Characterization of chronic pancreatitis in English Cocker Spaniels

Background: Chronic pancreatitis (CP) is common in dogs. The cause is unknown. In humans, different causes of pancreatitis have histologically distinct appearances. The histopathologic lesions in English Cocker Spaniels (ECS) with CP were noted to be histologically different than those of other breeds with CP. Hypothesis: CP in ECS is distinct from CP in other breeds and is characterized by a duct destruction similar to what is observed in autoimmune CP of humans. Animals: Eight ECS and 9 other breeds with histologically confirmed CP recruited over an 8‐year period and 50 postmortem control dogs with CP. Methods: Clinical, clinicopathological, and ultrasonographic findings were recorded. Histological sections were compared with a normal dog and 59 dogs of other breeds with CP. Immunohistochemistry using anti‐CD3, anti‐CD79a, and anti‐cytokeratin antibodies was used to evaluate distribution and type of lymphocytic inflammation and appearance of pancreatic ducts. Results: Four male and 4 female ECS presented at a mean age of 7.2 years. Clinical signs were similar in ECS and other breeds. The pancreas was enlarged and hypoechoic in 4 ECS and 2 controls. Histopathology was characterized by interlobular and periductular fibrosis and inflammation in ECS compared with intralobular disease in most other breeds. Immunohistochemistry identified prominent anti‐CD3⁺ lymphocytic infiltrates around venules and ducts and a marked absence of interlobular ducts in ECS compared with mixed T‐cell infiltration and ductular hyperplasia in most other breeds with CP. Conclusions and Clinical Importance: CP in ECS is distinct from CP in other breeds and is notably duct destructive.     

Diagnosis and management of pancreatitis

While there is no single diagnostic approach, other than direct examination of the pancreas, that is completely reliable for the diagnosis of pancreatitis, a presumptive diagnosis of acute pancreatitis can be made with a good degree of confidence by careful evaluation of the entire clinical picture - history and clinical signs, results of physical examination, abdominal imaging and laboratory testing. The approach to treatment is to rest the pancreas, by withholding food, while providing general supportive care by fluid therapy including, in severe cases, plasma transfusion to replace plasma protease inhibitors and albumin. Additional specific interventions in an effort to halt the progression of spontaneous pancreatitis have not yet been shown to be effective, but control of obesity and avoidance of high fat diets may help prevent pancreatitis or lessen its severity when it occurs. Pancreatitis is an unpredictable disease of widely varying severity. While many patients with uncomplicated pancreatitis recover spontaneously following several days of supportive care, other patients die in spite of prolonged intensive care.     

Time–course monitoring of serum amyloid A in a cat with pancreatitis

Abstract: Time‐course changes in the concentration of serum amyloid A (SAA), a major acute phase protein, were measured in a cat with pancreatitis over an 831‐day period and compared with changes in WBC count and feline trypsin‐like immunoreactivity (fTLI). SAA concentration was increased at the onset of the disease and gradually decreased over 5 days of treatment with an improvement in the clinical condition. In contrast, fTLI concentration and WBC count were not increased at the onset of the disease but increased gradually during the 5 days of treatment. Long‐term monitoring from days 68 to 831 revealed a good correlation between SAA concentration and the reoccurrence of clinical signs in the cat; however, WBC count did not increase even with the exacerbation of disease. These findings suggest that the SAA concentration may be a useful marker for evaluating response to treatment and disease exacerbation in feline pancreatitis.     

Diagnosis of pancreatitis.

In summary, pancreatitis is common in dogs and cats, but it seems that most cases remain undiagnosed. Serum amylase and lipase activities are useful as a quick screening test for pancreatitis in the dog only. Serum amylase or lipase activity must be at least three to five times the upper limit of the reference range to suggest a diagnosis of pancreatitis. Furthermore, the diagnosis must be confirmed by other diagnostic modalities, and normal test results do not eliminate the possibility of pancreatitis. Abdominal ultrasound is highly specific for pancreatitis in dogs and cats but is not particularly sensitive, especially in cats. Serum cPLI concentration is highly specific for exocrine pancreatic function and is also highly sensitive for pancreatitis. Similarly, initial data would suggest that serum fPLI is the most sensitive and specific diagnostic test for feline pancreatitis. Until further data are available, however, serum fPLI should be used in conjunction with other diagnostic tests to arrive at a diagnosis of feline pancreatitis. Histopathologic evidence of pancreatitis is conclusive for a diagnosis of pancreatitis. In most cases, however, lesions are localized, and the lack of histopathologic evidence of pancreatitis does not eliminate a diagnosis of pancreatitis.     

