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Hotz V, Brugger D, Kook PH. Evaluation of Disease Spectrum in Hospitalized Cats with Hyperlipasemia: Pancreatitis Alone Is Rare, Hyperlipasemia without Suspected Pancreatitis Is Common. Animals (Basel) 2024; 14:1479. [PMID: 38791696 PMCID: PMC11117254 DOI: 10.3390/ani14101479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Histological evidence of pancreatitis is commonly found in necropsy studies in cats. A clinical diagnosis of pancreatitis is challenging due to nonspecific clinical signs, a lack of diagnostic lipase cutoffs, and frequent presence of multiple diseases. It is still unknown how often pancreatitis alone is found in sick cats and how often clinicopathological evidence of pancreatitis in sick cats does not lead to a clinical diagnosis of pancreatitis. Our aims were to evaluate the extent of comorbidities in cats with suspected pancreatitis, evaluate how often sick cats with hyperlipasemia are diagnosed only with non-pancreatic diseases, and compare their clinical findings. Medical records of 563 client-owned hospitalized cats with available lipase activity measurement (LIPC Roche) > 30 U/L (RI, 6-26) were searched and medical diagnoses recorded and grouped by organ system. Clinicopathological findings were compared between cats with pancreatitis alone (PA), pancreatitis with concurrent disease (PD), and no suspected pancreatitis (NP). We found that PA was present in 33 (6%) cats, 159 cats (28%) were in the PD group, and 371 cats (66%) had no suspected pancreatitis (NP). Clinical, laboratory, and ultrasonographic findings did not differ between PA and PD cats. Lipase activities did not differ between the three groups. The most common disease categories in PD and NP cats were gastrointestinal, hepatobiliary, renal/urinary, and endocrine, and renal/urinary, gastrointestinal, cardiac, and musculoskeletal, respectively. We conclude that cats are rarely hospitalized because of suspected pancreatitis alone, and PA cats did not differ clinically from PD cats. Hyperlipasemia in sick cats without a diagnosis of pancreatitis may be due to a reactive pancreatopathy or preexisting chronic pancreatitis.
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Affiliation(s)
- Vanessa Hotz
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
| | - Daniel Brugger
- Institute of Animal Nutrition and Dietetics, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
| | - Peter Hendrik Kook
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
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2
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Pacheva M, Brugger D, Riond B, Dennler M, Kook PH. Effects of prednisolone on 1,2-O-dilauryl-rac-glycero glutaric acid-(60-methylresorufin) ester-lipase activity and pancreatic lipase immunoreactivity in healthy cats. J Vet Intern Med 2024; 38:1370-1376. [PMID: 38485220 PMCID: PMC11099763 DOI: 10.1111/jvim.17042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/27/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Corticosteroids are among the most commonly used drugs in cats and are increasingly discussed as a treatment for feline pancreatitis. However, its effects on serum lipase in healthy cats remain unknown. OBJECTIVES To evaluate the effects of prednisolone on serum lipase activity and pancreatic lipase immunoreactivity (PLI) in cats. ANIMALS Seven clinically healthy colony cats, aged 4 to 7 years, with unremarkable CBC/biochemistry panel were studied. METHODS Prospective study: Prednisolone (1.1-1.5 mg/kg, median 1.28 mg/kg PO) was given daily for 7 consecutive days. Lipase activity (LIPC Roche; RI, 8-26 U/L) and PLI (Spec fPL; RI, 0-3.5 μg/L) were determined at day 1 before first treatment and at days 2, 3, 8, 10, and 14. Cats were examined daily. An a priori power analysis indicated that 6 cats were needed to find a biological relevant effect at 1-β = 0.8. Statistical analyses comprised the Friedman test, random intercept regression, and repeated-measures linear regression. RESULTS Median (range) day 1 lipase activities and PLI were 22 U/L (14-52 U/L) and 3.2 μg/L (2.3-15.7 μg/L). One cat with abnormally high lipase activity (52 U/L) and PLI (15.7 μg/L) at day 1 continued having elevated lipase activities and PLI throughout the study. Lipase activities and PLI concentrations did not differ significantly among time points regardless of whether the cat with elevated values was included or not. All cats remained healthy throughout the study. CONCLUSIONS AND CLINICAL IMPORTANCE Administration of prednisolone in anti-inflammatory doses does not significantly increase serum lipase activity and PLI concentration.
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Affiliation(s)
- Militsa Pacheva
- Clinic for Small Animal Internal Medicine, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Daniel Brugger
- Institute of Animal Nutrition and Dietetics, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Barbara Riond
- Clinical Laboratory, Department for Clinical Diagnostics and Services, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Matthias Dennler
- Clinic of Diagnostic ImagingDepartment of Clinical ServicesVetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Peter Hendrik Kook
- Clinic for Small Animal Internal Medicine, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
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3
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Wu YA, Steiner JM, Huisinga E, Beall MJ, Buch J, Fosgate GT, Lidbury JA. Analytical validation of an ELISA for the measurement of feline pancreas-specific lipase and re-evaluation of the reference interval and decision threshold for diagnosing pancreatitis. Vet Clin Pathol 2023; 52:482-492. [PMID: 37468991 DOI: 10.1111/vcp.13283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/11/2023] [Accepted: 06/11/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND The diagnosis of feline pancreatitis can be challenging. The clinical presentation often includes mild, nonspecific clinical signs, such as vomiting, anorexia, and weight loss. Measurement of feline pancreatic lipase immunoreactivity (fPLI) concentration in serum has been reported to be sensitive and specific for a diagnosis of pancreatitis in cats. However, analytical validation for a widely available commercial assay for the measurement of fPLI concentration has not been published. OBJECTIVE We aimed to analytically validate the Spec fPL assay (IDEXX Laboratories, Westbrook, ME), a commercial ELISA for the measurement of fPLI concentration, and re-evaluate its reference interval and decision threshold for diagnosing pancreatitis in cats. METHODS Dilutional linearity, accuracy, precision, and the effect of interfering substances were assessed. The upper limit of the reference interval was calculated based on the 95th percentile of results from clinically healthy cats (n = 107), and a decision threshold for diagnosing pancreatitis was calculated with an expected specificity of 99%. RESULTS Analytical validation demonstrated good linearity, accuracy, and precision, as well as the absence of interference from lipemia, hemolysis, or icterus. The upper limit of the reference interval for Spec fPL was determined to be 4.4 μg/L, and the decision threshold (a theoretical cut-off) for diagnosing pancreatitis was determined to be 8.8 μg/L based on a desired specificity of 99%. CONCLUSIONS The Spec fPL assay is analytically valid, and results suggest that a decision threshold of 8.8 μg/L would have high diagnostic specificity for excluding clinically healthy cats.
