Veterinary Medicine - November 2008 - (Page DM10)

Protocol for diagnosing feline pancreatitis Presenting clinical signs Lethargy, decreased appetite, dehydration, weight loss, vomiting, and/or diarrhea Laboratory testing CBC Serum chemistry proﬁle plus Urinalysis ± FIV/FeLV testing + T4 (cats > 6 years) Spec fPL +/- Other diagnostic testing as appropriate • radiographs • ultrasonography • cobalamin • folate ≤ 3.5 µg/L Serum Spec fPL concentration is in the normal range It is very unlikely that the cat has pancreatitis. Investigate for other diseases that could cause observed clinical signs. 3.6 to 5.3 µg/L Serum Spec fPL concentration is increased The cat may have pancreatitis and Spec fPL should be reevaluated in two weeks if clinical signs persist. Investigate for other diseases that could cause observed clinical signs. ≥ 5.4 µg/L Serum Spec fPL concentration is consistent with pancreatitis The cat most likely has pancreatitis. Consider investigating for risk factors and concurrent diseases (e.g., IBD, cholangitis, hepatic lipidosis, diabetes mellitus). Periodic monitoring of Spec fPL can help assess response to therapy. if it is IBD without taking intestinal biopsies if the client wishes to be less aggressive. Treatment Robertson: What are your treatment recommendations for cats with acute pancreatitis? Steiner: It’s very important to recognize that no speci c treatment exists for pancreatitis, except for the small subgroup of cats with autoimmune pancreatitis. Everything else is management of pancreatitis. The truth of the matter is that of the treatments we’ll discuss, none are established for cats. We can only extrapolate from human studies and even those are often unclear. Twedt: When you look at placebo-controlled studies in people, about the only treatment strategies proven effective for pancreatitis are uid therapy, pain management, and nutritional therapy. Steiner: I’m a minimalist, meaning I only do what I really think will make a difference. Everybody can agree on fluids, nutrition, pain medication, and antiemetics. Everything else becomes very muddy. 10 Williams: First we want to remove the cause of the pancreatitis if it is one of those rare cases that you think you know what the cause is. I inquire about possible toxicity such as exposure to organophosphates, consider infectious causes such as FIP toxoplasmosis, or the , pancreatic uke, and I evaluate current medications and consider concurrent illnesses. Steiner: I routinely tell practitioners to measure calcium as part of their serum chemistry pro le because hypercalcemia may be associated with pancreatitis. I routinely ask for the patient’s drug history and any concurrent conditions. My main therapies are pain management and antiemetic therapy, even if the cat is not vomiting. In a signi cant number of these cases, the cat is anorectic, which may be due to nausea. Antiemetic therapy Robertson: Do you recommend a speci c antiemetic for pancreatitis? Steiner: I use dolasetron (Anzemet—Avantis) the most in cats simply because I’m most familiar with it. A lot of practitioners now use maropitant citrate (Cerenia—P zer) but this drug is only labeled for use in dogs, not cats.

Table of Contents Feed for the Digital Edition of Veterinary Medicine - November 2008

Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

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