Exocrine Pancreatic Disease in Cats

Acute pancreatitis in cats
Acute pancreatitis has been recognised as a common disease in dogs, with the highest incidence in obese, middle-aged, sedentary female dogs. Although acute pancreatitis was always thought to be much rarer in cats, it is now being recognised more often given greater awareness of the condition and improved diagnostic capabilities. Despite this, it remains a problematic disorder to manage.

Aetiology
Cases of pancreatitis are usually ‘idiopathic’ but various predisposing factors have been suggested in companion animals e.g. fat, (feeding a high-fat diet, obesity, and hyperlipidaemia), inflammation of other abdominal organs (e.g. the ‘triaditis’ syndrome), pancreatic ischaemia (e.g. hypovolaemia), trauma (e.g. the high-rise syndrome), drugs, (e.g. L-asparaginase, azathioprine, organophosphates, and glucocorticoids.) and infection (e.g. Toxoplasma).

Pathogenesis
Pancreatitis can have variable severity, ranging from mild disease (e.g. mild interstitial pancreatitis) to severe (e.g. haemorrhagic pancreatitis, acute pancreatic necrosis). It can be associated with both local effects (e.g. localised peritonitis and fat necrosis) and systemic effects (e.g. renal failure, cardiac arrhythmias, pleural effusion, shock, DIC, and death.

Clinical signs
As with the severity of pathology, clinical signs range from mild to fatal, and include depression, anorexia, vomiting, diarrhoea (± blood), icterus (jaundice) and abdominal pain. These signs are most consistent in dogs but, in cats, these signs are observed less consistently. In fact, the most frequently observed signs in feline pancreatitis cases are depression and anorexia! Thus, the clinician should maintain a high index of suspicion for this disease. Abdominal palpation may also confirm abdominal pain, a cranial abdominal ‘mass lesion, and/or ascites (occasionally present). Pyrexia may also be noted.

Diagnosis
Haematology and serum biochemistry
Abnormalities may include leucocytosis (neutrophilia and left shift), hyperglycaemia, hyperlipaemia, hypocalcaemia (due to saponification of fat, glucagon release, and increased calcitonin) and increased liver enzymes ± icterus if bile duct obstructed. Nonetheless, the findings in pancreatitis are not pathognomonic and, changes tend to be far less consistent in cats.  [...]