Complex therapy of exocrine pancreatic insufficiency in dogs. Pancreatitis in dogs, symptoms and treatment

Factors causing pancreatitis

AT recent times Many physicians have come to the conclusion that acute and chronic pancreatitis are phases of the same disease. Pancreatitis is a fairly common disease in small pets, but the issues of diagnosis and treatment

remain complex. Diagnosis of pancreatitis is one of the most difficult in both humane gastroenterology and veterinary medicine associated with non-specific manifestations clinical symptoms diseases and laboratory methods research. In veterinary medicine, pancreatic diseases are divided into non-inflammatory (diabetes mellitus, acinar atrophy leading to exocrine pancreatic insufficiency), inflammatory (acute edematous pancreatitis, acute hemorrhagic pancreatitis, etc.), pancreatic tumors (insulinomas, adenocarcinomas) and fibrosis with atrophy of the pancreas.

The factor that causes damage to the pancreas in both dogs and cats is often unknown. As provoking factors, they suggest abundant feeding with fatty foods, obesity and hyperlipidemia (in miniature schnauzers), infections (toxoplasmosis and infectious peritonitis virus in cats, parvovirus in dogs), pancreatic duct obstruction, ischemic and traumatic lesions pancreas caused by surgical intervention, and the injury itself, as well as a number of medications that can cause functional impairment.

genetic predisposition. To this disease miniature schnauzers, Yorkshire terriers, cocker spaniels, poodles are predisposed. In German Shepherds, pancreatic acinar atrophy is inherited and is transmitted in an autosomal recessive manner.

The pathogenesis (mechanism of development) of the disease includes autoimmune destruction of pancreatic tissue and atrophy of the acini. The affected areas of the gland decrease in size and cease to function.

Exocrine pancreatic insufficiency in dogs can develop at any age, but is more common in dogs younger than 4 years of age. German Shepherds and Rough Collies are predisposed to this disease. According to statistics, 70% of dogs with exocrine pancreatic insufficiency are German Shepherds, and 20% are Wire Collies.

In cats the cause of the disease is usually pancreatitis, no genetic inheritance has been identified.

Breed predisposition

• Miniature Schnauzers, Miniature Poodles, Cocker Spaniels
• Siamese cats

Average age and age range

• Acute pancreatitis is most common in middle-aged and older dogs (over 7 years old) with a median age of 6.5 years. Average age acute pancreatitis in cats 7.3 years.

Sexual predisposition

• Bitches (dogs)

Risk factors (contributing to the development of pancreatitis)

• Breed
• Obesity
• Intercurrent diseases in dogs such as diabetes, hyperadrenocorticism, chronic insufficiency kidney, neoplasia
• Recent drug use
• See also reasons

Pathophysiology

• The body has many defense mechanisms to prevent the gland from being self-digested by the digestive enzymes it secretes.
• Under certain circumstances, these natural mechanisms collapse, and self-digestion processes appear when enzymes begin to be activated inside the acinar cells.
• Local and systemic tissues are damaged by the activity of released gland enzymes and free radicals.

The reasons
Initial Causes The occurrence of pancreatitis in both dogs and cats remains unknown. The following etiological factors should be considered:

• Nutritional - hyperlipoproteinemia
• Ischemia and injury of the pancreas (pancreas)
• Duodenal reflux
• Medications and toxins (see Contraindications)
• Obstruction of the pancreatic ducts
• chronic kidney disease
• Hypercalcemia
• Infectious agents (toxoplasma and feline peritonitis virus).

Course of the disease.Pancreatitis is conditionally divided into acute and chronic. Acute pancreatitis is an inflammation that develops suddenly without showing any signs before. Chronic pancreatitis - long term inflammatory disease, which is often accompanied by irreversible morphological changes in the structure of the body. Acute pancreatitis can be mild (edematous) or severe, often fatal, in the form hemorrhagic pancreatic necrosis. Normally, the pancreas has a number of protective mechanisms that prevent the activation of digestive enzymes in the gland itself and its self-digestion. As a result of premature activation of enzymes (trypsin, and then chymotrypsin, lipase, etc.), edema and necrosis occur, damage to the walls of blood vessels. Clinical symptoms are quite diverse. Usually, dogs have lesions of the gastrointestinal tract (vomiting, diarrhea), pain in the epigastric region, weakness, refusal to feed. The disease very often develops some time after feeding. Severe forms of the disease are manifested by severe pain, which can quickly lead to the development of collapse and shock. This condition is very characteristic of the prayer posture (forelegs stretched forward, rib cage lies on the floor, and the back of the animal is raised). In cats, symptoms are often non-specific and may include lethargy, depression, and food refusal.

Affected Systems

• Gastrointestinal - change in mobility (ileus) due to regional chemical peritonitis, localized or generalized peritonitis due to increased permeability; hepatic damage due to shock, pancreatic enzymes, inflammatory cell infiltrates, and cholestasis.
• Urinary - hypovolemia from loss of gastrointestinal secretions, which can cause prerenal azotemia.
• Respiratory - pulmonary edema, pleural effusion, or pulmonary embolism in some animals.
• Cardiovascular - cardiac arrhythmia due to release of myocardial depressant factor in some animals.
• Blood/lymphatic/immune - disseminated intravascular coagulation in some animals.

Clinical features typically associated with this disease.

Clinical signs in dogs are more related to gastrointestinal disturbances.

• Clinical signs in cats are more vague, non-specific, and non-localized.

• Lethargy/depression common in cats and dogs
• Anorexia (in both species)
• Vomiting is more common in dogs due to acute inflammation, less common in cats
• Dogs may exhibit abdominal pain by displaying abnormal postures.
• Diarrhea is more common in dogs than in cats

• Usually dehydration
• Some animals feel fluid in the distended bowel loops
• Massive lesions are felt on palpation
• Fever is more common in dogs, and fever and hypothermia have been noted in cats.
• Jaundice is more common in cats than in dogs.