犬的急性胰腺炎

胰腺炎是胰腺因胰蛋白酶的自身消化作用而引起的,可分为急性和慢性两种。犬的急性胰腺炎以空发性前腹部疼痛、腹壁紧张、敏感、弓背,有时呈祈祷状、恶心、呕吐为特征。急性胰腺炎又分水肿型和出血坏死型两种,临床上多见水肿型。我院自2005年11月份到2006年11月份这一年中,共接诊胰腺炎病例30例,83Z的病例（24例）多为犬细小病毒感染或严重的肠道寄生虫感染后继发的急性水肿型胰腺炎,只有6例是暴饮暴食或饮食不当引起的原发性急性水肿型胰腺炎。     

A pilot study to assess tolerability of early enteral nutrition via esophagostomy tube feeding in dogs with severe acute pancreatitis

Background: The putative role of the gut in amplification of systemic inflammation in acute pancreatitis is gaining credence, and intraluminal nutrition has been shown to decrease inflammation in experimental models of pancreatitis. Prepyloric feeding often is used in people with acute pancreatitis, but has not been evaluated in dogs. Hypothesis: Early intervention with enteral nutrition (EN) delivered proximal to the pylorus will be well tolerated in dogs with acute pancreatitis and provide justification for further larger trials. Animals: Ten dogs with severe acute pancreatitis in an open‐label, prospective pilot study. Methods: Dogs were treated with plasma transfusion and standard care, and then consecutively assigned to receive either EN via esophagostomy tube feeding or parenteral nutrition (PN). Outcome was used to determine optimal study size for future studies, and complications were compared between the 2 groups. Results: A significantly greater number of vomiting or regurgitating episodes occurred in dogs receiving PN. The dogs receiving EN did not demonstrate any noticeable postprandial pain. There were more catheter‐related complications in the PN group. There was no difference in outcome between the 2 treatments, and 43 dogs for each treatment would be required in future studies to determine a difference in outcome. Conclusions and Clinical Relevance: Early EN delivered proximal to the pylorus is well tolerated in dogs with severe pancreatitis and resulted in fewer complications than PN. Prospective trials in a larger cohort are justified to fully establish the potential benefit of early EN, preferably compared with minimal enteral nutrition.     

犬急性胰腺炎的诊疗

胰腺炎是多发生在成年犬的一种消化系统疾病,该病发病率不高,占门诊或临床发病率的0.5%,但是该病死亡率高,特别是幼犬的发病率和死亡率偏高.从接触的病例来看,只有极少数的病例属于原发病,大多数病例是继发于肠胃炎、犬细小病毒、犬瘟热和肝炎等疾病.     

A case of feline pancreatitis

A 14-year-old, spayed female, domestic shorthair cat was referred to us with anorexia, pyrexia, and jaundice. Total bilirubin (TBIL) and feline trypsin-like immunoreactivity (fTLI) levels were remarkably high. Based on laparoscopic biopsy of the pancreas, the cat was diagnosed as having pancreatitis. As a result of treatment with a synthetic protease inhibitor and corticosteroid, the TBIL and fTLI values returned to normal and the clinical course was good.     

Acute pancreatitis in dogs

Objective: To summarize current information regarding severity assessment, diagnostic imaging, and treatment of human and canine acute pancreatitis (AP). Human‐based studies: In humans, scoring systems, advanced imaging methods, and serum markers are used to assess the severity of disease, which allows for optimization of patient management. The extent of pancreatic necrosis and the presence of infected pancreatic necrosis are the most important factors determining the development of multiple organ failure (MOF) and subsequent mortality. Considerable research efforts have focused on the development of inexpensive, easy, and reliable laboratory markers to assess disease severity as early as possible in the course of the disease. The use of prophylactic antibiotics, enteral nutrition, and surgery have been shown to be beneficial in certain patient populations. Veterinary‐based studies: The majority of what is currently known about naturally occurring canine AP has been derived from retrospective evaluations. The identification and development of inexpensive and reliable detection kits of key laboratory markers in dogs with AP could dramatically improve our ability to prognosticate and identify patient populations likely to benefit from treatment interventions. Treatment remains largely supportive and future studies evaluating the efficacy of surgery, nutritional support and other treatment modalities are warranted. Data sources: Current human and veterinary literature. Conclusions: Pancreatitis can lead to a life‐threatening severe systemic inflammatory condition, resulting in MOF and death in both humans and dogs. Given the similarities in the pathophysiology of AP in both humans and dogs, novel concepts used to assess severity and treat people with AP may be applicable to dogs.     

Acute pancreatitis in parrots

Acute pancreatitis was diagnosed in three parrots. Antemortem diagnosis of pancreatitis in the avian patient is rarely documented, and should be suspected in birds showing clinical signs attributable to abdominal pain or gastro-intestinal dysfunction. However, not all birds with confirmed pancreatitis display these signs. A serum amylase level greater than 1,500 U/L is suggestive of pancreatitis and pancreatic biopsy can be used to confirm a diagnosis. The aetiology of acute pancreatitis in parrots is discussed and a suggested treatment protocol is described.     

Eurytrema procyonis and pancreatitis in a cat

A young adult male domestic shorthair cat was presented for physical examination, routine vaccinations, and a fecal examination. Physical examination revealed no significant abnormalities. Eggs of the raccoon pancreatic fluke Eurytrema procyonis were detected by fecal flotation. Results of a complete blood count and serum biochemistry panel were normal. Abdominal sonography revealed an enlarged hypoechoic pancreas with a hyperechoic rim, and a distended and thickened pancreatic duct. Serum pancreatic lipase immunoreactivity (PLI) was increased. These findings supported the possibility of fluke-associated pancreatitis. Treatment with praziquantel/pyrantel/febantel was associated with resolution of sonographic abnormalities and normalization of PLI.