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Affiliation(s)
- Yu-An Wu
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Jörg M Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Elke Huisinga
- IDEXX Laboratories Inc., One IDEXX Drive, Westbrook, Maine, USA
| | - Melissa J Beall
- IDEXX Laboratories Inc., One IDEXX Drive, Westbrook, Maine, USA
| | - Jesse Buch
- IDEXX Laboratories Inc., One IDEXX Drive, Westbrook, Maine, USA
| | - Geoffrey T Fosgate
- Epidemiology Section, Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Jonathan A Lidbury
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
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4
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Marsilio S, Freiche V, Johnson E, Leo C, Langerak AW, Peters I, Ackermann MR. ACVIM consensus statement guidelines on diagnosing and distinguishing low-grade neoplastic from inflammatory lymphocytic chronic enteropathies in cats. J Vet Intern Med 2023; 37:794-816. [PMID: 37130034 PMCID: PMC10229359 DOI: 10.1111/jvim.16690] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/10/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Lymphoplasmacytic enteritis (LPE) and low-grade intestinal T cell lymphoma (LGITL) are common diseases in older cats, but their diagnosis and differentiation remain challenging. OBJECTIVES To summarize the current literature on etiopathogenesis and diagnosis of LPE and LGITL in cats and provide guidance on the differentiation between LPE and LGITL in cats. To provide statements established using evidence-based approaches or where such evidence is lacking, statements based on consensus of experts in the field. ANIMALS None. METHODS A panel of 6 experts in the field (2 internists, 1 radiologist, 1 anatomic pathologist, 1 clonality expert, 1 oncologist) with the support of a human medical immunologist, was formed to assess and summarize evidence in the peer-reviewed literature and complement it with consensus recommendations. RESULTS Despite increasing interest on the topic for clinicians and pathologists, few prospective studies were available, and interpretation of the pertinent literature often was challenging because of the heterogeneity of the cases. Most recommendations by the panel were supported by a moderate or low level of evidence. Several understudied areas were identified, including cellular markers using immunohistochemistry, genomics, and transcriptomic studies. CONCLUSIONS AND CLINICAL IMPORTANCE To date, no single diagnostic criterion or known biomarker reliably differentiates inflammatory lesions from neoplastic lymphoproliferations in the intestinal tract of cats and a diagnosis currently is established by integrating all available clinical and diagnostic data. Histopathology remains the mainstay to better differentiate LPE from LGITL in cats with chronic enteropathy.
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Affiliation(s)
- Sina Marsilio
- Department of Veterinary Medicine and EpidemiologyUC Davis School of Veterinary MedicineDavisCaliforniaUSA
| | - Valerie Freiche
- Ecole Nationale Vétérinaire d'AlfortCHUVA, Unité de Médecine InterneMaisons‐AlfortFrance
| | - Eric Johnson
- Department of Surgical & Radiological SciencesUC Davis School of Veterinary MedicineDavisCaliforniaUSA
| | - Chiara Leo
- Anicura Istituto Veterinario NovaraNovaraItaly
| | | | | | - Mark R. Ackermann
- Oregon Veterinary Diagnostic Laboratory, Oregon State UniversityCorvallisOregonUSA
- Present address:
US Department of AgricultureNational Animal Disease CenterAmesIowaUSA
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Lederer KA, Hittmair KM, Tichy A, Zeugswetter FK. Comparison of ultrasonographic echogenicity and outcome in cats with suspected pancreatitis. J Feline Med Surg 2022; 24:1228-1237. [PMID: 35166136 PMCID: PMC10812350 DOI: 10.1177/1098612x221074921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether ultrasonographic pancreatic echogenicity, especially hypoechogenicity, has an impact on the prognosis of cats with suspected pancreatitis. We hypothesised that cats with a hypoechoic pancreas have a longer duration of hospitalisation, higher treatment costs and a higher mortality rate. METHODS This was a retrospective study, which included cats with clinical signs of pancreatitis, a SNAP fPL test result above the reference interval and ultrasonographic abnormalities consistent with pancreatitis. Medical records and follow-up information were retrieved from the local electronic database. Cases were assigned to one of three groups based on pancreatic echogenicity: hypoechoic, hyperechoic or mixed echogenicity. Statistical analysis aimed to assess differences in outcome, ultrasonographic abnormalities, historical features, physical examination findings, laboratory results, concurrent diseases or treatment costs. RESULTS Thirty-six (64%) cats with a hypoechoic, seven (13%) with a hyperechoic and 13 (23%) cats with a mixed echoic pancreas were included. Cats with a hypoechoic pancreas had a significantly lower median body weight (P = 0.010) and lower median body condition score (P = 0.004) compared with the other cats. Furthermore, they were presented as being lethargic significantly more often (P = 0.014), were more likely to have a homogeneously enlarged pancreas (P <0.001) and were less likely to have concurrent abnormalities or diseases, such as ultrasonographic enteric abnormalities (P = 0.020), triaditis (P = 0.013) and diabetes mellitus (P = 0.041). However, there was no difference in treatment costs (P = 0.961), duration of hospitalisation (P = 0.898), survival of hospitalisation (P = 0.419) or survival time (P = 0.256) between groups. CONCLUSIONS AND RELEVANCE In this study, echogenicity was of no prognostic value in cats with suspected pancreatitis. Cats with a hypoechoic pancreas were not associated with a poorer outcome than cats with a hyperechoic or mixed echoic pancreas.
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Affiliation(s)
- Kristina A Lederer
- Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Katharina M Hittmair
- Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Alexander Tichy
- Department of Biomedical Sciences, University of Veterinary Medicine, Vienna, Austria
| | - Florian K Zeugswetter
- Internal Medicine, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
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6
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Burti S, Zotti A, Rubini G, Orlandi R, Bargellini P, Bonsembiante F, Contiero B, Marcuzzi M, Banzato T. Contrast-enhanced ultrasound features of focal pancreatic lesions in cats. Front Vet Sci 2022; 9:986948. [PMID: 36246338 PMCID: PMC9554590 DOI: 10.3389/fvets.2022.986948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/06/2022] [Indexed: 12/04/2022] Open
Abstract
A large overlap in the ultrasound (US) features of focal pancreatic lesions (FPLs) in cats is reported. Furthermore, only a small number of studies describing the contrast-enhanced ultrasound (CEUS) features of FPLs in cats have been conducted today. The aim of this study is to describe the B-mode US and CEUS features of FPLs in cats. Ninety-eight cats cytologically diagnosed with FPL were included. The lesions were classified as adenocarcinoma (n = 40), lymphoma (n = 11), nodular hyperplasia (n = 17), other benign lesion (OBL) (n = 20), cyst (n = 4) or other malignant lesion (OML) (n = 6). Several qualitative and quantitative B-mode and CEUS features were described in each case. OMLs and cysts were not included in the statistical analysis. A decision tree to classify the lesions based on their B-mode and CEUS features was developed. The overall accuracy of the cross-validation of the decision tree was 0.74 (95% CI: 0.63–0.83). The developed decision tree had a very high sensitivity and specificity for nodular hyperplasia (1 and 0.94, respectively) as well as good sensitivity and specificity for both adenocarcinomas (0.85 and 0.77, respectively) and OBLs also (0.70 and 0.93, respectively). The algorithm was unable to detect any specific feature for classifying lymphomas, and almost all the lymphomas were classified as adenocarcinomas. The combination between CEUS and B-mode US is very accurate in the classification of some FPLs, especially nodular hyperplasia and adenocarcinomas. Cytopathology and or histopathology is still a fundamental step FPL diagnostic workflow.