Less common systemic abnormalities include respiratory distress, bleeding disorders, cardiac arrhythmias

. Let's list them point by point:

• Arrhythmia
• heart murmur
• Muffled heart sounds
• Prolongation of capillary filling time
• Tachycardia
• Weakness of the pulse
• abnormal stretch
• Anorexia
• Ascites
• Bloody feces
• Decrease in the amount of feces
• Diarrhea
• Hematemesis
• Melena
• Vomiting, regurgitation
• Ataxia, discoordination
• Dysmetria, hypermetria, hypometria
• Fever, pyrexia
• Generalized weakness, paresis, paralysis
• Inability to stand
• Hypothermia
• Jaundice
• Abdominal masses
• Obesity
• Paleness of mucous membranes
• Petechiae and ecchymosis
• Polydipsia
• tetraparesis
• Trembling, tremor, fasciculation
• Lack of weight, fatness
• Weight loss
• Coma, stupor
• Stupidity, depression, lethargy
• head tilt
• Convulsions and fainting, convulsions, collapse
• Anisocoria
• nystagmus
• Colic, abdominal pain
• Pain from external pressure on the abdomen
• Abnormal lung and pleural sounds
• Muffled lung and pleural sounds
• Dyspnea
• Nose bleed
• Tachypnea
• Cold skin, ears, limbs
• Glucosuria
• Hematuria
• Hemoglobinuria or myoglobinuria
• Ketonuria
• Polyuria
• Proteinuria

Differential Diagnosis

• Differentiate acute pancreatitis from other abdominal pain
• Perform a complete blood count, biochemistry, and urinalysis to rule out metabolic disease.
• Perform an abdominal x-ray to rule out organ perforation; generalized loss of detail suggests pleural effusion; check for organomegaly, masses, radiopaque stones, obstructive disease, and radiopaque foreign bodies.
• Do abdominal ultrasonography to rule out masses or organomegaly.
• Perform paracentesis and fluid analysis if the patient has an effusion.
• Special studies are needed, including gastrointestinal contrast radiography, excretory urography, cytological examination.

Blood and urine tests

• Hemoconcentration, left shift leukocytosis, toxic neutrophils in many dogs
• Cats are more variable and may have neutrophilia (30%) and nonregenerative anemia (26%)
• Prerenal azotemia reflecting dehydration.
• Liver enzyme activity (ALT and AST) is often high as a consequence of hepatic ischemia and exposure to pancreatic toxins.
• Hyperbilirubinemia is more common in cats, caused by hepatocellular damage and intra- or extrahepatic obstruction.
• Hyperglycemia in dogs and cats with necrotizing pancreatitis caused by hyperglucagonemia. Intermediate degree hypoglycemia in some dogs. Cats with purulent pancreatitis may be hypoglycemic.
• Hypercholesterolemia and hypertriglyceridemia often.
• Serum amylase and lipase activity is high in some dogs, but non-specific. Serum amylase and lipase activity is high in some animals with liver disease, kidney disease, or neoplasia in the absence of pancreatitis. Administration of dexamethasone may increase serum lipase concentrations in dogs. Lipase may be high or normal in cats. Amylase is usually normal or decreased in cats. In general, lipase activity is a more reliable marker in the diagnosis of pancreatitis. A normal serum lipase level does not rule out disease.
• Urinalysis results are normal.

Laboratory tests The diagnosis can be indirectly confirmed by an increase in the activity of pancreatic amylase and lipase in the blood, but their normal content does not exclude inflammation of the pancreas. Conversely, an increase in these indicators in the absence of clinical symptoms of the disease does not indicate pancreatitis in an animal. Often there is an increase in transaminases (ALT, AST), leukocytosis, an increase in bilirubin, glucose. Abroad, trypsin-like immunoreactivity in blood serum is measured in animals. On ultrasound, even an edematous pancreas is often not visualized. Indirect sign is the presence of gas (flatulence) in gastrointestinal tract with radiography and ultrasound of organs abdominal cavity.

• The trypsin immunoreactivity test (TIRT) is specific to the pancreas and high serum concentrations have been observed in some dogs and cats with pancreatitis.
• TIRT tends to increase faster and returns to normal faster than amylase and lipase in dogs.
• Reduced glomerular filtration may cause an increase in serum TIRT.
• Normal TIRT values ​​do not rule out pancreatitis.

ELISA for trypsinogen-activating peptide (TAP)

• Acute pancreatitis stimulates intrapancreatic trypsinogen activation by tPA release into the blood serum. TPA is then excreted from the body in the urine.
• The recent development of the TPA ELISA test has made this study possible, but is not yet commercially available.

This assay is intended to be released as a specific and rapid aid in the diagnosis of acute pancreatitis.

Diagnostics

Contrary to popular belief, the activity of amylase and lipase in the blood are not decisive factors for the diagnosis of pancreatitis. The fact is that, unlike in humans, in acute pancreatitis in dogs and cats, the level of these enzymes can be normal, while in other diseases of the gastrointestinal tract, for example, a foreign body of the intestine or enteritis, their level can be high.

A sensitive pancreatitis test recently developed at Texas A&M University called Pancreatic Lipase Immunoreactivity (PLI) is not yet available in Ukraine.

Given the above, to diagnose pancreatitis, the doctor must analyze the animal's symptoms, clinical and biochemical blood tests, ultrasound and / or x-ray results of the abdominal cavity. Since uncomplicated pancreatitis is treated therapeutically, and its symptoms are similar to those of intestinal obstruction, the main diagnostic task that the doctor solves is to exclude a pathology that requires emergency surgical intervention.

Also, to diagnose pancreatic insufficiency, the doctor uses the maximum data about the animal, taking into account its breed, age, symptoms, data on the presence of the disease in the parents, and analysis of feces for the digestibility of food.

Visual diagnostic methods
X-ray of the abdomen

• Increased soft tissue opacity in the right cranial abdominal corpora. Loss of visceral detail (ground glass) due to pleural effusion.
• The presence of static gas in the proximal duodenum.
• Expansion of the angle between the pylorus and the proximal part of the duodenum.
• Delayed transit of contrast from the stomach and proximal small intestine.

chest x-ray

• Pulmonary edema
• Pleural effusion
• Changes suggestive of pulmonary embolism

Ultrasonography

• Inhomogeneous dense and cystic masses show pancreatic abscesses.
• Loss of normal pancreatic echogenicity in many patients.

Other diagnostic tests

• An ultrasound-guided biopsy can confirm the diagnosis.
• Laparotomy and pancreatic biopsy may be required to identify or confirm pancreatitis.

