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Pancreatitis: acute
Introduction
- Edematous and necrotic/hemorrhagic forms.
- Signs: acute abdominal pain, vomiting, depression and anorexia.
- Diagnosis: biochemistry, hematology, ultrasonography.
- Treatment: intravenous fluid support, antiemetics, analgesics, parenteral nutrition, plasma.
- Prognosis: recurrence common. Print off the owner factsheet on Pancreatitis Pancreatitis to give to your client.
Presenting signs
- Vomiting, diarrhea.
- Cranial abdominal pain.
- Anorexia.
- Jaundice.
- Dyspnea due to pulmonary edema Lung: pulmonary edema.
- Bleeding due to disseminated intravascular coagulation Disseminated intravascular coagulation and/or vasculitis.
- Cardiac arrhythmia.
Acute presentation
- Collapse.
- Dyspnea.
- Vomiting.
Age predisposition
- 4-8 years, variable.
Breed/Species predisposition
- Small breeds - Miniature Schnauzer Schnauzer: miniature , English Cocker spaniel English Cocker Spaniel , Cavalier King Charles spaniel Cavalier King Charles Spaniel.
Cost considerations
- Intensive care in severe cases may be prolonged and expensive.
Pathogenesis
Etiology
- Potential risk factors - cause usually unknown.
- Unknown - predisposing factors:
- Obesity.
- High nutritional plane - high fat diets; high fat protein restricted diets.
- Dietary indiscretion.
- Hyperlipoproteinemia - primarily in:
- Shetland Sheepdog Shetland Sheepdog.
- Schnauzer Schnauzer: miniature.
- Dachshund Dachshund.
- West Highland White Terrier West Highland White Terrier.
- Miniature Poodle Poodle: miniature.
- Ischemia: hypotension, general anesthesia, compression of the pancreatic vessels during abdominal surgery.
- Drugs, eg thiazides, furosemide, tetracyclines, azathioprine, high dose of corticosteroids (controversial and steroids may be indicated in some cases), particularly in patients with spinal trauma.
- Infection - bacterial, viral, protozoal.
- Duodenal reflux - not documented clinically.
- Duct obstruction - edematous form, eg bile stones - rare.
- Hypercalcemia Hypercalcemia: overview - particularly acute after IV calcium.
- Trauma.
- Uremia Uremia.
- Auto-immune pancreatitis: suspected in English Cocker spaniel.
- Idiopathic.
Predisposing factors
General
- Obesity/high plane of nutrition.
- High dietary fat.
- Diet indiscretion, eating table scraps.
Pathophysiology
- Activation of zymogen granule enzymes within the pancreas, eg trypsinogen → trypsin.
- Activation may be a consequence of hyperstimulation of pancreas → enzyme activation → pancreatic autodigestion.
- Oxygen free radicals → damage to cell membranes → increased capillary permeability → edema.
- Increased levels of cytokines, chemokines, proteases and phospholipase:
- Locally increased permeability, thrombosis and necrosis.
- Also have systemic effects.
- Multisystem involvement includes disseminated intravascular coagulopathy (DIC), hypoalbuminemia Hypoproteinemia , vasculitis, pulmonary edema, acute renal failure Kidney: acute kidney injury (AKI) , cardiac arrhythmia Heart: dysrhythmia , liver damage.
- Serum antiproteases help but rapidly used up, resulting in progression of enzymatic damage.
Timecourse
- Acute progression - 24-48 h; consequently - may develop bile duct obstruction 5-10 d after acute bout or pseudocyst/abscess - variable time of onset 2-10 days? (DIC most common multi-system consequence).
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Harris J P, Parnell N K, Griffith E H, Saker K E (2017) Retrospective evaluation of the impact of early enteral nutrition on clinical outcomes in dogs with pancreatitis: 34 cases (2010-2013). J Vet Emerg Crit Care (San Antonio) 27(4), 425-433 PubMed.
