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2013年9月22日星期日

Acute Pancreatitis

Introduction


To understand what Canine Pancreatitis is we first need to understand a little about the pancreas.


The pancreas is a large elongated gland located in the upper abdomen closely associated with the duodenum (upper small intestine).


It is made up of a number of different cells with numerous functions. The cells that make up the pancreas can be divided into two basic types; endocrine and exocrine.




  • The endocrine pancreatic cells are the cells involved in insulin production and blood glucose regulation and is important in diabetes mellitus.


  • The exocrine pancreatic cells secrete digestive enzymes to digest the food in the duodenum (upper small intestine). These are the cells that are important in Canine Pancreatitis.



In a normal healthy pancreas the digestive enzymes are produced in an inactive form and they are activated in the duodenum. This prevents the pancreas from digesting itself.


What is Canine Pancreatitis?


Pancreatitis is inflammation of the pancreas and results in the activation of the pancreatic enzymes in the pancreas rather than in the duodenum.


This causes local damage to the pancreas with severe swelling of the pancreatic tissue, pancreatic oedema, pancreatic bleeding, pancreatic necrosis (cell death), and also necrosis is the fat tissue surrounding the pancreas.


This process causes the release of certain chemicals called cytokines which circulate in the bloodstream and cause disease in other organs such as




  • renal failure (kidney),


  • pulmonary failure (lungs),


  • pancreatic encephalopathy (brain),


  • multi-organ failure,


  • generalized inflammation (whole body), and


  • Disseminated Intravascular Coagulopathy which causes widespread clots in the capillaries and often leads to sudden death.



Because the pancreas also contains cells that produce insulin, a common complication of Canine Pancreatitis is that they develop diabetes mellitus and may require insulin therapy.

There are two forms of Canine Pancreatitis; acute and chronic. Although they do not always follow this rule, for the most part acute pancreatitis causes a more severe disease whilst the chronic form is usually milder.


What Causes Canine Pancreatitis?

Canine Pancreatitis is caused by a variety of factors. These include:




  • pancreatic trauma,



  • high fat diets,



  • diets suddenly different from normal,



  • infections,



  • toxins, and



  • cancer.


The most common animals that we see Canine Pancreatitis in are dogs that are a bit overweight and have been given a high fat food.

Most veterinary clinics see more cases of Canine Pancreatitis around Christmas due to owners feeding a little bit of ham or turkey at this time.

What are the Clinical Signs of Canine Pancreatitis?

The clinical signs associated with Canine Pancreatitis are:




  • Anorexia,



  • Vomiting,



  • Weakness,



  • Abdominal pain,



  • Dehydration,



  • Diarrhoea.


How Is Canine Pancreatitis Diagnosed?

The veterinarian will start by obtaining a complete history. This includes diet, environment and any medications (particularly any cortisone).

This is followed by a general physical examination.

The veterinarian will then advise a blood test. There are generally two components to the blood test.

The first is a general profile which tells us what is happening in the kidneys, liver, pancreas, and in the red and white blood cells.

The second part is called a canine pancreas-specific lipase test which confirms Canine Pancreatitis.

Occasionally, radiographs (x-rays) are required to get a better idea of what is happening inside the abdomen and in cases which are prolonged then an abdominal ultrasound will be advised.

Very occasionally an abdominal exploratory laparotomy will be required. This is where the veterinarian is able to look at the pancreas through a surgical incision in the abdomen. If need be at this time the veterinarian can also take a pancreatic biopsy.

How is Canine Pancreatitis Treated?

Anything given orally (via the mouth) ends up in the stomach and anything in the stomach can cause more irritation to the exocrine pancreatic cells.

Thus the first part of treatment is having no food or water or medication via the mouth. This is termed nil per os. This often is required for 24 hours. If the period of nil per os is to be longer then an enteral feeding tube (jejunostomy tube) is often placed to bypass the stomach.

Fluid therapy is still the mainstay of treatment of Canine Pancreatitis. This keeps hydration up and also flushes out toxins. It also provides the appropriate electrolytes particularly required in animals that have been vomiting or having diarrhoea. Dogs normally stay in the veterinary hospital on a fluid pump for 3-4 days.

Antibiotics are given either primary or secondary bacterial infections.

Also Canine Pancreatitis is very painful. Pain relief should always be administered.

Anti-Emetics are also an important part of treatment as often the dog will be vomiting, or at least feeling nauseous.

How do you Prevent Canine Pancreatitis?

Canine Pancreatitis is known to be a recurrent problem if measures are not taken to try and prevent it. The best prevention that you can use is through the diet. No fatty meals! No fatty treats! There are diets made specifically for Canine Pancreatitis.