Histopathological studies

• Edematous pancreatitis - medium edema
• Necrotizing pancreatitis - greyish-yellow areas of pancreatic necrosis accompanied by varying degrees hemorrhages.
• Chronic pancreatitis - the pancreas is small in size, dense, gray in color, may contain extensive adhesions with surrounding organs.
• Microscopic changes include edema, parenchymal necrosis, and neutrophil cell infiltrate in animals with acute lesions. Chronic lesions are characterized by fibrosis of the pancreas around the ducts, hyperplasia of the ductal epithelium, and a mononuclear cell infiltrate.

Prevention

• Weight loss for obesity
• Avoiding a high-fat diet
• Avoid taking drugs that can cause pancreatitis.

Possible Complications

• Pulmonary edema
• Heart rhythm disorders
• Peritonitis
• Hepatic lipidosis in cats
• No response to supportive therapy.
• Diabetes
• Exocrine pancreatic insufficiency

Expected course and forecast

• Good prognosis for animals with edematous pancreatitis. These patients generally respond well to treatment. Relapse or treatment failure is most commonly observed in animals that are prematurely administered oral nutrition.
• Poor or cautious prognosis in animals with necrotizing pancreatitis and life-threatening complications.

Owner education (familiarization with the complexity of the disease and prognosis)

• Discuss the need for prolonged hospitalization.
• Discuss the possibility of complications such as relapse, diabetes mellitus, exocrine insufficiency.

Surgical aspects

• Surgery may be needed to remove an acute pancreatic abscess or necrotic tissue in patients with necrotizing pancreatitis.
• Extrahepatic obstruction caused by pancreatitis requires surgical correction.

Medicines and liquids.

Diet. In mild cases, a fasting diet for at least a day and painkillers and antispasmodics are indicated to reduce pancreatic secretion. In severe cases, it is necessary to hospitalize the animal with an intensive infusion therapy to prevent the development of such serious conditions as pulmonary edema, peritonitis, DIC. In therapy, analgesics (butorphanol), parenteral or enteral nutrition through a probe, plasma, and protease inhibitors (kontrykal) are also used. antacids and antiemetics, antisecretory drugs (sandostatin), antioxidant drugs (Mexidol, Essentiale), antibiotic therapy, lytic mixtures, dopamine.

• Aggressive intravenous therapy- pledge successful treatment. Balanced electrolyte solutions such as Ringer's lactate are the first choice in treatment. The volume of rehydration required for initial adjustment must be accurately calculated and entered over the first 4-6 hours.
• Colloids (dextrans and hetarstach) may be necessary to maintain pancreatic microcirculation.
• After making up the deficiency, additional fluids are given to provide support for the patient's needs and ongoing losses. Potassium chloride is needed because of the usual loss of potassium during vomiting.

• Corticosteroids are indicated only for patients in shock.
• Central antiemetics for patients with intractable vomiting are chlorpromazine (every 8 hours) and prochlorperazine (every 8 hours).
• Antibiotics are needed if the patient has clinical or laboratory evidence of sepsis - penicillin G (every 6 hours), ampicillin sodium (every 8 hours) and possibly aminoglycosides.
• Analgesics may become necessary to relieve abdominal pain: butorphanol (every 8 hours s.c.) is an effective remedy for dogs and cats.

Contraindications

• Avoid the use of anticholinergic drugs such as atropine. These drugs have variable effects on pancreatic secretion and can cause generalized suppression of GI motility leading to ileus.
• Avoid the use of azathioprine, chlorothiazide, estrogen, furosemide, tetracycline, and sulfamethazole.

Warning

• Use corticosteroids only in patients who are adequately hydrated due to corticosteroids' promotion of vasodilation. Corticosteroids may complicate pancreatitis.
• Use phenothiazine antiemetics only in well hydrated patients, as these drugs have an antihypertensive effect.
• Use dextrans cautiously in patients with hemorrhagic pancreatitis as they may contribute to bleeding.

conclusions

• Assessing the patient's hydration is especially important in the first 24 hours of starting treatment. Evaluation of results, general analysis blood, total plasma protein, residual urea nitrogen, body weight, diuresis - 2 times a day.
• Evaluation of rehydration therapy after 24 hours, correction of the intensity of fluid administration and its composition, respectively. Repeat serum chemistry to assess electrolytes and acid-base balance.
• Repeat plasma enzyme assay (eg, lipase or TIRT) after 48 hours to assess inflammatory status.
• Careful monitoring of systemic complications. Perform appropriate diagnostic tests as needed (see Complications).
• As Permission clinical signs gradually introduce oral nutrition.

Likar - VOLODYMYR GENADYOVYCH SUVOROV

Diseases of the pancreas of dogs

The pancreas is located between the sheets of the mesentery of the duodenum and stomach, has the right and left lobes. Her excretory ducts open at duodenum. The mass of the gland is 10-100 g, which corresponds to 0.13-0.36% of the dog's body weight. The endocrine part of the gland is only 3% and is formed by cells of the islets of Langerhans. Alpha cells secrete the hormone glucagon, beta cells secrete insulin. In addition, this part of the gland produces lipocaine, vagotonin and other hormone-like substances.

Most of the gland has exocrine function and produces digestive juice containing the enzymes trypsinogens, chymotrypsinogens, proelastase, ribonuclease, amylase, lipase, involved in the digestion of proteins, carbohydrates and fats from food. Owing to the fact that most of glands are an exocrine organ; with the development of a pathological process, the digestive function primarily suffers. Only in chronic disease is the insular part involved (or in the case of its specific lesion). Then it breaks endocrine function glands.

Four main forms of pancreatic lesions have been described: acute pancreatitis, chronic sclerosing pancreatitis (pancreocyrrhosis), hereditary atrophy, and insulinoma. Insulinoma and atrophy occur in german shepherds, in isolated cases in beagles and giant schnauzers. In dogs of other breeds, chronic sclerosing pancreatitis predominates, manifesting more often as symptoms of diabetes than exocrine insufficiency. There is no similar selectivity in the occurrence of acute pancreatitis. The incidence of pancreopathy in German Shepherds is 8 per 1000, and in other breeds - 3 per 10,000

exocrine insufficiency . The pancreas, due to its complex anatomical location, is difficult to respond to conventional physical methods research. Its condition can only be judged by the violation of the functions of other organs associated with it. Lack of function of the gland can manifest itself both in the lack of enzymes and in the inability of the digestive juice to maintain an alkaline pH in the intestine. Under these conditions, normal intestinal cavitary digestion is disrupted, microbes multiply intensively in the thin section, intestinal dysbacteriosis occurs, which further worsens digestive processes. Violated parietal enzymatic digestion (maldigestion syndrome) and absorption of enzymatic hydrolysis products (malabsorption syndrome). Exhaustion increases with increased appetite (malnutrition syndrome), the function of other endocrine glands is disrupted.

