Veterinary Medicine - November 2008 - (Page DM3)

disease, do you think we are actually missing cases of pancreatitis? Forman: One study showed that 67% of cats presented for necropsy irrespective of the cause of death had evidence of pancreatitis on biopsy.1 I think that is too high. We need to agree about what pancreatitis is on a histopathologic level. If you agree with Dr. De Cock’s assessment of pancreatitis, then the prevalence is extremely high in the population of cats that she evaluated at a tertiary hospital.1 Earlier studies established the prevalence as 1.3%, but that is very likely too low.3 It is probably much higher than initially thought. Robertson: So we agree that the prevalence of pancreatitis in cats is unknown but between 1.3% and 67%. This is an extremely wide range, but it’s probably much more common than previously believed. presentation. Cats with acute pancreatitis are dehydrated and may have metabolic changes. We should include pancreatitis as a differential diagnosis for sick cats regardless if vomiting is present or not. Steiner: Maybe vomiting is more common than we think. When you carefully question the owner, you often nd that the cat had a couple of vomiting episodes two or three weeks back and then seemed ne. Then when the cat is presented it is anorectic and lethargic. The owner doesn’t come in because of the vomiting. Another presentation that veterinarians should consider is a cat with diabetes mellitus. Our focus is on the diabetes when, in fact, the underlying cause of the diabetes may be pancreatitis. I think we miss a lot of those cases. Twedt: That’s a good point about diabetes. In an unpublished study reviewing 40 cases of pancreatitis in necropsied cats, I found about 35% were ketoacidotic diabetics. The pancreatitis probably signi cantly contributed to the reason those diabetic cats died. Robertson: To summarize, cats with pancreatitis can present with lethargy, decreased appetite, weight loss, and vomiting and/or diarrhea. Abdominal pain is dif cult to appreciate. They may present for other diseases like diabetes mellitus and pancreatitis is often overlooked. Are there any known age, breed, or sex predispositions associated with pancreatitis in cats? Twedt: I don’t think any information exists on that, but I see more problems in older cats. Williams: I agree that older cats get more pancreatic disease, just like older dogs and older people. However, there’s a published case about chronic pancreatitis in a 9-month-old cat that led to pancreatic insuf ciency. A whole spectrum exists.5 Clinical signs and risk factors Robertson: What are the classic clinical signs in a cat presenting with pancreatitis? Forman: The clinical signs are vague, but we usually see lethargy and inappetence. Cats often vomit, though it’s not usually severe, and some are thin and have been ill. Nothing is speci c to the pancreas. Robertson: You are describing cats with the more typical clinical signs of chronic pancreatitis. Do cats with acute pancreatitis present differently than dogs? Forman: One study showed cats with acute necrotizing pancreatitis could not be distinguished from chronic pancreatitis based on history, physical examination, results of clinicopathologic testing, abdominal radiographs, or ultrasound. 4 Cats with chronic pancreatitis were signi cantly more likely to have higher serum alanine transaminase and alkaline phosphatase activities and concurrent diseases. However, in my experience, cats with acute necrotizing pancreatitis are frequently hypotensive, febrile and develop cavitary effusions more commonly than dogs. Robertson: Pain is harder to detect in cats. How frequent is vomiting, anorexia, and abdominal pain in cats with acute pancreatitis compared with dogs? Williams: With regards to vomiting and abdominal pain, the literature would say less frequently in cats than in dogs, and I think that’s true. However, anorexia is common in cats and may be a manifestation of abdominal pain. Dr. David Twedt: More than 90% of the dogs that I treat have vomiting as part of their clinical Causes of pancreatitis Drugs Robertson: In dogs, drugs such as potassium bromide, and L-asparaginase have been implicated as a cause of pancreatitis. Are any drugs thought to cause pancreatitis in cats? Steiner: The only class of drugs proven is organophosphates.6 In people, virtually every drug is considered capable of causing pancreatitis as an idiosyncratic reaction. I think that is true in any species, just as you can have hepatic necrosis from almost any drug. It is not predictable. Potassium bromide in dogs shows no dose response,7 which would suggest that it is an idiosyncratic reaction 3

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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