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Affiliation(s)
- Silvia Burti
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Alessandro Zotti
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | | | | | | | - Federico Bonsembiante
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Barbara Contiero
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Mabel Marcuzzi
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Tommaso Banzato
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
- *Correspondence: Tommaso Banzato
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Xenoulis PG, Fracassi F. Feline Comorbidities: Clinical perspective on diabetes mellitus and pancreatitis. J Feline Med Surg 2022; 24:651-661. [PMID: 35775305 DOI: 10.1177/1098612x221106355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PRACTICAL RELEVANCE Diabetes mellitus (DM) is one of the most common feline endocrine disorders. It has been shown by several studies that DM in cats frequently coexists with pancreatitis. CLINICAL CHALLENGES It has not been definitively established what the exact pathogenetic association between DM and pancreatitis is in the cat. However, the association between these two conditions is most likely bidirectional, with DM predisposing cats to pancreatitis and vice versa. Diagnosis of pancreatitis in cats with DM is crucial because concurrent pancreatitis commonly leads to difficulties in the management of DM. When pancreatitis is associated with diabetic ketoacidosis (DKA), therapeutic management is even more challenging. AIMS This review focuses on the concurrent presence of DM or DKA and pancreatitis in cats, mainly focusing on their clinical management. EVIDENCE BASE Information provided in this review is based on feline-specific clinical research when available. In addition, comparative and human research, as well as clinical experience, has been used to enrich knowledge in areas where feline-specific research is not yet available.
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Affiliation(s)
- Panagiotis G Xenoulis
- Clinic of Medicine, Faculty of Veterinary Science, University of Thessaly, Karditsa, Greece
| | - Federico Fracassi
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
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Krasztel MM, Czopowicz M, Szaluś-Jordanow O, Moroz A, Mickiewicz M, Kaba J. Accuracy of acute-phase proteins in identifying lethargic and anorectic cats with increased serum feline pancreatic lipase immunoreactivity. Vet Clin Pathol 2022; 51:93-100. [PMID: 35146787 DOI: 10.1111/vcp.13097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/12/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022]
Abstract
The mainstay of laboratory diagnostics of feline pancreatitis (FP) is measuring serum feline pancreatic lipase immunoreactivity (fPLI). Thus far, several studies have investigated the relationship between acute-phase proteins (APPs) and the presence and severity of FP. Although changes in serum amyloid A (SAA) concentration have been linked with FP, its diagnostic accuracy remains unknown. We aimed to determine the accuracy of selected APPs in identifying cats with a high risk of FP based on increased fPLI. Serum fPLI was measured in cats (n = 52) that were presented to veterinary clinics with signs of lethargy and anorexia. The cats were divided into two groups (fPLI ≤3.5 μg/L; n = 27 and fPLI >3.5 μg/L, n = 25), corresponding to low and high risks of FP. Serum albumin, globulin, haptoglobin (Hp), and SAA concentrations, as well as the albumin-to-globulin ratio (A/G) and SAA-to-albumin (SAA/A) ratios, were determined and compared between groups. The accuracy of these measurements was examined using a multivariable logistic regression model and receiver operator characteristic (ROC) curve analysis. SAA concentrations and SAA/A ratios were significantly (P = .026 and P = .022) higher in cats with increased fPLI, with the area under ROC curve (AUROC) of 68.1% (CI 95%: 53.4%, 82.9%) and 68.6% (CI 95%: 54.0%, 83.2%), respectively. The logistic regression model combining SAA and A/G had AUROC of 75.2% (CI 95%: 62.0%, 88.4%) for identifying cats with increased fPLI. SAA as a sole analyte or combined with A/G had low to moderate accuracy in identifying anorexic, lethargic cats with increased fPLI. Serum albumin, globulin, and Hp concentrations had no discriminatory potential in these cats.
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Affiliation(s)
- Magdalena Maria Krasztel
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Michał Czopowicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Olga Szaluś-Jordanow
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Agata Moroz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Marcin Mickiewicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Jarosław Kaba
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
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Krasztel MM, Czopowicz M, Szaluś-Jordanow O, Moroz A, Mickiewicz M, Kaba J. Correlation between metabolomic profile constituents and feline pancreatic lipase immunoreactivity. J Vet Intern Med 2022; 36:473-481. [PMID: 35023223 PMCID: PMC8965226 DOI: 10.1111/jvim.16349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Feline pancreatic lipase immunoreactivity (fPLI) is commonly used to diagnose pancreatitis in cats (FP). Untargeted metabolomics has been extensively applied in human and veterinary medicine, but no metabolomic studies regarding FP have been conducted. Objectives To identify metabolites significantly associated with increased fPLI. Animals Forty‐nine client‐owned cats: 11 clinically healthy and 38 with various clinical conditions. Methods Analytical cross‐sectional study with convenience sampling. A panel of 630 metabolites belonging to 26 biochemical classes was quantified in plasma using a commercial metabolomic assay. The correlation between plasma metabolite concentrations and serum fPLI was evaluated using Spearman's rank correlation coefficient (Rs) with Bonferroni correction. Multivariable analysis then was performed to control for glomerular filtration rate, liver damage, and blood glucose concentration. The accuracy of selected metabolites in discriminating between cats with normal (≤3.5 μg/L) and increased (>5.3 μg/L) fPLI was estimated using the area under the receiver operating characteristic curve (AUROC). Results Four hundred and seven of 630 metabolites (64.6%) were quantified in all cats. When controlled for potential confounders only 3 sphingolipids were significantly positively correlated with fPLI: 2 cerebrosides: HexCer(d18:1/24:0); (Rs = .56), and HexCer(d18:1/24:1); (Rs = .58) and 1 sphingomyelin: SM C18:0 (Rs = .55). Their AUROCs in identifying cats with increased fPLI were 82% (95% confidence interval [CI 95%], 70%‐94%), 84% (CI 95%, 72%‐96%), and 78% (CI 95%, 65%‐92%), respectively. Conclusions and Clinical Importance Selected sphingolipids are moderately positively correlated with fPLI and appear to have fair to moderate diagnostic accuracy in discriminating between cats with normal and increased fPLI.