Symptoms. Endocrine pancreatic insufficiency is characterized by: polydipsia and polyuria, vomiting, flatulence (discharge of fetid gases), pancreatogenic diarrhea (malodorous, with increased defecation and an increase in the volume of feces, not amenable to therapy), pancreatogenic stools (polyfecalia is a voluminous stool in the form of foamy, soft, porous colorless masses with sour smell, oily sheen and undigested food residues, sometimes with an admixture of blood), polyphagia up to coprophagia, flatulence of all parts of the intestine, hyperglycemia, glucosuria, hypocholesterolemia, an increase in serum amylase, steatorrhea, creatorrhea, amylorrhea, fecal acidity.

Diagnosis it is not always possible to deliver during the life of the animal. If during the examination the listed symptoms are found, there is reason to suspect pancreopathy. Ascites in combination with hyperglycemia also indicates the involvement of the pancreas in the pathological process. For greater confidence in the diagnosis, one or two functional tests are performed.

Differential Diagnosis. Symptoms of exocrine pancreatic insufficiency must be distinguished from polyphagy caused by chronic enteritis, and various kinds malabsorption. For pancreopathy characterized by polyphagia against the background of progressive cachexia. The activity and performance of the animal for a long time may persist, which is not characteristic of chronic enteritis and hepatopathy (rapid increase in depression, temporary or prolonged loss of appetite). Pancreopathy is also distinguished by concomitant bradycardia; in contrast to enterocolitis, defecation is frequent, but tenesmus is absent.

Acute pancreatitis . Necrosis of the pancreas caused by enzymatic autolysis of tissues with hemorrhagic impregnation. The etiology has not been precisely established. Acute pancreatitis is observed when bile enters the lumen of the gland ducts. Important role plays the activation of proteolytic enzymes in the gland itself, resulting in enzymatic digestion (autolysis) of its parenchyma with hemorrhages and fatty necrosis.

Symptoms. Acute pancreatitis occurs more often in females with impaired fat metabolism. The disease begins suddenly after eating and develops over several hours or days. In mild cases, growing weakness, apathy, vomiting, fetid diarrhea, increased body temperature, sometimes anemia, jaundice, ascites and other symptoms of exocrine pancreatic insufficiency syndrome.

Severe cases of the disease (acute necrosis of the pancreas) are manifested by severe pain, quickly leading to the development of collapse and shock. Pain is accompanied by excruciating vomiting, salivation and bradycardia. The animal assumes a forced position of "prayer": the front paws are extended forward, the chest lies on the floor, and the rear part of the body is raised. Palpation reveals acute pain in the abdominal wall. In the blood and urine, already in the first hours of the disease, increased content amylase. However, with necrotizing pancreatitis, the content of amylase may be normal or even reduced. In these cases, a decrease in the amount of calcium in the blood and an increase in the activity of aspartate aminotransferase have a certain diagnostic value.

Acute pancreatitis lasts for several days and may end in complete recovery or progress to chronic recurrent pancreatitis. In severe form, death can occur in the initial period of the disease with the phenomena of collapse, shock and peritonitis.

Treatment provides for: 1) combating shock - intravenous drip infusion of a 5% glucose solution, dextrans, blood or plasma transfusion; 2) creation of physiological rest for the pancreas: complete starvation for 2-4 days, subject to parenteral administration of Alvezin; 3) inactivation of proteolytic enzymes by antienzymatic drugs (gordox, contrykal, etc.); 4) suppression of pancreatic secretion and elimination of pain (atropine and analgin with seduxen); 5) prevention of secondary infection (antibiotics).

If acute pancreatitis is suspected, it is better to play it safe and immediately begin intensive treatment, since in the event of a diagnostic error it will not hurt, and a delay in prescribing therapy will no longer save the patient's life. When an improvement in the condition of the animal occurs, it is recommended to slowly start feeding high-quality proteins and fat - several times a day in small portions.

Atrophy of the pancreas . The atrophied gland looks no thicker than a parchment sheet, transparent, but retains its ducts. Mostly German Shepherds are affected. The etiopathogenesis is unknown. Animals are born with a normal pancreas. Its atrophy and, as a result, exocrine insufficiency develop in the first months of life, but sometimes even in middle age. Factors causing atrophy of the gland have not been established.

Symptoms. The anamnesis of the disease is already characteristic, indicating the strongest hunger of the animal up to eating its own feces and, despite this, progressive emaciation. Along with common symptoms The semiotics of the disease is supplemented by the following data: frequent defecation, the amount of feces is very increased, they are excreted in large single or multiple small scattered piles, have a wet sheen, foamy in texture, with an unpleasant sour smell and, depending on the fat content, colorless gray or clay yellow. In such pancreatogenic stools, undigested grains of cereals or pieces of potatoes can be found. At times, feces may be shaped. In the abdominal cavity, the sounds of splashing and rumbling are auscultated, the large intestine filled with fecal masses is palpated. Pronounced bradycardia. The coat of a sick animal is disheveled, does not hold well, dry skin, scaly.

Diagnosis put almost unmistakably by a combination of five symptoms: a German shepherd, a sharp emaciation of the animal, irrepressible appetite, pancreatogenic stools, hypocholesterolemia.

Atrophic pancreatitis completely excludes the reserve secretory capacity of the gland. Without treatment, sick animals die.

Treatment. The main role is assigned replacement therapy. The animal is prescribed pancreatic enzyme preparations (pancreatin, panzinorm), painkillers and antibiotics. Diet. It is recommended to give only lean meat and no fats and carbohydrates. If treatment fails, euthanasia is offered.

insulinoma . A hormonally active tumor, an adenoma, that develops from the beta cells of the islets of Langerhans and produces excessive amounts of insulin. Very rare in German Shepherds. Excessive production of insulin by adenoma causes increased destruction of glucose in the body and a state of chronic hypoglycemia.