- Pratschke K M, Ryan J, McAlinden A & McLauchlan G (2015) Pancreatic surgical biopsy in 24 dogs and 19 cats: postoperative complications and clinical relevance of histological findings. J Small Anim Pract 56 (1), 60-66 PubMed.
- Chartier M A, Hill S L, Sunico S, Suchodolski J S, Robertson J E & Steiner J M (2014) Pancreas-specific lipase concentrations and amylase and lipase activities in the peritoneal fluid of dogs with suspected pancreatitis. Vet J 201 (3), 385-389 PubMed.
- Haworth M D, Hosgood G, Swindells K L & Mansfield C S (2014) Diagnostic accuracy of the SNAP and Spec canine pancreatic lipase tests for pancreatitis in dogs presenting with clinical signs of acute abdominal disease. J Vet Emerg Crit Care (San Antonio) 24 (2), 135-143 PubMed.
- Paek J, Kang J H, Kim H S, Lee I, Seo K W & Yang M P (2014) Serum adipokine concentrations in dogs with acute pancreatitis. J Vet Intern Med 28 (6), 1760-1769 PubMed.
- McCord K, Morley P S, Armstrong J, Simpson K, Rishniw M, Forman M A, Biller D, Parnell N, Arnell K, Hill S, Avgeris S, Gittelman H, Moore M, Hitt M, Oswald G, Marks S, Burney D & Twedt D (2012) A multi-institutional study evaluating the diagnostic utility of the spec cPL" and SNAP® cPL" in clinical acute pancreatitis in 84 dogs. J Vet Intern Med 26 (4), 888-896 PubMed.
- Mansfield C (2012) Pathophysiology of acute pancreatitis: potential application from experimental models and human medicine to dogs. J Vet Intern Med 26 (4), 875-87 PubMed.
- Trivedi S, Marks S L, Kass P H, Luff J A, Keller S M, Johnson E G & Murphy B (2011) Sensitivity and specificity of canine pancreas-specific lipase (cPL) and other markers of pancreatitis in 70 dogs with and without histopathologic evidence of pancreatitis. J Vet Intern Med 25 (6), 1241-1247 PubMed.
- Mansfield C S, James F E, Steiner J M, Suchodolski J S, Robertson I D & Hosgood G (2011) A pilot study to assess tolerability of early enteral nutrition via esophagostomy tube feeding in dogs with severe acute pancreatitis. J Vet Intern Med 25 (3), 419-425 PubMed.
- Weatherton L K & Streeter E M (2009) Evaluation of fresh frozen plasma administration in dogs with pancreatitis: 77 cases (1995-2005). J Vet Emerg Crit Care (San Antonio) 19 (6), 617-622 PubMed.
- Lem K Y, Fosgate G T, Norby B & Steriner J M (2008) Associations between dietary factors and pancreatitis in dogs. J Am Vet Med Assoc 233 (9), 1425-1431 PubMed.
- Mansfield C S, James F E, Robertson I D (2008) Development of a clinical severity index for dogs with acute pancreatitis. JAVMA 233 (6), 936-944 PubMed.
- Flint RS & Windsor JA (2003) The role of the intestine in the pathophysiology and management of severe acute pancreatitis. HPB (Oxford) 5 (2), 69-85 PubMed.
- Holm J L, Chan D L & Rozanski E A (2003) Acute pancreatitis in dogs. J Vet Emerg Crit Care 13 (4), 201-213 VetMedResource.
- Steiner J M, Broussard J, Mansfield C S, Gumminger S R & Williams D A (2001) Serum canine pancreatic lipase immunoreactivity (cPLI) concentrations in dogs with spontaneous pancreatitis. JVIM 15, 274 Research Gate.
- Mansfield C S & Jones B R (2000) Plasma and urinary trypsinogen activation peptide in healthy dogs, dogs with pancreatitis and dogs with other systemic diseases. Aust Vet J 78 (6), 416-422 PubMed.
- Hess R et al (1998) Clinical, clinicopathologic, radiographic and ultrasonographic abnormalities in dogs with fatal acute pancreatitis: 70 cases. JAVMA 213 (