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Affiliation(s)
- Magdalena Maria Krasztel
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Michał Czopowicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Olga Szaluś-Jordanow
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Agata Moroz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Marcin Mickiewicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Jarosław Kaba
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
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Krasztel MM, Czopowicz M, Szaluś-Jordanow O, Moroz A, Mickiewicz M, Kaba J. Application of a complete blood count to screening lethargic and anorectic cats for pancreatitis. BMC Vet Res 2021; 17:383. [PMID: 34895249 PMCID: PMC8665532 DOI: 10.1186/s12917-021-03098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022] Open
Abstract
Background Feline pancreatitis (FP) is an important health problem of cats. Its diagnostics is based on the combination of quantification of serum pancreatic lipase immunoreactivity (fPLI) and abdominal ultrasonography (AUS). These modalities allow for establishing highly specific diagnosis, however they are relatively expensive and time-consuming. On the other hand, a screening test of high sensitivity which would allow to rule out FP on the first visit without a considerable increase of costs would be clinically useful. To evaluate accuracy of nonspecific inflammatory biomarkers based on complete blood count (CBC) in diagnosing FP 73 client-owned cats with signs of lethargy and reduced appetite lasting for at least 2 days before presentation were enrolled in the cross-sectional study. They were examined with fPLI assay and AUS and classified as cats with very low risk of FP when fPLI ≤3.5 μg/L and AUS negative for FP, or as cats with increased risk of FP in the case of any other combination of results. Then, 7 various CBC measurements were measured in each cat and linked to the risk of FP using the multivariable logistic regression. Results Five CBC measurements turned out to be significantly associated with the risk of FP – total leukocyte count (WBC; crude odds ratio(ORcrude) = 12.2; CI 95%: 1.52, 98.5), total neutrophil count (ORcrude = 5.84; CI 95%: 1.22, 27.9), band neutrophil count (BNC; ORcrude = 6.67; CI 95%: 1.98, 22.4), neutrophil-to-lymphocyte ratio (ORcrude = 3.68; CI 95%: 1.25, 10.9), and eosinophil count (EC; ORcrude = 0.34; CI 95%: 0.12, 0.96). The model based on WBC, BNC, and EC proved to have at least fair diagnostic potential (area under ROC curve 82.7%; CI 95%: 72.8%, 92.5%). When WBC < 18 G/L, BNC < 0.27 G/L, and EC > 0.3 G/L was considered as a negative result, and any other combination as the positive result, the CBC model had high sensitivity (91.8%; CI 95%: 80.8%, 96.8%) at a relatively low specificity (58.3%; CI 95%: 38.8%, 75.5%). Conclusion The combination of three CBC measurements is an immediately available and fairly accurate screening method for identification of lethargic and anorectic cats with increased risk of FP. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-021-03098-z.
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Affiliation(s)
- Magdalena Maria Krasztel
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, 02-776, Warsaw, Poland
| | - Michał Czopowicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, 02-776, Warsaw, Poland.
| | - Olga Szaluś-Jordanow
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, 02-776, Warsaw, Poland
| | - Agata Moroz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, 02-776, Warsaw, Poland
| | - Marcin Mickiewicz
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, 02-776, Warsaw, Poland
| | - Jarosław Kaba
- Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c, 02-776, Warsaw, Poland
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The Agreement between Feline Pancreatic Lipase Immunoreactivity and DGGR-Lipase Assay in Cats-Preliminary Results. Animals (Basel) 2021; 11:ani11113172. [PMID: 34827904 PMCID: PMC8614432 DOI: 10.3390/ani11113172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Feline pancreatitis is a common disease with diagnostics requiring a combination of clinical, laboratory and imaging methods. Measuring of pancreatic lipase concentration is the laboratory mainstay of feline pancreatitis diagnostics. It can be done using immunoenzymatic assay (feline pancreatic immunoreactivity, fPLI) or colorimetric assay based on hydrolyzing a special substrate (DGGR) to a color product. A DGGR-lipase assay is manufactured by various companies. Studies carried out in cats on the DGGR-lipase assay of a single manufacturer have shown a high agreement with fPLI, however studies in dogs indicate that the performance of assays of different manufacturers may vary considerably. One of the largest Polish veterinary laboratories working 24/7 in the largest Polish cities offers the DGGR-lipase assay of a large Polish laboratory solutions provider. The values obtained in this assay are higher than those yielded by the traditional DGGR-lipase assay validated in studies carried out so far. Therefore, we decided to evaluate the agreement between the DGGR-lipase assay of the Polish manufacturer and fPLI. The agreement proved to be as high as for the traditional assay. Abstract The colorimetric catalytic assay based on the use of 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) (DGGR) ester as a substrate for pancreatic lipase activity is commonly used for the diagnosis of pancreatitis in dogs and cats. Even though the assay has generally been shown to yield consistent results with feline pancreatic lipase immunoreactivity (fPLI) assay, the agreement may vary between assays of different manufacturers. In this study, the chance-corrected agreement between a DGGR-lipase assay offered by one of the biggest providers of diagnostic solutions in Poland and fPLI assay was investigated. The study was carried out on 50 cats in which DGGR-lipase activity and fPLI were tested in the same blood sample. The chance-corrected agreement was determined using Gwet’s AC1 coefficient separately for the fPLI assay’s cut-off values of >3.5 μg/L and >5.3 μg/L. The DGGR-lipase activity significantly positively correlated with fPLI (Rs = 0.665; CI 95%: 0.451, 0.807, p < 0.001). The chance-corrected agreement between the fPLI assay and DGGR-lipase assay differed considerably depending on the cut-off values of the DGGR-lipase assay. When the cut-off value reported in the literature (>26 U/L) was used, it was poor to fair. It was moderate at the cut-off value recommended by the laboratory (>45 U/L), and good at the cut-off value recommended by the assay’s manufacturer (>60 U/L). The highest agreement was obtained between the fPLI assay at the cut-off value of 3.5 μg/L and the DGGR-lipase assay at the cut-off value of 55 U/L (AC1 = 0.725; CI 95%: 0.537, 0.914) and between the fPLI assay at the cut-off value of 5.3 μg/L and the DGGR-lipase assay at the cut-off value of 70 U/L (AC1 = 0.749; CI 95%: 0.577, 0.921). The study confirms that the chance-corrected agreement between the two assays is good. Prospective studies comparing both assays to a diagnostic gold standard are needed to determine which of them is more accurate.