Symptoms. Hypoglycemia leads to muscle tremors, ataxia, epileptiform seizures, and eventually to hypoglycemic coma.

Diagnosis suggest on the basis of three signs: German Shepherd, hypoglycemia below 2.8 mmol / l, epileptiform convulsions. Differentiate from severe liver dystrophy and insufficiency of the function of the adrenal cortex. Only diagnostic laparotomy can serve as the final confirmation of the diagnosis.

Treatment. If an insulinoma is detected, a partial pancreectomy is performed. Before surgery, therapeutic diet: 1/3 meat and 2/3 starch jelly, 4-6 portions per day.

Operation technique. General anesthesia is performed in the dorsal position of the animal, and then laparotomy along the white line in the supra-umbilical region. Examine organs. Allocate the proportion of the gland affected by the tumor. The glandular tissue is separated with tweezers at some distance from the tumor and the intralobular artery is exposed. Ligate and cross the arteries. Remove the affected part of the gland. The wound of the abdominal wall is sutured.

Most common cause The development of exocrine pancreatic insufficiency (EPFP) in dogs is atrophy of the secretory acini in the pancreas. Most often this pathology is detected in German Shepherds, but the disease can develop in dogs of other breeds, including mestizos. It is known that German Shepherds have a genetic predisposition to HELV, but the etiology of this phenomenon is unknown. The disease is progressive in nature: at a young age, the exocrine function of the pancreas is normal, the first clinical signs of the disease begin to appear in animals aged 1 to 5 years. In other cases, NEPV can be caused by chronic, recurrent inflammation (pancreatitis), which is commonly seen in cats, and pancreatic hypoplasia. NEPV and diabetes mellitus often complicate the course of chronic pancreatitis in dogs.

TABLE OF CONTENTS

2.1Pathophysiology

Clinical signs of NEPV usually appear when the secretory activity of this organ is reduced by about 90%. Insufficiency of digestive enzymes leads to disruption of the processes of digestion and absorption in the intestine. In addition, abnormal activity of digestive enzymes in small intestine, traffic disruption nutrients, atrophy of the intestinal villi, infiltration of the intestinal mucosa by inflammatory mediator cells were found in all cases of NEPV. A common complication that accompanies the disease - a violation of the intestinal microflora - often leads to en-teropathy caused by antibiotics (EPA).TABLE OF CONTENTS

2.2 Clinical symptoms and results of general physical examination

The three classic signs of NEPV are chronic unexplained diarrhea, weight loss, and polyphagia. At the same time, feces are poorly formed, stand out in in large numbers and have signs of steatorrhea. Often seen liquid stool. Often in sick animals there is a tendency to coprophagia, while vomiting is rarely observed in them. Dog owners celebrate with their pets severe flatulence and rumbling in the stomach. Outwardly, dogs with NEPV look emaciated, muscle mass their coat is reduced, the coat loses its luster and becomes unpleasant, greasy to the touch. However, animals are physically active and mobile. If your dog is drowsy, refuses to eat, and has a fever, the diarrhea is most likely due to another illness.TABLE OF CONTENTS

2.3Diagnosis

Many laboratory tests are used to diagnose NEPV, with the most effective method- definition tripsyn-like immunoreactivity (TPIR) in the blood. Kits for the determination of TPIR are strictly species specific, therefore, only special kits should be used for dogs and cats (for example, a kit is used for catsfTLI by GI-Lab , USA). Other laboratory studies (biochemical or hematological) do not give a specific result, but they are necessary to identify concomitant diseases. If helminthic invasion or bacterial infection is suspected, fecal examinations are performed (for the presence of helminth eggs and for bacteriological cultivation).

When determining TPIR, the amount of trypsinogen in the patient's blood is measured. The only source of trypsinogen in the body is the pancreas, so the test result indirectly reflects the amount of functionally active glandular tissue. The determination of TPIR is carried out after a 12-hour fast and is very sensitive and specific. Values ​​below 2.5 µg/l clearly indicate HELV, while values ​​in the range of 2.5-5 µg/l are normal. TPIR is stable at room temperature and can remain unchanged for several days, but it rapidly degrades when heated. Therefore, samples, especially in summer, should be protected from direct sun rays. If the level of TPIR in the patient's blood is normal, the diagnosis of NEPV is excluded.TABLE OF CONTENTS

2.4Treatment

Most dogs and cats affected by NEPV have a good clinical response to enzyme replacement therapy. .More convenient It is best to use powdered enzyme substitutes without special coatings. The initial dosage is 2 teaspoons of powder for every 20 kg of animal body weight with each serving of food. It must be emphasized that enzyme substitutes must be supplied to the animal's body with each portion of food, even with treats. Otherwise, diarrhea may recur. Enzyme substitutes in the form of tablets or capsules for cats and dogs are less effective than powders. The clinical symptoms of NEPV are reduced after the start of enzyme replacement therapy, and in the future, the dose of enzyme replacements can be gradually reduced until minimal effective dosage. It should be borne in mind that different batches of replacement enzymes may have different enzymatic activities. In the treatment of NEPV, enzyme replacement therapy should not be supplemented with pre-treatment of feed with enzyme preparations for 30 minutes, administration of drugs that reduce the acidity of gastric juice (for example, type 2 histamine receptor antagonists) and enrich the animal's feed with bile salts or soda. Very good substitutes for pancreatic enzymes are fresh frozen porcine pancreas. When stored frozen at -20°C, they retain a large amount of active enzymes for 1 year.

