Feline exocrine pancreatic disorders.

Despite the uncommon clinical diagnosis, cats frequently suffer from disorders of the exocrine pancreas. Pancreatitis is the most common feline exocrine pancreatic disorder. Pancreatitis can be acute or chronic and mild or severe. The etiology of most cases of feline pancreatitis is idiopathic. Some cases have been associated with severe abdominal trauma, infectious diseases, cholangiohepatitis, and organophosphate and other drug intoxication. The clinical presentation of cats with pancreatitis is nonspecific. Vomiting and signs of abdominal pain, which are the clinical signs most commonly observed in humans and dogs with pancreatitis, are only uncommonly observed in cats with pancreatitis. Routine laboratory findings are also nonspecific. Abdominal ultrasonography is a valuable diagnostic tool in feline patients with pancreatitis. Serum activities of lipase and amylase are rarely increased in cats with pancreatitis; however, these cats often have elevated serum fTLI concentrations. The goals of management are removal of the inciting cause, provision of supportive and symptomatic therapy, and careful monitoring for and aggressive treatment of systemic complications. Exocrine pancreatic insufficiency is a syndrome caused by insufficient synthesis of pancreatic digestive enzymes by the exocrine portion of the pancrease. The clinical signs most commonly reported are weight loss, loose and voluminous stools, and greasy soiling of the hair coat. Serum fTLI is subnormal in affected cats. Treatment of cats with EPI consists of enzyme supplementation with powdered pancreatic extracts or raw beef pancreas. Many cats with EPI have concurrent small intestinal disease. Most cats with EPI also have severely decreased serum cobalamin concentrations and may require parenteral cobalamin supplementation. Pancreatic adenocarcinoma is the most common neoplastic condition of the exocrine pancreas in the cat. At the time of diagnosis, the tumor has already metastasized in most cases, and the prognosis is poor. Pancreatic pseudocyst, pancreatic abscess, pancreatic parasites, pancreatic bladder, and nodular hyperplasia are other exocrine pancreatic disorders, that are less commonly seen in cats.     

Contrast-enhanced power and color Doppler ultrasonography of the pancreas in healthy and diseased cats

Background: The diagnosis of feline pancreatic disease is difficult, because clinical abnormalities and routine noninvasive diagnostic tests are unreliable. Objective: The purpose of this study was to investigate by Doppler ultrasonography if vascularity and blood volume differs in the otherwise ultrasonographically normal and diseased feline pancreas. Animals: Thirty‐six client owned cats. Methods: The pancreas was examined with B‐mode and contrast‐enhanced color and power Doppler ultrasonography. Doppler images were analyzed with a computer program: parameter fractional area represents a vascularity index and color‐weighted fractional area assesses blood volume. Results: Based on the B‐mode findings, the pancreas was considered normal in 11 clinically healthy cats and diseased in 25 cats of which 4 were clinically healthy and 21 had clinical signs consistent with pancreatic disease. Histologic or cytologic samples were taken in all diseased pancreata. Fifteen samples were of diagnostic quality: purulent or mixed cellular inflammation (8), nodular hyperplasia (4), and neoplasia (3) were identified. Vascularity and blood volume for all Doppler methods was significantly higher in cats with pancreatic disease. Significantly higher Doppler values were detected with power Doppler than with color Doppler, and with postcontrast color and power Doppler than with precontrast Doppler technologies. Conclusion: Contrast‐enhanced Doppler ultrasonography appears feasible in the feline pancreas. Significant differences were found between normal cats and those with evidence of pancreatic pathology. Further studies are needed to evaluate its use for the differentiation of pancreatic disorders and in cats suspected to have pancreatic disease but without B‐mode ultrasonographic changes of the pancreas.     

Pancreatitis in cats: diagnosis and management of a challenging disease

Feline pancreatitis can be a very difficult disease to diagnose and often requires a combination of clinical suspicion, appropriate physical examination findings, elevations in serum feline pancreatic lipase immunoreactivity, and changes on abdominal ultrasonography consistent with pancreatic disease. The diagnostic difficulties encountered are related to a lack of specific and readily attributable clinical signs in cats. The sensitivity and specificity of the diagnosis of pancreatitis are highest when a combination of tests is utilized; but even when such tests are employed, the diagnosis is still problematic, especially in cats with chronic pancreatitis. Therapy is symptomatic and focuses on maintaining fluid volume, controlling pain and vomiting, preventing infection, and adjusting to changes in the cat's condition as they occur.     

