Veterinary Medicine - November 2008 - (Page DM9)

pancreatic margin rather than a smooth one is also a consistent nding. Based on recent report that showed the pancreatic duct width was associated with age and not associated with pancreatitis, the duct width has been determined to be an inconsistent nding.17 Robertson: Do you ever collect a ne-needle aspirate of the pancreas in a cat? Twedt: We do. Forman: Radiologists in the past have been concerned about creating pancreatitis by doing that, but this has been shown not to be the case. I do it, and it is helpful for me to see if I nd a lymphocytic or neutrophilic population. Sometimes it helps us diagnose cancer. Steiner: Yes, even with ultrasound it can be difficult to distinguish cancer from pancreatitis because inflammatory masses of the pancreas develop quite often. A fine-needle aspirate of a mass-like lesion can help determine if it is pancreatitis or cancer. be intestinal disease causing malabsorption, and it must have been present for a signi cant period of time in order to deplete the body stores. Twedt: All of us have probably seen cases in which we treat a patient for IBD or pancreatitis that does not respond. When we nd out an animal is cobalaminde cient, and with adequate supplementation, then there is clinical improvement. Robertson: In addition to measuring cobalamin and folate levels, if you have a cat with intestinal disease, you should test them for concurrent pancreatic disease. Forman: Yes, cats with intestinal disease should have Spec fPL, cobalamin, and folate concentrations measured. One of the advantages of testing for cobalamin and folate de ciencies is that we can treat them. It is a way that we can help these cats, even though we don’t have a clear-cut treatment for pancreatitis. Robertson: Do you think we should perform intestinal biopsies on cats diagnosed with pancreatitis? “ if you have a cat with intestinal disease, you should test them for concurrent pancreatic disease.” — Dr. Jane Robertson Williams: Techniques such as contrast-enhanced ultrasound may help elucidate some of these differences in the future. Robertson: Do you perform any other diagnostics on a cat in which you’ve diagnosed pancreatitis, based on its history, clinical signs, or Spec fPL elevations plus or minus compatible ultrasonographic changes? Williams: I almost always perform serum cobalamin and folate measurements because of the frequency of concurrent intestinal disease. A low cobalamin or folate and high Spec fPL would indicate concurrent intestinal and pancreatic pathology. If liver enzymes were increased too we would likely make a diagnosis of “triaditis.” Robertson: For clari cation: how are cobalamin and folate helpful in diagnosing intestinal disease? Williams: Cobalamin and folate are two water-soluble vitamins. In cats, cobalamin is absorbed in the distal small intestine, and folate is absorbed in the proximal small intestine. Given that all feline diets have suf cient amounts of cobalamin and folate if subnormal serum concentrations of cobalamin or folate exist, there must Forman: In cats that I am suspicious of pancreatitis and intestinal disease I always recommend intestinal biopsies. It permits speci c therapy if lymphoma or rarely fungal disease is present or documentation of IBD. On some occasions I will delay anesthesia if the patient is unstable and wouldn’t tolerate anesthesia. Williams: I would take a slightly more conservative approach. It is not wrong to perform biopsies, but many clients can’t afford it. Also, I would ask myself what I would be likely to nd and how that would change my plan of action. Twedt: My philosophy is that you do your diagnostic tests to rule out diseases. If you think it is pancreatic disease based on your diagnostics you would then treat that patient. If the animal fails to improve, then I would investigate further and possibly perform intestinal biopsies because the patient could have gastrointestinal lymphoma and pancreatitis or severe cholangitis and pancreatitis. Steiner: The question is what the client’s goal is. If the owner wants a de nitive diagnosis, then I would recommend doing biopsies early in the disease process. On the other hand, I think it is ne to treat as 9

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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