For cats with NEPV, it is good to supplement enzyme replacement therapy with parenteral administration of cobalamin, since in this pathology they have impaired absorption of vitamin B 12 in the digestive tract.TABLE OF CONTENTS

3Pancreatitis

Pancreatitis in cats and dogs is difficult to diagnose, but with careful examination, a number of symptoms can be identified. The easiest way to identify acute necrotizing pancreatitis, the outcome of which is usually unfavorable. Indolent recurrent acute or chronic pancreatitis is most common in cats and quite common in dogs. Treating pancreatitis is quite difficult. Severe acute forms require immediate hospitalization of the patient and intensive care to prevent death. At the same time, sluggish chronic pancreatitis is quite treatable at home with the help of appropriate diet therapy.TABLE OF CONTENTS

3.1 Definitions and pathophysiology

Pancreatitis in small domestic animals is a variety of forms of diseases that differ in severity - from mild subclinical forms that occur without obvious symptoms to acute necrotizing pancreatitis, which most often ends in the death of the patient. The classification of forms of pancreatitis is based on histopathological changes in the tissues of the pancreas:

Acute pancreatitis: neutrophil infiltration, necrosis, edema. The changes are potentially reversible.

Chronic pancreatitis: monocyte infiltration, fibrosis. Usually has a relapsing course.

These types of disease, in turn, are divided into subtypes, including acute necrotizing pancreatitis (in which there is marked necrosis of the adipose tissue surrounding the pancreas) and chronic active pancreatitis (characterized by the infiltration of pancreatic tissue by both neutrophils and monocytes against the background of nodular pancreatic hyperplasia and fibrosis) . Histopathological classification is useful for understanding the mechanisms of disease development, but is not very effective clinically. In this regard, it is more convenient to apply a classification based on the characteristics of the clinical course of the pathology, taking into account the scoring of the severity of pancreatitis and its symptoms. (see table).

Scoring system for assessing the severity of pancreatitis in dogs and cats (according to Ruaux , 2000)

*Note: The scoring system for assessing the severity of pancreatitis is based on the number of organ systems involved in pathological process and damaged as a result of the disease at the time of applying for veterinary care.

The pathophysiology of pancreatitis is still not fully understood. Acinar cells of a healthy pancreas secrete enzymes involved in the initial stage of digestion of food components (the products of their activity, relatively low molecular weight compounds, are further destroyed by the enzymes of the brush border of the cells of the mucous membrane of the small intestine). The composition of pancreatic enzymes includes lipase (the pancreas is the main source of this enzyme), a-amylase, phospho-lipase, proteolytic enzymes (elastase, chymotrypsin and trypsin). Normally, pancreatic cells are protected from the action of produced enzymes due to the fact that many of them are synthesized as inactive precursors, the so-called zymogens (for example, trypsinogen and chymotrypsinogen). Zymogens accumulate in special granules separated from lysosomes. In addition, the content of the granules contains a pancreatic trypsin inhibitor, which prevents premature activation of this enzyme. Trypsin is activated in the lumen of the small intestine by enterokinase. The activated trypsin then activates chymotrypsin.

The main link in the pathogenesis of pancreatitis is the unacceptable fusion of lysosomes with granules containing zymogens in pancreatic acinar cells. The acidic environment of lysosomes inactivates secreted trypsin and other enzymes in cells, local " self-digestion", an inflammatory reaction and necrosis of the acini of the gland develops, and then - necrosis of the adipose tissue surrounding the pancreas. Free enzymes enter the abdominal cavity, where they cause local or extensive peritonitis, as well as into the bloodstream. In the blood, pancreatic enzymes are relatively rapidly inactivated by a number of plasma protease inhibitors, in particular, a 1 -antitrypsin (also known as "plasma a r protease inhibitor). Inhibitor o ^- antitrypsin temporarily binds proteases, and then transfers them to a 2 -macroglobulin, which, in turn, binds these enzymes irreversibly. The resulting complex of pancreatic enzyme and o ^- macroglobulin excreted by the reticuloendothelial system. In severe pancreatitis, the number of proteinase inhibitors in blood decreases, and free active proteolytic enzymes appear in the plasma. The action of these enzymes, as well as the activation of neutrophils and monocytes, the absorption into the bloodstream of endotoxins from the lumen of the gastrointestinal tract and the release pro-inflammatory cytokines and active oxygen radicals directly from pancreatic tissues and leukocytes into the blood, alveoli and other organs lead to generalized inflammatory reaction, vasodilation, increased blood clotting and simultaneous activation of fibrinolysis. In especially severe cases, disseminated intravascular coagulation (DIC) can occur. The functions of many organs are impaired, especially the kidneys (prerenal and / or renal azotemia develops) and the lungs (in especially severe cases, pulmonary edema and acute respiratory failure may develop).

The factors leading to the development of pancreatitis in each case are not fully known. Under experimental conditions, it is possible to induce the development of pancreatitis by obstructing the secretory duct of the gland. In this case, the disease is usually mild, although it can be exacerbated by stimulating the secretory activity of the pancreas. Obstruction of the excretory duct caused by a neoplasm in the pancreas, due to cholangitis or inflammation of the intestine, may be the cause of pancreatitis. This is especially true for cats, in which the excretory duct of the pancreas merges with the bile duct at the place where it enters the duodenum.

In dogs, the development of pancreatitis is often preceded by overeating fatty foods. It is possible that in this case, the pathogenetic mechanisms leading to pancreatitis begin with gastric overflow and stimulation of increased secretion in the pancreas. An important factor contributing to the development of pancreatitis is hypertriglyceridemia(hereditary or caused by diet or endocrine disorders). Pancreatitis can also be caused by certain medications. However, in relation to steroids, the data are contradictory: these drugs do increase the activity of lipase in the secretion of the gland by 5 times, but so far in the experiment they have not been able to induce pancreatitis with their help.TABLE OF CONTENTS

3.2 Clinical symptoms

Clinical signs of pancreatitis vary depending on the severity of the disease. The classic triad of symptoms (vomiting + severe pain in the cranial abdomen ± "praying posture") in dogs and cats is observed only in severe, acute cases. Often, pancreatitis is accompanied by acute colitis, in which there is fresh blood in a small amount of feces - this is a consequence of local peritonitis, spreading to the transverse colon, adjacent to the left lobe of the pancreas. In severe cases, the patient has collapse and signs of dehydration against the background of shock symptoms, and in especially severe cases, acute renal failure, respiratory failure, DIC.

In other, milder forms of acute or chronic pancreatitis, the symptoms of the disease may be mild. It is usually represented by anorexia with or without mild bouts of colitis, occasional vomiting, increased flatulence, and mild abdominal pain. These forms of pancreatitis are especially common in cats. In these animals, it is often very difficult to distinguish pancreatitis from cholangitis or intestinal inflammation. In addition, in cats, these pathologies often accompany each other, which further complicates the diagnosis.