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Cyclosporine Treatment in Cats with Presumed Chronic Pancreatitis-A Retrospective Study. Animals (Basel) 2021; 11:ani11102993. [PMID: 34680012 PMCID: PMC8532754 DOI: 10.3390/ani11102993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Chronic pancreatitis (CP) is a common disease in middle-aged to older cats. Cyclosporine, an immunosuppressive drug, has been suggested as an alternative treatment when other drugs that suppress inflammation are ineffective or unsuitable. However, no published studies have investigated its efficacy in cats with CP. The aim of this retrospective study was to evaluate the efficacy of cyclosporine as a treatment for pancreatitis in cats with presumed CP. All cats had a history and clinical signs suggestive of CP and blood samples showed abnormally high concentrations of feline pancreas-specific lipase (Spec fPL) on at least two occasions. This is common in CP. All cats were treated with cyclosporine for at least three weeks. Nineteen cats, aged 6.9–17.5 years, were included. Daily treatment with cyclosporine resulted in an improvement of serum Spec fPL concentrations which indicates that the pancreatic inflammation likely had improved. The study has several limitations, including different treatment durations and doses, lack of biopsies to confirm CP and the treatment effect was not compared with an untreated control group. Despite the limitations, our results suggest that cyclosporine treatment decreases serum Spec fPL concentrations and may be effective in the management of feline chronic pancreatitis. Abstract Chronic pancreatitis (CP) is a common disease in middle-aged to older cats. Cyclosporine has been suggested as an alternative treatment when other immunosuppressive treatments are insufficient or contraindicated. However, no published studies have investigated its efficacy on feline CP. The aim of this retrospective study was to evaluate the efficacy of cyclosporine on supranormal serum feline pancreas-specific lipase (Spec fPL) concentrations in cats with presumed CP. Inclusion criteria were history and clinical signs suggestive of CP, serum Spec fPL concentrations above 5.3 μg/L (reference range 0–3.5 μg/L, equivocal range 3.6–5.3 μg/L) on at least two occasions and treatment with cyclosporine for at least three weeks. Serum Spec fPL was analyzed at Idexx Laboratories, Kornwestheim, Germany. Nineteen cats, aged 6.9–17.5 years (median 11.6), were included. No pancreatic biopsies were available. Median (range) serum Spec fPL concentration was 14.2 μg/L (6.1–43.3) at baseline and 6.7 μg/L (0.9–23.6) at follow-up. Cyclosporine treatment (5.0–7.9 mg/kg orally SID) was associated with a significant reduction in serum Spec fPL concentrations (p < 0.001) at follow-up after 23–206 days (median 35). Body weight decreased significantly between inclusion and follow-up (p = 0.013). Significant improvement of clinical signs could not be measured (p = 0.781). This study has several limitations, including unstandardized treatment length and dose, no control group and lack of pancreatic biopsies. Despite the limitations, our results suggest that cyclosporine treatment reduces supranormal serum Spec fPL concentrations in cats with presumed CP.
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Sorrell S. Diagnosing and treating chronic vomiting in cats. IN PRACTICE 2021. [DOI: 10.1002/inpr.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Kook P, Oppliger S. Letter regarding "ACVIM consensus statement on pancreatitis in cats". J Vet Intern Med 2021; 35:1648-1649. [PMID: 34021508 PMCID: PMC8295706 DOI: 10.1111/jvim.16165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Peter Kook
- Vetsuisse Faculty University of Zurich, Clinic for Small Animal Internal Medicine, Zurich, Switzerland
| | - Samuel Oppliger
- Vetsuisse Faculty University of Zurich, Clinic for Small Animal Internal Medicine, Zurich, Switzerland
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Forman MA, Steiner JM, Armstrong PJ, Camus MS, Gaschen L, Hill SL, Mansfield CS, Steiger K. Response to letter regarding "ACVIM consensus statement on pancreatitis in cats". J Vet Intern Med 2021; 35:1646-1647. [PMID: 34021507 PMCID: PMC8295654 DOI: 10.1111/jvim.16164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Marnin A Forman
- Cornell University Veterinary Specialists, Stamford, Connecticut, USA
| | - Joerg M Steiner
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - P Jane Armstrong
- College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA
| | - Melinda S Camus
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Lorrie Gaschen
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Steve L Hill
- Flagstaff Veterinary Internal Medicine Consulting, Flagstaff, Arizona, USA
| | - Caroline S Mansfield
- Melbourne Veterinary School, University of Melbourne, Melbourne, Victoria, Australia
| | - Katja Steiger
- Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
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Forman MA, Steiner JM, Armstrong PJ, Camus MS, Gaschen L, Hill SL, Mansfield CS, Steiger K. Response to letter regarding "ACVIM consensus statement on pancreatitis in cats". J Vet Intern Med 2021; 35:1650-1651. [PMID: 34021509 PMCID: PMC8295698 DOI: 10.1111/jvim.16167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Marnin A Forman
- Cornell University Veterinary Specialists, Stamford, Connecticut, USA
| | - Joerg M Steiner
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - P Jane Armstrong
- College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA
| | - Melinda S Camus
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Lorrie Gaschen
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Steve L Hill
- Flagstaff Veterinary Internal Medicine Consulting, Flagstaff, Arizona, USA
| | | | - Katja Steiger
- Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
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Neumann S. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in dogs and cats with acute pancreatitis. Vet Clin Pathol 2021; 50:45-51. [PMID: 33759228 DOI: 10.1111/vcp.12979] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 08/13/2020] [Accepted: 08/26/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been described as prognostic markers in cancer and inflammatory diseases. The use of these measurements in dogs and cats with acute pancreatitis has not yet been investigated. OBJECTIVE The objective was to evaluate NLR and PLR for usefulness as biomarkers for severity and clinical course of acute pancreatitis in dogs and cats. METHODS In this prospective study, we investigated 67 dogs and 41 cats with acute pancreatitis and 17 healthy dogs and cats as controls. We compared the NLR and PLR of dogs and cats with acute pancreatitis with control animals. The severity of disease was measured using a modified "bedside index of severity in acute pancreatitis" (BISAP) score in humans, and the course of the disease was measured with the time to clinical recovery. RESULTS NLR and PLR were significantly higher in dogs and cats with pancreatitis than in healthy controls. However, no significant relationship between NLR or PLR and disease severity was found, as assessed with the modified BISAP score. Dogs and cats with pancreatitis and prolonged recovery displayed a significantly increased PLR, and those same cats also displayed a significantly increased NLR. CONCLUSIONS We conclude that increased NLR and PLR provide information regarding the course of pancreatitis in dogs and cats.