One such diet is Hill’s Prescription Diet Canine i/d. The benefits of this diet are:




  • It provides complete balanced nutrition.

  • It is highly digestible which both ensures availability of nutrients and also assists in healing of the digestive tract.

  • It has reduced fat which encourages stomach emptying.

  • It has increased fibre to aide in restoring normal intestinal flora.

  • It contains balanced electrolytes and B vitamins to replace those lost from vomiting and diarrhoea.

  • It has a superior antioxidant formula to aide in healing of damaged tissue.


This diet can be used for dogs with Canine Pancreatitis which are not hyperlipaemic (excess fat in the blood).

For those dogs that are hyperlipaemic there is Hill’s Prescription Diet Canine w/d which has lower fat levels and also an enzyme called L-carnitine which increases the conversion of fat to energy.


2013年9月18日星期三

Pancreatitis In Animals | Acute Pancreatitis

+:lang=”EN-US” xml:lang=”EN-US”>As we all know swelling of pancreas which lies beneath the stomach and above liver can lead to pancreatitis. Feline pancreatitis is something that happens to the cats and is hard to identify. The only way you can make it by seeing your cat vomiting but then remember not every cat would display the same symptom. Other symptoms that can be considered are the fever or abdominal distress which can also ring bell that your cat might be suffering from lots of troubles. Overall, two most common things that can be observed in cats is a sudden loss of appetite making then lazy.


+:lang=”EN-US” xml:lang=”EN-US”>You can say for if these symptoms are related to any other diseased complication and the only way to be certain on this is to get your cat checked by a veterinarian with lab tests. To begin with a blood test and urine test can reveal certain enzymes irregularities. But a pancreatic lipase immunoreactivity test can confirm the existence of feline pancreatitis. This lab test can only be performed at specialized centers only.


+:lang=”EN-US” xml:lang=”EN-US”>Unfortunately, no one knows the exact cause of such a disease to exist as there is nothing specific identified yet. And incase, the cat is diagnosed positive for feline pancreatitis, then your vet is going to monitor your cat to see if there are no further complications. Swelling on abdomen can be treated so as the nausea and appetite loss with the help of certain fluid injections and IVs to prevent any dehydration as no matter what, this is a serious disease and must be cured in time.

2013年9月17日星期二

Acute Pancreatitis in the Cat

Acute Pancreatitis in the Cat


In the cat acute pancreatitis causes anorexia, depression and severe abdominal discomfort.  Vomiting tends to occur less frequently than that seen in the dog.


Diagnosis of pancreatitis in cats is made through a characteristic history, physical examination, abdominal ultrasound imaging and clinical pathology.  A complete blood count will typically demonstrate a leukocytosis with or without a left shift.  On serum chemistries there is typically an azotemia (elevation in blood ammonia levels), various serum electrolyte abnormalities and the total bilirubin concentration is characteristically elevated.  A feline specific pancreatic lipase test has been developed and is characteristically elevated.


Treatment includes intensive fluid and electrolyte therapy.  Nutritional support given by a jejunostomy tube is a key to long term management in severe cases.


The prognosis is guarded, at least initially.


References;


Schaer, Michael.  “Acute Pancreatitis in the Cat.”  NAVC Clinician’s Brief.  April 2008. P. 17.



2013年9月10日星期二

Acute Pancreatitis




This is a story about acute pancreatitis in two small dogs; one was a young male and the other an old female. They had been vomiting for several days, would not eat, their abdomens were tense and painful, and they had low-grade fevers.  The disease developed spontaneously in both dogs.  Serum lipase and amylase, two enzymes normally found in pancreatic cells, were elevated three and ten times the normal level. When pancreatic cells are injured some of the enzymes they contain leak into blood and become important for diagnosing acute pancreatitis. The pancreas is located in the abdomen alongside the small intestine and contains several enzymes that digest food when they are secreted into the intestine.  Normally, while within pancreatic cells, the enzymes are inactive.  However, enzymes can become activated inside the cells. When activated, they injure the cells by digesting them, thereby causing inflammation and the disease, pancreatitis.

            To counter the inflammation and pain from the pancreatitis both dogs were treated morning and night with minocycline, an antibiotic with cytokine-modulating anti-inflammatory properties.  Within 24 hours the dogs appeared to feel better, for they were more active and in less pain.  At 48 hours serum amylase and lipase levels had returned to normal in one dog and near normal in the other. Treatment was continued for 10 days and full recovery was uneventful.  The promptness and extent of response to treatment of pancreatitis were greater than anticipated and suggest there was modulation of inflammatory cytokine effects in the pancreas and/or suppression of intracellular enzyme activation by minocycline.




Image courtesy of Mike Barid – Flickr