With pancreatitis, there is a risk of developing acute or chronic complications. Sharp forms diseases can cause dehydration, acidosis, electrolyte imbalance as a result of transient vomiting and anorexia (hypokalemia, hypochloridemia, hyponatremia), prerenal azotemia, and in some cases, a systemic inflammatory reaction, hypotension, respiratory failure and DIC. In cats, acute pancreatitis is often accompanied by the development of hepatic lipidosis. Accompany pancreatitis in cats (rarely in dogs) also cholangitis and cholangiohepatitis, which is determined by the anatomical proximity of the proximal pancreas and bile duct in both species. The liver tissue is affected due to the ingress of inflammatory mediators into it with blood from the portal vein.

Chronic pancreatitis can cause destruction of so much of the pancreatic secretory units that the patient develops diabetes mellitus, NEPV, or both. People with chronic pancreatitis usually develop diabetes mellitus earlier, which precedes the development of NEPV by several months. This is due to the fact that diabetes mellitus begins to manifest itself clinically with the loss of 80% of the active glandular tissue of the pancreas, and NEFP - with the loss of 90% of this tissue.TABLE OF CONTENTS

3.3Laboratory diagnostics

It is rather difficult to diagnose pancreatitis, since at the present stage there are no specific and sensitive diagnostic methods, except for the histopathological examination of biopsy specimens of pancreatic tissue obtained during surgery, during laparoscopy or post-mortem. Clinical symptoms and anamnesis data suggest the presence of pancreatitis, especially in acute course: if the dog constantly has vomiting and severe pain in the anterior part of the abdomen after overeating, there is reason to suspect acute pancreatitis. However, such symptom complex may also be the result of partial or complete intestinal obstruction, volvulus, intussusception of the intestine or perforation of a stomach ulcer. For milder pancreatitis in both cats and dogs clinical symptoms become nonspecific: similar signs are observed with various diseases gastrointestinal tract, liver, etc. For differential diagnosis further research is needed.

In the absence of biopsy specimens, the diagnosis of pancreatitis is usually based on clinicopathological tests and ultrasound examination of the pancreas. At clinical analysis blood, neutrophilic leukocytosis is most often detected with a shift of the formula to the left (with severe forms- with a degenerative shift to the left). When the patient is dehydrated, the hematocrit increases. Chronic pancreatitis in cats in 20-80% of cases is accompanied by mild anemia, which is rarely observed in dogs. In severe cases, due to DIC, the number of platelets decreases. Hypokalemia is common in both dogs and cats. It is often accompanied by hyperglycemia (glucose can even be detected in the urine) due to stress and the release of hydrocortisol, catecholamines and glucagon into the blood. But cats with purulent pancreatitis may have hypoglycemia. Although one of the possible causes of pancreatitis is considered hypercalcemia, the course of the disease leads to the development of mild hypocalcemia and hypomagnesemia due to saponification of fats in the adipose tissue surrounding the pancreas. With pancreatitis, very often detected hypercholesterolemia and hypertriglyceridemia in blood samples obtained during fasting. These deviations can be both a cause and a consequence of pathological processes in the pancreas. In severe acute cases, azotemia associated with prerenal kidney failure and kidney damage due to dehydration and the action of toxins. To clarify the severity of kidney damage, it is useful to determine the specific gravity of urine and examine its sediment. In the blood of patients with pancreatitis, due to damage to liver cells by toxins entering this organ through the portal vein, the activity of liver enzymes is often slightly or moderately increased.

The above shifts are non-specific. Monitoring of these indicators is useful for evaluating the effectiveness of pancreatitis therapy, but not for diagnostic purposes. To diagnose the disease, the activity of pancreatic enzymes is determined in the patient's blood: amylase, lipase and trypsin. For amylase and lipase, a direct catalytic determination is carried out, which evaluates the number of active centers, and for trypsin, the determination trypsin-like immunoreactivity (TPIR). Sometimes the content of specific pancreatic lipase (SPL) is also analyzed. This enzyme is defined immunologically antigens that are not part of its active site. Immunological methods convenient in that they make it possible to identify not only the active forms of enzymes, but also the corresponding zi-mogen. All immunological tests are strictly species-specific.

In dogs, the determination of the content of pancreatic enzymes in the blood is the main method of diagnosing the disease. These tests are not always sufficiently sensitive and specific, but they are the most accessible and common. It would be ideal to supplement the obtained data with an ultrasound examination of the pancreas. The content of pancreatic enzymes in the blood of dogs, corresponding to the norm, does not exclude the presence of pancreatitis! The level of amylase, compared with the level of lipase and TPIR, rarely increases in pancreatitis, therefore, in a diagnostic study, it is not enough to determine the content of only amylase in the blood. When diagnosing a disease, the content of all three pancreatic enzymes in the patient's blood should be determined.

In cats, methods for determining blood levels of amylase and lipase are of no diagnostic value. The TPID test is the only test available for diagnosing pancreatitis in cats. The specificity of the test for determining TPIR in cats for pancreatitis is about 80%, and the sensitivity of the test is 46-80%. This is much higher than other diagnostic methods that do not involve obtaining pancreatic tissue samples.

It is optimal, however, to complement the determination of TPIR in cats with an ultrasound of the pancreas. Ultrasound diagnostics well reveals acute necrotic forms of pancreatitis, in which the production of enzymes is weakened, and the determination of TPIR is especially convenient for diagnosing chronic pancreatitis, when changes in the pancreas are not noticeable during ultrasound examination.

Other diagnostic techniques currently used in humans, dogs and cats are used only to clarify the diagnosis and predict the outcome of pancreatitis. They include the definition trypsin-activating peptide (TAP) in urine and blood serum, blood levels of trypsin complex withά 1 -inhibitor protei-naz and pancreatic lipase immunoreactivity (IRLS) in dogs. In medicine, the content of a series is also determined pro-inflammatory cytokines in the blood serum, which allows you to clarify the prognosis of the outcome of the disease.TABLE OF CONTENTS

3.4Instrumental diagnostics

Along with determining the content of pancreatic enzymes in the patient's blood ultrasound procedure(ultrasound) of the pancreas is one of the few specific methods for diagnosing pancreatitis. However, the peculiarities of the location of the pancreas in dogs and cats impose increased requirements on the qualifications and experience of the specialist conducting the examination. Ultrasound can diagnose pancreatitis because this pathology is accompanied by swelling of the gland, its swelling, necrosis of the adipose tissue surrounding the gland, and peritonitis. Ultrasound can also detect neoplasms, abscesses or pseudocysts in the pancreas, as well as diagnose cholangitis and thickening of the walls of the small intestine near the gland.

