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Diagnosis and treatment of feline pancreatitis

Though clinical signs may not be severe, it is important to take a proactive approach in the treatment of chronic feline pancreatitis

According to cat specialist Susan Little, pancreatitis in cats can be classified into three forms: 1. acute necrotising, 2. acute suppurative, which is unique to cats, and 3. chronic non-suppurative, which is the most common, and differs slightly from the canine variety.

While often idiopathic, on rare occasions the cause can be identified as trauma, organophosphate poisoning or viral infection. Another important point to note, particularly with regards to management of the patient, is that unlike dogs, no link between high-fat foods or obesity and pancreatitis has been made (Little, 2016). 

The acute condition is generally associated with high mortality, but the chronic version causes gradual deterioration of exocrine and endocrine functionality while also causing pain and reducing quality of life for the patient. One necropsy study of 115 cats (De Cock et al., 2007) found that 67% of pancreatic tissue examined showed signs of chronic pancreatitis, even though 45% of the cats had not shown any clinical signs. This could mean that despite pancreatitis having been established as an important and significant disease in cats, it may remain undetected and therefore appear clinically irrelevant in some animals.

Making a diagnosis

Diagnosis can be tricky and presenting signs are generally fairly non-specific, including anorexia, lethargy and weight loss, with vomiting and diarrhoea being more variably present. Abdominal pain is not often reported in cats, but the reason for this is thought to be more that cats are very good at hiding discomfort; it would be safe to assume that if you suspect pancreatitis, some degree of discomfort will be present. No particular age or sex of cat has been found to be more at risk, although some retrospective studies showed that domestic short-haired and Siamese breeds might have an increased risk (Ferreri et al., 2003).

When working up a suspected case, a complete blood count, serum biochemistry profile and urinalysis should always be performed because even though findings would not be specific for pancreatitis, this will identify other concurrent conditions, such as hepatic lipidosis or diabetes mellitus. A SNAP fPLI test is generally considered the best test to use for pancreatitis, and diagnostic sensitivity increases further with radiographs to rule out other concurrent conditions, mentioned later. In addition, on ultrasound, where thickening of the left limb of the pancreas, severely irregular pancreatic margins or hyperechoic peripancreatic fat are seen in cats would be highly indicative of pancreatitis. An ultrasound-guided fine needle aspirate is also useful; however, localised lesions could be missed and lead to a false negative result. 

A naso-oesophagal tube should be considered if the cat is anorexic
A naso-oesophagal tube should be considered if the cat is anorexic

How to treat

Treatment of the feline pancreatic patient should include replacing electrolytes lost through vomiting and diarrhoea with crystalloids. The calculation for hydration de cit is BW(kg) x % dehydration = loss (Davis et al., 2013) and generalised supportive care. Analgesia should also be a priority, particularly in acute cases, even when the clinician is unable to detect abdominal pain because it should be assumed that some degree of abdominal pain is present.

In terms of nutrition, it is not ideal to withhold food from pancreatic patients that are not vomiting and when controlled with antiemetics, food with a moderate fat level and high-quality protein content should be offered. As is usually the case, oral feeding is best, but it’s important to consider tube feeding via a naso-oesophageal, oesophagostomy or gastrostomy tube in cats that are off food but not vomiting, and in the case of uncontrolled vomiting, a jejunostomy tube could be considered.

Finally, many studies have reported a strong association between chronic pancreatitis and the development of other serious conditions such as hepatic lipidosis, diabetes mellitus, in ammatory bowel disease or exocrine pancreatic insuf ciency. For this reason, we should always take a proactive approach to feline pancreatitis, even when signs are mild. 

Nutritional support can be given via continuous rate infusion
Nutritional support can be given via continuous rate infusion

Jennifer Parker

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