posted: 18/Jan/2017

Diagnosing and Treating Pancreatits

With the holiday season comes parties, and table scraps for our furry friends.  Around this time of year, we see a lot of patients who have stolen ham off the table, or licked grease form under the barbeque and have presented with Pancreatitis.  These animals have signs of lethargy, inappetence, vomiting, diarrhea, a sore abdomen, and can appear hunched.  

Physical Examination:

Panretits is a spectrum disease, therefor you canhave mild disease or severe disease, so any range from a few or all of the following signs could be present:

  • Painful abdomen
  • Vomiting
  • Diarrhea
  • Dehydration (tacky mm, delayed crt)
  • Pyrexia
  • Tachycardia
  • Tachypnea
  • Jaundice (secondary sign)

Diagnostics:

  • Hematology:
    • A stress leukogram may be present or elevated or decreased WBCs present
    • Band neutrophils may be present
  • Biochemistry:
    • Elevated amylase, lipase, +/- glucose are often present but not always
    • Liver involvement may be present if cholagiohepatitis present (obstructive hepatopathy with elevated Bil, ALP and ALT and ascending cholangitis)
    • Depending on level of dehydration other organs may be involved
  • PCV/TP:
    • Dehydration often present, if severe can have hypoproteinemia
  • Blood Gases:
    • Changes in pH:
      • metabolic acidosis due to hyperlactatemia from dehydration
      • respiratory alkalosis from panting
  • SNAP cPLi
    • Questionable utility, as this test is sensitive but not specific, and does not rule out other disease conditions that can cause secondary pancreatitis (FB, gastritis, hepatitis, bile disease, etc).
  • AFAST: Free fluid present in the abdomen, septic or not
  • Radiographs: lack of detail in region of the pancreas, mass effect in region of pancreas if severe, calcification if severe or chronic
  • Ultrasound: Only way to definitely diagnose and can assess for complications/investigate if not improving

Treatment:

Treatment is based on supportive care, however aggressive early therapy can decrease damage to organs, severity of disease and duration of hospitalization.

  • FLUIDS:
    • Aggressively correct dehydration and maintain appropriate fluid rates to correct for ongoing losses
  • PAIN MANAGEMENT:
    • These are PAINFUL!!!  Methadone 0.2mg/kg IV q4 or CRI is a good place to start, some will need a Fentanyl CRI.  The sooner you treat the pain the sooner they will feel better and eat and the sooner they will be home.
  • GASTRO-PROTECTANTS:
    • Omeprazole 1mg/kg IV q24
    • Ranitidine 1mg/kg SQ/IM/PO/IV slow q12 – add in if needed
  • ANTI-EMETICS
    • Maropitant 0.1mL/kg SQ q24
    • Metoclopramide 0.5mg/kg IV/SQ q6, or 0.03-0.09mg/kg/hr CRI- CRI much more effective then intermittent – add in if needed
    • Ondansetron 0.1-0.5mg/kg IV/PO q12- add in if needed
  • FEEDING
    • Feeding as soon as possible will decrease hospitalization time and morbidity
    • If nauseous consider adding in more anti-emetics
    • Current recommendation is to not fast and begin enteral nutrition as soon as possible.
  • ANTIBIOTICS:
    • Only use if indicated, most will resolve without antibiotics
      • Pyrexia (not in itself an indication for antibiotics, see if treated with fluids and pain management first)
      • Elevated WBCs (above stress leukogram, or if signs of bands or intracellular bacteria on smear)
      • Low WBCs
      • Signs of Sepsis
        • Tachycardia
        • Hypotension
        • Tachypnea
        • Hyperthermia/hypothermia
        • High/low WBCs
      • Antibiotic choice:
        • Amoxicillin 22mg/kg IV q8
        • Metronidazole 10mg/kg IV q12



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