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Affiliation(s)
- Stephan Neumann
- Institute of Veterinary Medicine, University of Goettingen, Goettingen, Germany
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18
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Forman MA, Steiner JM, Armstrong PJ, Camus MS, Gaschen L, Hill SL, Mansfield CS, Steiger K. ACVIM consensus statement on pancreatitis in cats. J Vet Intern Med 2021; 35:703-723. [PMID: 33587762 PMCID: PMC7995362 DOI: 10.1111/jvim.16053] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022] Open
Abstract
Background Pancreatitis in cats, although commonly diagnosed, still presents many diagnostic and management challenges. Objective To summarize the current literature as it relates to etiology, pathogenesis, diagnosis, and management of pancreatitis in cats and to arrive at clinically relevant suggestions for veterinary clinicians that are based on evidence, and where such evidence is lacking, based on consensus of experts in the field. Animals None. Methods A panel of 8 experts in the field (5 internists, 1 radiologist, 1 clinical pathologist, and 1 anatomic pathologist), with support from a librarian, was formed to assess and summarize evidence in the peer reviewed literature and complement it with consensus clinical recommendations. Results There was little literature on the etiology and pathogenesis of spontaneous pancreatitis in cats, but there was much in the literature about the disease in humans, along with some experimental evidence in cats and nonfeline species. Most evidence was in the area of diagnosis of pancreatitis in cats, which was summarized carefully. In contrast, there was little evidence on the management of pancreatitis in cats. Conclusions and Clinical Importance Pancreatitis is amenable to antemortem diagnosis by integrating all clinical and diagnostic information available, and recognizing that acute pancreatitis is far easier to diagnose than chronic pancreatitis. Although both forms of pancreatitis can be managed successfully in many cats, management measures are far less clearly defined for chronic pancreatitis.
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Affiliation(s)
- Marnin A Forman
- Cornell University Veterinary Specialists, Stamford, Connecticut, USA
| | - Joerg M Steiner
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - P Jane Armstrong
- College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA
| | - Melinda S Camus
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Lorrie Gaschen
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Louisiana, USA
| | - Steve L Hill
- Flagstaff Veterinary Internal Medicine Consulting, Flagstaff, Arizona, USA
| | | | - Katja Steiger
- Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
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Griffin S. Feline abdominal ultrasonography: What's normal? What's abnormal? The pancreas. J Feline Med Surg 2020; 22:241-259. [PMID: 32093577 DOI: 10.1177/1098612x20903599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PRACTICAL RELEVANCE Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the pancreas is a vital part of the investigation into feline pancreatic disease. CLINICAL CHALLENGES Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings such as nodular hyperplasia and pathological changes such as neoplasia can be challenging. AIM This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination and appearance of the normal and diseased pancreas. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. EQUIPMENT Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience. EVIDENCE BASE Information provided in this article is drawn from the published literature and the author's own clinical experience.
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Affiliation(s)
- Sally Griffin
- Radiology Department, Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull B90 4NH, UK
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20
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Abstract
In recent years, increased awareness of feline pancreatitis by the veterinary profession and improved diagnostic modalities have led to an increased frequency of diagnosis of pancreatitis in this species. Consequently, pancreatic diseases, especially chronic pancreatitis, are considered highly prevalent, even in populations of apparently healthy individuals. This prevalence has led to the suspicion that the condition may be overdiagnosed. This article summarizes the difficulties of diagnosis of acute and chronic pancreatitis, assesses the reasons why this is a challenging disease to recognize, and considers whether these difficulties could result in either overdiagnosis or underdiagnosis.
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Lester S. New Tests in Feline Veterinary Medicine: When to Use Them and When to Stick with Tried-and-True Tests. Vet Clin North Am Small Anim Pract 2020; 50:883-898. [PMID: 32360014 DOI: 10.1016/j.cvsm.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The focus of this article is on how interpretations of laboratory data can utilize both population and individual reference intervals, while making the most of routine testing procedures coupled with some of the newer laboratory tests, which can complement the existing tests in diagnosing disease.
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Affiliation(s)
- Sally Lester
- True North Veterinary Diagnostics, Langley, British Columbia, Canada; Pilchuck Veterinary Hospital, Snohomish, WA, USA.
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22
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Nivy R, Kaplanov A, Kuzi S, Mazaki-Tovi M, Yas E, Segev G, Ben-Oz J, Lavy E, Aroch I. A retrospective study of 157 hospitalized cats with pancreatitis in a tertiary care center: Clinical, imaging and laboratory findings, potential prognostic markers and outcome. J Vet Intern Med 2018; 32:1874-1885. [PMID: 30315665 PMCID: PMC6271303 DOI: 10.1111/jvim.15317] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 08/03/2018] [Accepted: 08/09/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pancreatitis in cats (FP) has been increasingly diagnosed in recent years, but clinical studies of large numbers of affected cats are scarce. OBJECTIVES To describe a large cohort of cats with FP requiring hospitalization. ANIMALS One hundred and fifty-seven client-owned cats. METHODS Retrospective study, including cats diagnosed with pancreatitis based on sonographic evidence, positive SNAP feline pancreatic lipase immunoreactivity test results, increased 1,2-o-dilauryl-rac-glycerol-glutaric Acid-(6'-methylresorufin ester)-lipase activity, histopathology, or some combination of these. RESULTS One-hundred and twenty-two cats (77.7%) survived to discharge. Median time from onset of clinical signs to presentation was longer (P = .003) in nonsurvivors. Causes of FP included recent general anesthesia, trauma, hemodynamic compromise, and organophosphate intoxication, but most cases (86.6%) were idiopathic. Ultrasonographic findings consistent with pancreatitis were documented in 134 cats, including pancreatomegaly (81.3%), decreased (31.3%), or increased (14.9%) pancreatic echogenicity, extra-hepatic biliary tract dilatation (24%), and increased peri-pancreatic echogenicity (13%). Lethargy (P = .003), pleural effusion (P = .003), hypoglycemia (P = .007), ionized hypocalcemia (P = .016), azotemia (P = .014), parenteral nutrition administration (P = .013), and persistent anorexia during hospitalization (P = .001) were more frequent in nonsurvivors, whereas antibiotics were more frequently administered to survivors (P = .023). Nevertheless, when Bonferroni's correction for multiple comparisons was applied, none of the variables was statistically significant. CONCLUSIONS AND CLINICAL IMPORTANCE Previously unreported, clinically relevant, potential prognostic factors, including hypoglycemia, azotemia, parenteral nutrition, and withholding antibacterial treatment were identified in this exploratory study. These preliminary results should be examined further in confirmatory studies.
