Veterinary Medicine - November 2008 - (Page DM13)

Antibiotics Robertson: Do you recommend using antibiotics when treating a cat with pancreatitis, especially a cat with acute pancreatitis? Twedt: We don’t have any scienti c evidence to show that bacteria are the cause in most cases. Some cats with acute suppurative cholangitis probably also have acute suppurative pancreatitis. I put those patients on antibiotics. Robertson: So if a patient has a concurrent disease that warrants antibiotic therapy, you treat the concurrent disease. Twedt: Yes, I do. I do not think we have enough data to say antibiotics are indicated in cats that have chronic lymphocytic plasmacytic changes in their pancreas. Williams: They don’t seem to die of septic complications. Scienti cally, I don’t think there is any reason to put them on antibiotics. Glucocorticoids Robertson: I would like to discuss the use of glucocorticoids in the treatment of feline pancreatitis. Is glucocorticoid therapy ever recommended for treating acute pancreatitis? Steiner: No, I don’t think so. Robertson: As we have discussed, chronic pancreatitis is more common in cats than acute pancreatitis. These cats usually do not require hospitalization or may be hospitalized during acute are-ups of their pancreatitis, but their pancreatitis persists after returning home. How should cats with chronic pancreatitis be managed? Steiner: The rst thing I do is look for potential causes. I look for and treat concurrent disease. After that, I decide whether I want to use glucocorticoids. Many of us believe that glucocorticoids are effective in some cats with chronic pancreatitis, but so far we do not have any studies to support that. “It’s trial and error to ﬁnd a diet that works and that the cat will eat.” — Dr. David Twedt Forman: Yes, but a lot of practitioners put pancreatitis patients on antibiotics. We know that antibiotics can cause side effects. We know they can cause vomiting, and the uoroquinolones are associated with acute retinal blindness in cats. A rationale exists for not using them in these patients. Twedt: Sepsis, bacterial peritonitis, and urinary tract infections are indications. But that’s probably about it. Robertson: So what is the rationale for using glucocorticoids in cats with chronic pancreatitis? Twedt: We use them to address chronic in ammation, just as with our IBD patients. The interesting thing is that when you rebiopsy the gastrointestinal tract of animals that are doing well clinically, many times no signi cant histologic abnormalities are present. Would we see similar signi cant histologic improvement in cats with chronic pancreatitis given corticosteroids? That would be a good study to perform. Steiner: I have found that the Spec fPL decreases in many cats given steroids. Would it decrease anyway just because the disease is cyclic? It is hard to prove a cause and effect relationship, but the cats certainly feel better. Robertson: For cats with chronic pancreatitis alone, we have a rationale for considering glucocorticoids. For cats with suspected IBD or intestinal disease, decreased serum cobalamin, and an elevated Spec fPL, we have reason to supplement with parenteral cobalamin and treat concurrently with glucocorticoids. 13 H2 blockers Forman: I place most of my acute pancreatitis patients on H2 blockers because I’m concerned about gastric ulceration. Do you do that? Twedt: I usually don’t unless I see evidence of gastric ulceration. No research shows that it prevents gastric ulcer development. Williams: I suspect it is mostly a habit to prescribe H2 blockers. We presume patients are better off not vomiting acid, but that may not be true. Personally I do not prescribe H2 blockers for these patients unless an endoscopic examination has provided evidence that there is signi cant gastritis, and that is rarely the case.

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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