase activity in blood and abdominal effusion, and treatment modalities are reported. Three cats underwent surgical abdominal exploration, one cat was euthanased. Rupture of the left pancreatic limb was confirmed in all cases. Two of the operated cats survived to date. High-rise syndrome can lead to abdominal trauma, including pancreatic rupture. A prompt diagnosis and surgical treatment should be considered.
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Affiliation(s)
- Lea M Liehmann
- Clinic for Surgery, Ophthalmology and Dentistry, Department of Companion Animals and Horses University of Veterinary Medicine Vienna, Austria.
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46
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Marolf AJ, Leach L, Gibbons DS, Bachand A, Twedt D. Ultrasonographic Findings of Feline Cholangitis. J Am Anim Hosp Assoc 2012; 48:36-42. [DOI: 10.5326/jaaha-ms-5671] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cholangitis is a common inflammatory disorder of the biliary system in cats. There are two major forms based on the predominate type of inflammatory cell infiltrates: lymphocytic or neutrophilic. Ultrasound is a common imaging modality used in these patients. This retrospective study evaluated the ultrasound examinations of 26 cats with a histologic diagnosis of cholangitis. Most cats with cholangitis had sonographically normal liver size, echogenicity, and normal biliary systems. Statistically significant sonographic changes for cats with cholangitis included hyperechoic liver parenchyma, hyperechoic gallbladder contents, and increased pancreatic size. No statistically significant changes were noted to distinguish lymphocytic and neutrophilic forms of cholangitis. Cats with the sonographic features of diffuse liver hyperechogenicity, gallbladder contents and enlarged pancreas may suggest cholangitis.
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Affiliation(s)
- Angela J. Marolf
- Department of Environmental and Radiological Health Sciences (A.M., D.G., A.B.) and Department of Clinical Sciences (D.T.), James L. Voss Veterinary Medical Center, Colorado State University, Fort Collins, CO; and Moore Animal Hospital, Fort Collins, CO (L.L.)
| | - Lesley Leach
- Department of Environmental and Radiological Health Sciences (A.M., D.G., A.B.) and Department of Clinical Sciences (D.T.), James L. Voss Veterinary Medical Center, Colorado State University, Fort Collins, CO; and Moore Animal Hospital, Fort Collins, CO (L.L.)
| | - Debra S. Gibbons
- Department of Environmental and Radiological Health Sciences (A.M., D.G., A.B.) and Department of Clinical Sciences (D.T.), James L. Voss Veterinary Medical Center, Colorado State University, Fort Collins, CO; and Moore Animal Hospital, Fort Collins, CO (L.L.)
| | - Annette Bachand
- Department of Environmental and Radiological Health Sciences (A.M., D.G., A.B.) and Department of Clinical Sciences (D.T.), James L. Voss Veterinary Medical Center, Colorado State University, Fort Collins, CO; and Moore Animal Hospital, Fort Collins, CO (L.L.)
| | - David Twedt
- Department of Environmental and Radiological Health Sciences (A.M., D.G., A.B.) and Department of Clinical Sciences (D.T.), James L. Voss Veterinary Medical Center, Colorado State University, Fort Collins, CO; and Moore Animal Hospital, Fort Collins, CO (L.L.)
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Digestive System, Liver, and Abdominal Cavity. THE CAT 2012. [PMCID: PMC7158306 DOI: 10.1016/b978-1-4377-0660-4.00023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Respiratory and Thoracic Medicine. THE CAT 2012. [PMCID: PMC7158197 DOI: 10.1016/b978-1-4377-0660-4.00030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bailey S, Benigni L, Eastwood J, Garden OA, McMahon L, Smith K, Steiner JM, Suchodolski JS, Allenspach K. Comparisons between cats with normal and increased fPLI concentrations in cats diagnosed with inflammatory bowel disease. J Small Anim Pract 2010; 51:484-9. [DOI: 10.1111/j.1748-5827.2010.00973.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
PRACTICAL RELEVANCE Diverse disease processes result in sufficient fluid accumulation within the pleural space to cause respiratory compromise. Determining the underlying aetiology is key to appropriate management. This review outlines a practical approach to cases of pleural effusion, focusing on early recognition and confirmation of pleural space disease, stabilisation of the patient and logical diagnostic investigation. It emphasises the importance of a holistic approach, incorporating fluid analysis with other clinical data to determine the underlying aetiology. CLINICAL CHALLENGES Cats with pleural effusion often have severe respiratory compromise at presentation. Careful handling and prompt and adequate stabilisation, incorporating supplemental oxygen and therapeutic thoracocentesis, is essential to avoid respiratory failure. The typical, stepwise approach to the case must be adapted and the clinician may have to proceed, at least initially, without the luxury of information gained from a full history and physical examination. The challenge is to juggle stabilisation, localisation and confirmation of pleural effusion, owner communication and minimally invasive examination while remaining vigilant for clues that allow ranking of the differentials to formulate a diagnostic plan. EVIDENCE BASE Appropriately designed studies to determine the utility of diagnostic techniques in cases with confirmed aetiology are limited. The evidence supporting this review is grade II, III and IV, comprising a small number of prospective studies, several case series, reviews, extrapolation from other species, pathophysiological justification and combined clinical experience of those working in the field.
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Affiliation(s)
- Julia Beatty
- Valentine Charlton Cat Centre, Faculty of Vaterinary Science, University of Sydney, NSW 2006, Australia.
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