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Affiliation(s)
- Ran Nivy
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Alina Kaplanov
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Sharon Kuzi
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Michal Mazaki-Tovi
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Einat Yas
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Gilad Segev
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Jennifer Ben-Oz
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Eran Lavy
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Itamar Aroch
- Department of Small Animal Internal Medicine, Koret School of Veterinary Medicine - Veterinary Teaching Hospital and Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel
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Bayton WA, Westgarth C, Scase T, Price DJ, Bexfield NH. Histopathological frequency of feline hepatobiliary disease in the UK. J Small Anim Pract 2018; 59:404-410. [DOI: 10.1111/jsap.12810] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 11/30/2022]
Affiliation(s)
- W. A. Bayton
- Department of Veterinary Medicine; University of Cambridge; Cambridge UK
| | - C. Westgarth
- Department of Veterinary Medicine and Science; The University of Nottingham; Nottingham UK
| | - T. Scase
- Bridge Pathology LTD; Bristol, BS7 0BJ UK
| | - D. J. Price
- Department of Veterinary Medicine; University of Cambridge; Cambridge UK
| | - N. H. Bexfield
- Department of Veterinary Medicine and Science; The University of Nottingham; Nottingham UK
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25
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Köster LS, Shell L, Ketzis J, Rajeev S, Illanes O. Diagnosis of pancreatic disease in feline platynosomosis. J Feline Med Surg 2017; 19:1192-1198. [PMID: 28094661 DOI: 10.1177/1098612x16685676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives Platynosomum species are cat-specific parasitic trematodes that parasitize the biliary ducts and gall bladder. Due to the common connection to the major duodenal papilla of the pancreas and common bile ducts in addition to the periductal proximity of the pancreas, it is possible that platynosomosis could cause pancreatitis. The objective of this study was to determine whether platynosomosis, a commonly diagnosed parasitic disease in cats on St Kitts, has any association with pancreatic disease. Methods To investigate this possibility, the pancreas of free-roaming cats with naturally acquired platynosomosis were evaluated via ultrasound, serum concentrations of feline pancreatic lipase (fPL), cobalamin, folate and feline trypsin-like immunoreactivity (fTLI) and histopathology. Twenty free-roaming, young adult, feral cats, positive for feline immunodeficiency virus, and diagnosed with Platynosomum species infection via fecal analysis were recruited. The liver, biliary system and pancreas were evaluated via ultrasonography during a short duration anesthesia. Serum concentrations of fPL, fTLI, folate and cobalamin were measured. Sections of the right limb, left limb and body of the pancreas were evaluated histopathologically using hematoxylin and eosin (H&E) stain. Results None of the cats had sufficient criteria to fulfill the ultrasonographic diagnosis of pancreatitis. One cat had an elevated fPL concentration in the range consistent with pancreatitis. Four cats had cobalamin deficiencies and 11 had abnormal folate concentration. The fTLI concentration was equivocal for the diagnosis of exocrine pancreatic insufficiency in one cat. With a single exception, histopathology changes, when present (n = 12), were mild, non-specific and predominantly characterized by lymphocytic infiltrates and fibrosis. The exception was a cat that presented a chronic interstitial and eosinophilic pancreatitis of slightly increased severity, likely the result of platynosomosis. Conclusions and relevance The results of this study suggest that platynosomosis rarely induces pancreatic damage in cats. With only one exception, chronic pancreatitis diagnosed in cats with fluke-induced cholangitis and cholangiohepatitis was subtle and interpreted as an incidental background lesion unrelated to platynosomosis.
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Affiliation(s)
- Liza S Köster
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, West Indies
- Current address: School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Linda Shell
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, West Indies
| | - Jennifer Ketzis
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, West Indies
| | - Sreekumari Rajeev
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, West Indies
| | - Oscar Illanes
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, West Indies
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Schaefer S, Kooistra HS, Riond B, Suchodolski JS, Steiner JM, Prins M, Zini E, Reusch CE. Evaluation of insulin-like growth factor-1, total thyroxine, feline pancreas-specific lipase and urinary corticoid-to-creatinine ratio in cats with diabetes mellitus in Switzerland and the Netherlands. J Feline Med Surg 2016; 19:888-896. [DOI: 10.1177/1098612x16664390] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives The aim of the study was to evaluate circulating insulin-like growth factor-1 (IGF-1), feline pancreas-specific lipase (fPLI) and total thyroxine (TT4) concentrations and urinary corticoid-to-creatinine ratio (UCCR) as indicators for the prevalence of acromegaly, pancreatitis, hyperthyroidism and hypercortisolism in cats with diabetes mellitus. Methods Blood and urine samples were collected from diabetic cats treated in primary care clinics in Switzerland and the Netherlands. Standardised questionnaires and physical examination forms provided clinical information from owners and veterinarians. Laboratory testing included serum biochemistry profile analysis and measurement of circulating fructosamine, IGF-1, fPLI, and TT4 concentrations and UCCR. CT of the pituitary gland was performed using a multidetector computed tomography scanner. Results Blood samples were available from 215 cats and urine samples were collected at home from 117 cats. Age ranged from 2–18 years (median 12 years) and body weight from 2.7–12.3 kg (median 5.5 kg). Sixty-five percent of the cats were castrated male and 35% were female (33% spayed); 82% were domestic shorthair cats. Eighty percent of cats received a porcine insulin zinc suspension, 19.5% insulin glargine and 0.5% a human neutral protamine hagedorn insulin. Thirty-six of 202 (17.8%) cats had IGF-1 concentrations >1000 ng/ml. Serum fPLI, and TT4 concentrations and UCCR were increased in 86/196 (43.9%), 9/201 (4.5%) and 18/117 cats (15.3%), respectively. Prevalence did not differ between countries. Conclusions Hyperthyroidism is rare, whereas increased fPLI concentration, possibly reflecting pancreatitis, is common in diabetic cats. The high UCCR may reflect activation of the hypothalamus–pituitary–adrenal axis, which also occurs in diabetic humans. The percentage of cats with increased IGF-1 was high but lower than reported in recent studies.
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Affiliation(s)
- Sandra Schaefer
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Hans S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Barbara Riond
- Clinical Laboratory, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Jan S Suchodolski
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, USA
| | - Jörg M Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, USA
| | - Marrit Prins
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Eric Zini
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Department of Animal Medicine, Production and Health, University of Padova, Legnaro, Italy
- The Veterinary Institute of Novara, Granozzo con Monticello, Italy
| | - Claudia E Reusch
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Ultrasound Imaging of the Hepatobiliary System and Pancreas. Vet Clin North Am Small Anim Pract 2016; 46:453-80, v-vi. [DOI: 10.1016/j.cvsm.2015.12.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Oppliger S, Hilbe M, Hartnack S, Zini E, Reusch CE, Kook PH. Comparison of Serum Spec fPL(™) and 1,2-o-Dilauryl-Rac-Glycero-3-Glutaric Acid-(6'-Methylresorufin) Ester Assay in 60 Cats Using Standardized Assessment of Pancreatic Histology. J Vet Intern Med 2016; 30:764-70. [PMID: 26968865 PMCID: PMC4913568 DOI: 10.1111/jvim.13924] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 01/11/2016] [Accepted: 02/18/2016] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Feline pancreas-specific lipase (Spec fPL) is considered a useful test for the antemortem diagnosis of pancreatitis in cats. A recent study found good agreement between the results of the Spec fPL and catalytic 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester (DGGR) lipase assay. Prospective studies evaluating their sensitivity and specificity are lacking. OBJECTIVES To compare the results of the Spec fPL and the DGGR assays with a standardized histologic assessment of the pancreas. ANIMALS Sixty client-owned cats presented for necropsy. METHODS PROSPECTIVE STUDY Spec fPL concentrations and serum DGGR lipase activity were measured from the same blood sample. The pancreas was removed within 3 hours after euthanasia; serial transverse sections were made every 0.5 cm throughout the entire pancreas and reviewed using a histologic grading scheme. Sensitivity and specificity for the Spec fPL and DGGR assay results were determined. RESULTS The sensitivity and specificity for the Spec fPL assay (cutoff value ≥5.4 μg/L) was 42.1 [95% confidence interval (95% CI), 29.4-55.9%] and 100% (95% CI, 31.0-100.0%). The sensitivity and specificity for the DGGR assay (cutoff value >26 U/L) was 36.8 (95% CI, 24.7-50.7%) and 100% (95% CI, 31.0-100.0%). When lymphocytic inflammation up to 10% of a section was considered normal, the sensitivity and specificity for Spec fPL assay (cutoff value ≥5.4 μg/L) was 61.1 (95% CI, 36.1-81.7%) and 69.0% (95% CI, 52.8-81.9%) and the sensitivity and specificity for the DGGR assay (cutoff value >26 U/L) was 66.7 (95% CI, 41.2-85.6%) and 78.6% (95% CI, 62.8-89.2%). CONCLUSIONS AND CLINICAL IMPORTANCE Both lipase assays performed similarly well, but their agreement with histologic pancreatic inflammation was limited.