CONTRAST‐ENHANCED ULTRASONOGRAPHIC FINDINGS IN THREE DOGS WITH PANCREATIC INSULINOMA

Abdominal ultrasonography is one of the most common diagnostic imaging modalities used for dogs with suspected insulinoma; however, pancreatic masses are clearly identified in fewer than half of affected dogs and benign pancreatic nodules can be difficult to differentiate from malignant ones. The purpose of this prospective study was to describe contrast‐enhanced ultrasonography (CEUS) characteristics of confirmed pancreatic insulinoma in a group of dogs. Inclusion criteria were as follows: (1) repeated hypoglycemia (blood glucose levels <60 mg/dl, twice or more); (2) elevated blood insulin levels with hypoglycemia; (3) pancreatic nodules detected with conventional ultrasonography; and (4) histological confirmation of pancreatic islet cell carcinoma. Immediately following conventional ultrasonography of the entire abdomen, CEUS of the pancreatic nodule and adjacent parenchyma was performed using contrast‐specific technology pulse inversion imaging and perflubutane microbubble contrast agent. Three dogs met inclusion criteria. Pancreatic nodules in all the three dogs became more clearly demarcated after injection of the contrast agent. Each nodule showed different enhancement patterns: markedly hyperechoic for 5 s, slightly hyperechoic for 1 s, and clearly hypoechoic for over 30 s. These results were not in complete agreement with previously reported CEUS findings in human patients with insulinoma. All nodules were surgically resected and histopathologically confirmed as malignant insulinomas. Findings from the current study indicated that contrast‐enhanced ultrasound may help to increase conspicuity of pancreatic insulinomas in dogs and that enhancement characteristics may be more variable in dogs than in humans.     

Pancreatic rupture in four cats with high-rise syndrome

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.     

PANCREATIC ULTRASONOGRAPHY IN DOGS WITH EXPERIMENTALLY INDUCED ACUTE PANCREATITIS*

Two-dimensional ultrasonography was evaluated as an imaging modality in experimentally induced, acute pancreatitis in six dogs. Ultrasonic scans were performed once daily for one week following the induction of pancreatitis. Pancreatitis. Pancreatic inflammation, characterized by the development of nonhomogeneous masses and loss of echodensity in the pancreatic region, was consitently observed in all dogs. The results suggest that pancreatic ultrasonography may be a valuable technique for evaluating dogs with spontaneously occurring, acute pancreatitis.     

Ultrasonographic findings in cats with clinical,gross pathologic,and histologic evidence of acute pancreatic necrosis: 20 cases (1994-2001)

OBJECTIVE: To determine ultrasonographic findings in cats with clinical, gross pathologic, and histologic evidence of acute pancreatic necrosis. DESIGN: Retrospective study. ANIMALS: 20 cats. PROCEDURE: Ultrasound reports and permanent ultrasonographic images were reviewed, and ultrasonographic findings were recorded. Thoracic and abdominal radiographs were also reviewed, when available. Anatomic localization of pancreatic necrosis was determined from the gross pathology report; duration and severity of pancreatic necrosis were determined by reviewing histologic specimens. The presence of concurrent disease was recorded from the final pathology report. RESULTS: The pancreas was considered ultrasonographically normal in 10 cats and was not observed in 3. Ultrasonographic findings were considered compatible with pancreatitis in the remaining 7 cats. Gross pathologic findings indicated that pancreatitis was multifocal in all 7 of these cats; histologically, pancreatitis was acute or subacute in 5 and associated with severe or moderate necrosis in 6. In the remaining 13 cats, gross pathologic findings indicated that pancreatitis was multifocal (n = 8) or focal (2), or gross pathologic findings were normal (3). Histologically, pancreatitis was peracute or acute in 11 of these 13 cats and associated with severe or moderate necrosis in 8. Thoracic and abdominal radiographic findings were nonspecific. CONCLUSIONS AND CLINICAL RELEVANCE: Results of ultrasonography were consistent with a diagnosis of pancreatitis in only 7 of 20 cats with acute pancreatic necrosis in the present study. This suggests that new diagnostic criteria must be established if abdominal ultrasonography is to be an effective tool in the diagnosis of pancreatitis in cats.     

Description of the use of contrast‐enhanced ultrasonography in four dogs with pancreatic tumours

Canine pancreatic tumours are rare compared to human medicine and the detection and differentiation of pancreatic neoplasia is challenging with B‐mode ultrasonography, which often leads to late clinical diagnosis and poor prognosis. This case report describes the findings of contrast‐enhanced ultrasonography in four dogs with pancreatic adenocarcinoma or insulinoma. B‐mode ultrasonography of the pancreas revealed a hypoechoic nodule in three dogs and heterogenous tissue in one dog. Contrast‐enhanced ultrasonography was able to differentiate between two tumour types: adenocarcinomas showed hypoechoic and hypovascular lesions, whereas insulinomas showed uniformly hypervascular lesions. Contrast‐enhanced ultrasonography findings were confirmed by cytology and/or histopathology. The results demonstrated that contrast‐enhanced ultrasonography was able to establish different enhancement patterns between exocrine (adenocarcinoma) and endocrine (insulinoma) tumours in dogs .     

