Veterinary Medicine - November 2008 - (Page DM5)

pancreatitis and ductular in ammation. We’ve identi ed enteric bacteria associated with the wall in and around the pancreatic ducts and brous tissue. With some chronic cases of pancreatitis there may be resident bacteria that persists and could be responsible for the chronic in ammatory changes. We’ve yet to determine the signi cance of the bacteria in these cases. Robertson: Should virulent, systemic feline calicivirus be on the list of infectious causes of pancreatitis in cats? Forman: A study about an outbreak in California showed histopathologic proof that it was.9 Twedt: Occasionally we will see cases of cats with toxoplasmosis or feline infectious peritonitis, especially the dry form, that involve the pancreas. Robertson: The term triaditis is used to describe cats with pancreatitis, in ammatory bowel disease (IBD), and cholangitis. Do you agree that this condition exists, and do we know why these Steiner: The only problem I have with triaditis is the term itself. In human medicine, triaditis means something completely different—in ammation of the portal triad in the liver. However, I certainly believe that a combination of in ammatory diseases of abdominal organs occurs in cats, but I don’t think it’s unique to cats. In people there is an association of IBD and pancreatitis. Many dogs have chronic IBD and chronic mild pancreatitis. We just ignore the chronic mild pancreatitis. Forman: It’s important to remember that disease may exist in other organs because if we focus on treatment for pancreatitis, we sometimes have therapeutic failure. We have to redirect treatment to the intestinal disease. It’s good to keep in mind that you have to look at the pancreatitis and other disease processes at the same time. Twedt: I agree. If an animal has cholangitis, it is prudent to evaluate that animal’s pancreas as well. Pancreatitis may be a complicating factor in the overall course of the disease, and it would be good to know that as early as possible. “Detecting abdominal pain is uncommon, but this may be underestimated because it’s difﬁcult to assess in cats.” — Dr. Marnin Forman diseases frequently occur in combination? Williams: A 1972 study identi es an association between pancreatitis and in ammation in the biliary tree.10 Subsequently, others identi ed similar types of pancreatic pathology along with in ammation of the intestine.11 Clinically over the years, Dr. Steiner and I have seen very large numbers of abnormal serum cobalamin, folate, TLI, and pancreatic lipase immunoreactivity (PLI) test results, all in association in individual patients. A considerable body of evidence supports this association between pancreatitis, IBD, and cholangitis. Twedt: Clinically, I see this association as well. The duct system in cats is different than in dogs. The common bile duct attaches to the pancreatic duct and a common channel enters the intestinal tract. It’s not hard to see that if in ammatory changes are present around one duct system, then in ammatory changes can also exist around the second duct system. Forman: In the study we did on PLI, we included biopsies of the intestinal tract and the liver in addition to the pancreas. Fifty percent of the cats had triaditis or in ammation at three different sites.12 Williams: We occasionally see dogs with obvious clinical signs of in ammatory disease of the biliary tract, and we tend not to look for concurrent pancreatitis or small intestinal disease. It could be there, but we don’t look for it. Robertson: So do you think veterinarians look for concurrent diseases in cats more than in dogs? Twedt: Yes, I think so. Williams: Clearly, more diffuse, multi-organ disease exists in cats than in dogs. For example, cobalamin de ciency re ecting malabsorption secondary to IBD, is far more commonly seen in association with pancreatitis in cats than it is seen in association with pancreatitis in dogs. Robertson: So IBD, cholangitis, and pancreatic disease occur together commonly in cats. Do any other diseases occur with pancreatitis in cats? Forman: Hepatic lipidosis. Twedt: My philosophy is that sick anorexic cats mobilize fat to the liver and develop secondary 5

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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