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Affiliation(s)
- S Oppliger
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - M Hilbe
- Institute for Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - S Hartnack
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - E Zini
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Department of Animal Medicine, Production and Health, University of Padova, Legnaro, PD, Italy.,Istituto Veterinario di Novara, Granozzo con Monticello, NO, Italy
| | - C E Reusch
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - P H Kook
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Zini E, Hafner M, Kook P, Lutz TA, Ohlerth S, Reusch CE. Longitudinal evaluation of serum pancreatic enzymes and ultrasonographic findings in diabetic cats without clinically relevant pancreatitis at diagnosis. J Vet Intern Med 2015; 29:589-96. [PMID: 25818213 PMCID: PMC4895493 DOI: 10.1111/jvim.12565] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 11/24/2014] [Accepted: 01/28/2014] [Indexed: 12/18/2022] Open
Abstract
Background Cats with diabetes mellitus can have subclinical pancreatitis but prospective studies to confirm this are lacking. Metabolic control of diabetic cats with pancreatitis is difficult. Hypothesis Subclinical pancreatitis occurs in diabetic cats at the time diabetes is diagnosed or might develop during the follow‐up period, hampering diabetic remission. Animals Thirty cats with newly diagnosed diabetes without clinical signs of pancreatitis on admission. Methods Prospective study. On admission and 2 and 6 months later, serum Spec fPL and DGGR‐lipase were measured and the pancreas underwent ultrasonographic examination. Pancreatitis was suspected if serum markers were increased or ≥2 ultrasonographic abnormalities were detected. Cats were treated with insulin glargine and diabetic remission was defined as euglycemia ≥4 weeks after discontinuation of insulin. Nonparametric statistical tests were used for analysis. Results Subclinical pancreatitis at the time of diagnosis was suspected in 33, 50, and 31% of cats based on Spec fPL, DGGR‐lipase and ultrasonography, respectively; and in 60% when diagnostic criteria were combined. During the follow‐up period, suspected pancreatitis developed in additional 17–30% cats. Only 1 cat had transient clinical signs compatible with pancreatitis. Seventeen of the 30 cats (57%) achieved remission. Frequency of abnormal Spec fPL and DGGR‐lipase and abnormal ultrasonographic findings did not differ in cats achieving remission and those who did not. Cats achieving remission had significantly lower Spec fPL at 2 months (P < .001). Conclusions and Clinical Importance Based on laboratory and ultrasonographic measurements, many cats with diabetes might have pancreatitis, although without clinical signs. Cats with high Spec fPL might have a reduced chance of diabetic remission; however, this topic needs further studies in large cohorts of diabetic cats.
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Affiliation(s)
- E Zini
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland; Department of Animal Medicine, Production and Health, University of Padova, Legnaro, PD, Italy; Istituto Veterinario di Novara, Granozzo con Monticello, NO, Italy
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Sparkes AH, Cannon M, Church D, Fleeman L, Harvey A, Hoenig M, Peterson ME, Reusch CE, Taylor S, Rosenberg D. ISFM Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats. J Feline Med Surg 2015; 17:235-50. [DOI: 10.1177/1098612x15571880] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Practical relevance: Diabetes mellitus (DM) is a common endocrinopathy in cats that appears to be increasing in prevalence. The prognosis for affected cats can be good when the disease is well managed, but clinical management presents challenges, both for the veterinary team and for the owner. These ISFM Guidelines have been developed by an independent, international expert panel of clinicians and academics to provide practical advice on the management of routine (uncomplicated) diabetic cats. Clinical challenges: Although the diagnosis of diabetes is usually straightforward, optimal management can be challenging. Clinical goals should be to limit or eliminate clinical signs of the disease using a treatment regimen suitable for the owner, and to avoid insulin-induced hypoglycaemia or other complications. Optimising bodyweight, feeding an appropriate diet and using a longer acting insulin preparation (eg, protamine zinc insulin, insulin glargine or insulin detemir) are all factors that are likely to result in improved glycaemic control in the majority of cats. There is also some evidence that improved glycaemic control and reversal of glucose toxicity may promote the chances of diabetic remission. Owner considerations and owner involvement are an important aspect of management. Provided adequate support is given, and owners are able to take an active role in monitoring blood glucose concentrations in the home environment, glycaemic control may be improved. Monitoring of other parameters is also vitally important in assessing the response to insulin. Insulin adjustments should always be made cautiously and not too frequently – unless hypoglycaemia is encountered. Evidence base: The Panel has produced these Guidelines after careful review of the existing literature and of the quality of the published studies. They represent a consensus view on practical management of cats with DM based on available clinical data and experience. However, in many areas, substantial data are lacking and there is a need for better studies in the future to help inform and refine recommendations for the clinical management of this common disease.
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Affiliation(s)
| | | | - David Church
- Professor, Small Animal Medicine and Surgery Group, The Royal Veterinary College, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
| | - Linda Fleeman
- Animal Diabetes Australia, Rowville Veterinary Clinic, Rowville, VIC 3178, Australia
| | - Andrea Harvey
- Small Animal Specialist Hospital, North Ryde, NSW 2113, Australia
| | - Margarethe Hoenig
- Professor, Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana-Champaign, Illinois, USA
| | - Mark E Peterson
- Animal Endocrine Clinic, 21 West 100th Street, New York, NY 10025, USA
| | - Claudia E Reusch
- Professor & Director, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | | | - Dan Rosenberg
- Micen Vet Centre, 58 Rue Auguste Perret, Parc Technologique, Europarc, 9400 Créteil, France
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