Biochemical changes in the jejunal mucosa of dogs with exocrine pancreatic insufficiency following pancreatic duct ligation

The effects of exocrine pancreatic insufficiency on the small intestinal mucosa were examined in dogs following pancreatic duct ligation. There were no significant changes either in villus architecture or enterocyte height after duct ligation, but numbers of bacteria in duodenal juice increased then subsequently decreased following treatment with exogenous pancreatic enzymes. Pancreatic insufficiency resulted in a considerable increase in the proportion of microvillar membrane proteins of molecular mass over 200 kDa from 3.3 +/- 4 per cent (mean +/- SEM) to 13.6 +/- 7.2 per cent, and this decreased to 6.9 +/- 5.2 per cent following pancreatic enzyme supplementation. However, anticipated increases in activities of maltase and sucrase were not observed following duct ligation, and there was a reduction in lactase activity which was reversed by pancreatic supplementation. Activities of marker enzymes for the other subcellular organelles showed relatively minor or no changes throughout the study. These findings are consistent with a specific role for pancreatic enzymes in the post-translational processing of intestinal microvillar membrane proteins, and suggest that reduced degradation of brush border proteins in the absence of pancreatic secretions may be masked by quantitative and qualitative changes in the intestinal microflora.     

Retrospective comparison of abdominal ultrasonography and radiography in the investigation of feline abdominal disease

Abdominal radiography and ultrasonography are commonly used as part of the initial diagnostic plan for cats with nonspecific signs of abdominal disease. This retrospective study compared the clinical usefulness of abdominal radiography and ultrasonography in 105 feline patients with signs of abdominal disease. The final diagnosis was determined more commonly with ultrasonography (59%) compared to radiography (25.7%). Ultrasonography was also able to provide additional clinically relevant information in 76% of cases, and changed or refined the diagnosis in 47% of cases. Based on these findings, ultrasonography may be sufficient as an initial diagnostic test for the investigation of feline abdominal disease.     

Exocrine pancreatic neoplasia in the cat: a case series

Eight cases of feline pancreatic adenocarcinoma and two cases of pancreatic adenoma were reviewed. The adenomas were incidental findings. Most cats with adenocarcinomas had anorexia (75%) and vomiting (63%), while 38% had abdominal pain, a palpable abdominal mass, and/or jaundice. Diagnostic abnormalities included leukocytosis, hyperglycemia, increased alanine aminotransferase activity, poor serosal detail on abdominal radiography, and an abdominal mass effect on ultrasonography. The majority of cats with carcinomas had metastases (mostly to liver, lung, and small intestine), and all were euthanized or died within 7 days of diagnosis. Clinically, feline pancreatic carcinoma may be difficult to distinguish from feline pancreatitis.     

Gastrointestinal ultrasonography of the dog: a review of 265 cases (1996-1998)

The findings of ultrasonography of the gastrointestinal (GI) tract of 265 dogs with GI disorders were analysed retrospectively. The sonographic changes associated with various inflammatory and neoplastic conditions and mechanical obstruction of the GI system were recorded and discussed. Sonographic alterations of the pancreas and the tissues adjacent to the GI tract were also included in the study. Ultrasonographic alterations of the GI tract were classified into three main categories: thickening of the GI wall, changes in peristalsis and dilation of the lumen. Localised thickening of the GI wall with disruption of its structure was caused by both neoplastic diseases and by inflammatory disorders. However, diffuse thickening with retained wall structure was generally associated with inflammatory diseases. The criteria previously established for the ultrasonographic diagnosis of intestinal obstruction were successfully applied to a large number of GI disorders. Pancreatitis was most often associted with hyperchoic mesentery and hypoechoic pancreas mass, but similar alterations were encountered in some cases of gastric or duodenal ulceration. Except in cases of invaginations and intestinal obstructions, the observed ultrasonographic changes were not specific enough for a definitive diagnosis. Nevertheless, ultrasonography proved to be a valuable technique in the diagnostic process of GI disorders of the dog.     

Ultrasonographic imaging of experimentally induced pancreatitis in cattle

This study was conducted to determine the ultrasonographic patterns of pancreatitis evoked in cattle, with reference to laboratory and pathological findings. Using ultrasonographic guidance, acute necrotizing pancreatitis was induced in six cows by injecting chloroform into the pancreatic tissue. Ultrasonographic examination was then performed once daily for nine days. Pancreatic lesions were visible 24h after induction of pancreatitis, as represented by a uniform increase in echogenicity and by intralobular and subcapsular fluid accumulation. As the experiment progressed, patchy hypoechogenic foci appeared within the gland parenchyma. Amylase and lipase activities showed rapid increases. Post mortem examination revealed gross and microscopic necrotic and haemorrhagic lesions in the body and right lobe of the pancreas, accompanied by oedema and fibrosis. Ultrasonography was found to be extremely useful for the detection and characterization of experimentally induced pancreatitis and to monitor its progression in the cow. These findings are of potential value as a reference for the diagnostic workup of bovine pancreatitis, and ultrasonography is seen as a promising non-invasive technique for the diagnosis of suspected pancreatitis in cattle.     

