1. Feline Pancreatitis

2. Overview Many cats have mild disease and are not presented to a vet. The true incidence of pancreatitis in cats is unknown but thought a common problem. And the aspect of disease in feline is quite differ from canine. Often develops concurrent with hepatic lipidosis, cholangiohepatitis and IBD (feline triad disease) Pancreatic disorders 1) exocrine disorder -> EPI 2) endocrine disorder -> DM 3) inflammation of the organ --> Pancreatitis ; cause unknown

3. Etiology  More than 90% of cases are idiopathic  Other multiple factors - trauma(high-rise syndrome), active viral infections(feline parvovirus, feline herpesvirusI, FIP), toxoplasma, hepatic fluke, IBD, hepatic lipidosis, organophosphate insecticide exposure, - Use of drugs ; azathioprine, thiazide diuretics, furosemide, tetracycline, valproic acid, procaineamide  Breed predisposition - Siamese cats seems to be at greater risk  Ingestion of a high-fat meal is not a cause unlike in dogs and obesity is not an independent risk factor.

4. Clinical Signs  Could be a chronic, intermittent problem  Nonspecific & quite variable * any cat with acute unexplained depression - lethargy (100%) - anorexia – poor appetite (97%) - dehydration (92%) - weight loss * vomiting, abdominal pain, diarrhea, fever, jaundice : appears less than 30%  If associated with IBD - loose stools, diarrhea, chronic vomiting

5. Diagnosis  Difficult to diagnosis  Rule out of other causes of symptoms  Hematology : uncommon and nonspecific 1) CBC - elevated WBC maybe present - mild non-regenerative anemia maybe present 2) Blood Chemistry - serum AMYL, LIPA lv have no clinical use! - elevated renal associated & liver enzyme maybe present 3) fTLI test & fPLI test** * PLI - remained elevated longer - relatively specific for pancreatitis

6.  US - most sensitive, commonly available, non-invasive tool. * HOWEVER!!! Detection rate 11-35% needs well-trained, skillful ultrasonographer hard to detect chronic case - hypoechoic pancreas surrounded by hyperehhoic mesentery, with or w/o dilated bile ducts - swelling, increased echogenicity, mass effects, fluid accumulation …

10.  biopsy – gold standard for pancreatitis but… : Peripancreatic fat necrosis with variable acinar cell necrosis and inflammation

11. Treatment  Goals of tx - Correct dehydration - Provide pain relief - Control vomiting - Provide nutritional support - Prevent complications  Many cats are anorexic, and fasting the cat for an additional 3-5 days to rest the pancreas will be of little to no clinical benefit

12.  Modification of gastric acidity - famotidine 0.5mg/kg IV q12h  Feed a balanced, non protein-restricted diet  Antibiotics - Enrofloxaine 5mg/kg Iv,q12h - cefotaxime 25-50mg/kg IV q 8h  If vomit presents 1) prokinetic drugs eg) metoclopramide 1-2mg/kg/24hrs chlorpromazine 0.5mg/kg q8h IM 2) withheld intake for 24hrs * Do not fast longer than 48hrs 3) tube feeding for 7-10 days

13. Prognosis  Dependant on the severity of the disorder and the presence of other complications.  Many cats have mild disease and are not presented to a vet