Veterinary Medicine - November 2008 - (Page DM6)

lipidosis. The question is whether it is idiopathic hepatic lipidosis or a sick cat that is mobilizing fat. Cats with evidence of lipid in their livers may have idiopathic disease but research has shown many have other conditions such as renal disease, IBD, or pancreatitis.13 This is important to know when recommending therapy. Robertson: One disease mentioned earlier that often develops secondary to chronic pancreatitis in cats is diabetes mellitus. It is important to recognize if diabetes is present or develops in these cats, so that it can be managed appropriately. This usually requires insulin therapy, at least in the short term. However, the diabetes in these cats may be transient and as the pancreatitis resolves, the diabetes may also resolve. Managing these cats can be challenging. Forman: I agree. The pancreatitis is also a common contributing factor in insulin resistance in diabetic cats. Williams: Even if the diabetes mellitus is not caused by the pancreatitis per se destroying islet cells, the presence of in ammation in the pancreas can make diabetic cats more dif cult to regulate and stabilize. In rare cases chronic pancreatitis can lead to concurrent exocrine pancreatic insuf ciency and diabetes mellitus, so that treatment with pancreatic extract supplements as well as insulin is required. Steiner: I think that it is pretty much agreed upon that pancreatitis and diabetes mellitus often occur together. Managing the pancreatitis may alleviate the need for insulin therapy. I think that is quite signi cant for the cat and the owner. Robertson: In summary, the clinical signs of pancreatitis are vague and varied. It is not uncommon for cats with other diseases such as diabetes mellitus, IBD, hepatic lipidosis, or cholangitis to also have pancreatitis. disease, or diabetes mellitus. Robertson: So a cat with pancreatitis can have normal or nonspeci c changes on its CBC, serum chemistry pro le, and urinalysis results, or it can have evidence of concurrent disease. A retrospective study of cats with acute pancreatitis found that the most common abnormalities on the CBC were a nonregenerative anemia, leukocytosis, or leukopenia, and the most common chemistry abnormalities were hypocalcemia, hypokalemia, azotemia, hyperglycemia, hypercholesterolemia, elevated liver enzymes, and hyperbilirubinemia.6 However, no speci c ndings on a CBC or serum chemistry pro le would make you say this cat has pancreatitis? Twedt: That is correct, but certain changes are suggestive and require follow-up. In addition, if you have a diabetic patient, you should investigate its pancreas. If you have evidence of liver disease, investigate the pancreas. Unexplained in ammatory leukogram? Investigate the pancreas. Forman: When the cats in the feline PLI study were broken into subgroups of cats that were sick without pancreatitis, with mild pancreatitis, or with severe pancreatitis, there was no difference between their liver enzyme activities, bilirubin levels, or calcium levels. We couldn’t statistically pick out anything that was more likely to occur in cases of pancreatitis.12 The feline pancreatic lipase immunoreactivity (PLI) test is a radioimmunoassay that detects a unique lipase that is only present in the feline pancreas. Feline PLI was show to be elevated in cats with pancreatitis and within the normal range in cats without pancreatitis. Robertson: Amylase and lipase activities have been used to help diagnose pancreatitis in dogs. Is there any clinical utility to amylase and lipase activities in cats for diagnosing pancreatitis? Williams: No. Only one abstract is published on this topic.14 Not a single cat with severe acute pancreatitis had serum amylase or lipase activities above those in the control group. Robertson: Can the feline TLI test be used to diagnose pancreatitis in cats? Steiner: The fTLI test should no longer be used for diagnosing feline pancreatitis. The fTLI is a fantastic diagnostic tool for diagnosing exocrine pancreatic insuf ciency, but it has a poor sensitivity for diagnosing pancreatitis. The feline pancreatic lipase immunoreactivity (fPLI) test is more sensitive, and is at least as speci c as the TLI test. Williams: The fTLI test was the one that rst alerted us to the fact that so many cases of feline pancreatitis existed. But the fPLI has replaced it for diagnosing feline pancreatitis because it is more sensitive. Diagnostic testing Robertson: What changes would veterinarians see on a minimum database, including a complete blood count (CBC), serum chemistry pro le, and urinalysis, to make them suspect pancreatitis in a cat? Williams: The results of those tests don’t make me suspect pancreatitis. Rather, I look at the cat’s clinical signs and presentation. Steiner: What is useful in the serum chemistry pro le for speci cally diagnosing pancreatitis? Absolutely nothing. But is it still useful to run a serum chemistry pro le and a CBC? Absolutely. We want to look for concurrent conditions that are either complicated by pancreatitis or may actually be the underlying cause of the pancreatitis, and we want to evaluate the patient as a whole. A serum chemistry pro le can suggest other diseases occurring concurrently with pancreatitis, such as hepatic disease, intestinal 6

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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