ULTRASONOGRAPHIC FEATURES OF CANINE HEPATIC NODULAR HYPERPLASIA

Hepatic nodular hyperplasia is a benign, usually clinically inapparent, proliferative lesion commonly found at necropsy in older dogs. Three examples of hepatic nodular hyperplasia are described in dogs with clinical signs compatible with hepatic disease in which ultrasonography revealed a variety of echotextural changes in the liver similar to those reported in primary or secondary hepatic neoplasia. In subsequent in vitro ultrasonographic studies of hepatic nodular hyperplasia lesions detected at necropsy in dogs without clinical signs of hepatic disease, only subtle echotextural changes were seen. Hence, hepatic nodular hyperplasia may be inapparent in vivo in many dogs. Hepatic nodular hyperplasia is a potentially confusing sporadic finding which must be considered by ultrasonographers examining dogs with clinical signs of hepatic disease. The diagnosis of hepatic neoplasia should not be made on the basis of ultrasonographic findings alone.     

ENDOSCOPIC ULTRASONOGRAPHIC FINDINGS OF THE PANCREAS AFTER PANCREATIC DUCT LIGATION IN THE DOG

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

ULTRASONOGRAPHIC FINDINGS IN CHOLECYSTOKININ-INDUCED PANCREATITIS IN DOGS

Pancreatitis can be induced in dogs by intravenous infusion of supraphysiologic doses of synthetic cholecystokinin octapeptide (CCK-8). Eight anesthetized female beagles were given either CCK-8 or saline in a randomized, blinded fashion and had abdominal ultrasonography to study the development of pancreatic lesions. Pancreatic lesions were apparent 2 hours after the start of CCK-8 infusion and included swelling, interlobular and subcapsular fluid accumulation and patchy hypoechogenicity of the gland parenchyma. CCK-8 had a variable effect on gallbladder emptying. No signs of biliary obstruction or duodenal lesions were identified. Dogs given CCK-8 had severe edematous pancreatitis at necropsy six hours after the start of the infusion. Compared to the oleic acid model of pancreatitis, CCK-8 infusion induces a rapid onset of pancreatitis and an ultrasonographic appearance that reflects diffuse edema of the gland. The short time-scale of the experiment may account for the relative absence of secondary lesions affecting the biliary tract or duodenum compared to the naturally-occurring disease.     

Assessment of the urinary system.

History and physical examination alone will most often provide conclusive evidence of urinary tract disorders in ruminants. Detailed examination of the urinary system is described, and examples of disease are presented. Ancillary testing may be indicated to confirm the diagnosis, direct treatment, or clarify the prognosis. Serum chemistry interpretation, urinalysis, urinary tract endoscopy and radiography, ultrasonography, abdominocentesis, and renal biopsy are discussed.     

Ultrasonographic evaluation of cattle and buffaloes with respiratory disorders

The purpose of the present study was to evaluate cattle and buffaloes with respiratory disorders, determine the extent of the lesions, and assess prognosis. The results were compared with the findings determined following physical examination and at slaughter. Animals were referred to Veterinary Teaching Hospitals because of inappetance, loss of body condition, cough, dyspnea, and nasal discharges. Ultrasonographically, it was possible to detect bronchopneumonia, consolidation, pleural effusion, pulmonary emphysema, and pleuritis. It was not possible to visualize lesions located deeper within the lungs where peripheral tissue was not affected. Laboratory findings included a neutrophilic leukocytosis, γ-globulinemia, and increased activity of aspartate aminotransferase. A diagnosis of respiratory disease was made on the basis of clinical and ultrasonographic findings and confirmed in 25 cases at slaughter. Bovine ultrasonography appears to be suitable as a screening tool for detection of pathologic lung processes near the pleura. Thoracic ultrasonography allows assessment of the extent and severity of pulmonary changes so that further evaluations can be considered.     

Hepatic ultrasonography in the dog

Ultrasonography may be used to evaluate noninvasively a wide variety of diseases affecting the canine liver. Hepatic mass lesions, parenchymal pathology, gallbladder and biliary disease, and vascular abnormalities may be detected and characterized by ultrasonography. Ultrasonically guided percutaneous liver biopsy can improve the succes and safety of obtaining diagnostic cytologic material. The response of liver disorders to treatment may be effectively monitored by serial ultrasonographic examination. The ultrasonographic diagnosis of canine liver disease is described and illustrated with 11 case history reports.