Radiography of the abdominal cavity allows only to clarify the diagnosis of "pancreatitis". It can be used to detect if a patient has foreign bodies in the gastrointestinal tract, which is important for differential diagnosis. For acute pancreatitis in cats and dogs radiographically a decrease in density and local peritonitis in the anterior part of the abdominal cavity is detected. In the ventrodorsal projection, dilatation of the duodenum and its displacement laterally and dorsally from the normal position, caused by pancreatic edema, are revealed. The transverse colon is also displaced, most often in a caudal direction. Contrasting it is better not to use barium: it does not give significant advantages, and filling the lumen of the gastrointestinal tract with a contrast agent stimulates the secretion of pancreatic enzymes in the affected pancreas.. TABLE OF CONTENTS

3.5Treatment

The method of treating pancreatitis in dogs and cats is largely determined by its form and severity at the time of seeking veterinary care. If it is possible to identify the cause of pancreatitis (for example, hypercalcemia) should be removed. In most cases, pancreatitis is idiopathic character, and only symptomatic therapy is possible. In addition, comorbidities that complicate the course of the disease (cholangitis, intestinal inflammation, in cats - liver lipidosis) should be identified and treated.

In severe necrotizing pancreatitis (3-4 points) in cats and dogs, the prognosis of the outcome of the disease is very unfavorable. These patients usually have severe water and electrolyte balance against the background of a systemic inflammatory reaction, there is renal failure and increased risk DIC syndrome. Patients are shown intensive care, including plasma transfusions and tube feeding (in some cases, a full transfer to parenteral nutrition). It is best to hospitalize the patient in a specialized veterinary clinic. The prognosis of the outcome of the disease is very unfavorable.

Mild pancreatitis (score 0) may require hospitalization for 12 to 24 hours for intravenous fluid therapy, especially if the patient is vomiting and shows signs of dehydration. If there are no signs of dehydration, and general state the animal is satisfactory, it can be treated at home by the method of "unloading" the pancreas (enteral administration of fluids) within 24-48 hours. If necessary, the animal is given analgesics. For a long time, the animal is fed an appropriate dietary ration. In animals with chronic pancreatitis Mild gastrointestinal symptoms and anorexia are commonly observed intermittently.

Moderate forms of pancreatitis (1-2 points), accompanied by vomiting and dehydration, require hospitalization, during which patients undergo fluid therapy, fasting, and pain relief. In many cases, the use of antibiotics is indicated, and in some - transfusion of blood plasma. .TABLE OF CONTENTS

3.5.1 Intravenous administration of fluids and electrolytes

Intravenous fluid therapy is of great importance in any form of pancreatitis, but is especially effective in mild forms of the disease. It allows you to eliminate the violation of the water and electrolyte balance caused by vomiting, and to ensure a sufficient amount of blood flow through the pancreas. In fluid therapy, blood substitute solutions are used (in particular, lactated Ringer's solution). The rate of administration and the volume of infused fluid depend on the degree of dehydration of the patient. With mild or moderate pancreatitis (0-1 points), it is usually sufficient to maintain the rate of fluid administration. in more severe forms of the disease, it is necessary to deal with developing shock (injection rate up to 90 ml / kg / hour for 30-60 minutes. In such cases, after therapy with Ringer's solution, it is necessary to introduce solutions of synthetic colloids. The content of electrolytes in the patient's blood should be carefully monitored .Severe pancreatitis is usually accompanied by hyponatremia, hypochloremia, hypocalcemia and hypomagnesemia, while hypokalemia is of particular danger and requires immediate correction. The level of potassium in the blood must be measured and, as necessary, introduce additional potassium chloride into the infusion fluid. Intravenous fluid therapy against the background of fasting and increased loss of potassium through the kidneys can exacerbate hypokalemia, as this accelerates its excretion by the kidneys, and absorption decreases. Given this phenomenon, it is recommended to increase the amount of potassium in lactated Ringer's solution from the usual 5 meq/l to 20 meq/l. The rate of introduction of potassium into the body, as a rule, should not exceed 0.5 meq / l / kg / hour.

In especially severe cases (2-4 points), blood plasma transfusion is recommended. This allows you to replenish stocks of o^ - a nittrypsin and (x 2 -macroglobulin in the patient's blood. Blood clotting factors are introduced with donor plasma, therefore, to reduce the risk of CVD, it is better to supplement plasma transfusion with the administration of heparin. .TABLE OF CONTENTS

3.5.2 Unloading the pancreas

"Unloading" the pancreas occurs during complete starvation and is traditionally used in the treatment of acute pancreatitis. When "unloading" the stimulation of the pancreas caused by the filling of the stomach or the ingress of proteins and fats into the lumen of the duodenum is minimized. However, this technique is excluded for the treatment of humans and animals with signs of malnutrition and exhaustion. In addition, even when normal weight animal, this approach is not always acceptable - in cats, for example, Anorexia Painkillers and anti-inflammatory drugs

Pancreatitis in both humans and animals is accompanied by severe pain. The condition of patients in the clinic should be closely monitored and, if necessary, anesthesia should be applied. For this, opiates are often used - morphine and its analogues (in particular, buprenorphine). Non-steroidal anti-inflammatory drugs in pancreatitis are contraindicated - their use increases the risk of ulceration in the gastrointestinal tract and potentiates the development of renal failure in animals with arterial hypertension and shock. In pancreatitis, steroids should not be used either - these agents have not been proven to reduce inflammation in the pancreas, but it is well known that steroids reduce the activity of the reticuloendothelial system. .TABLE OF CONTENTS

3.5.4 Antibiotics

With pancreatitis, infectious complications are relatively rare, but if they occur, they are very difficult. In these cases, the use of antibiotics significantly reduces mortality. Thus, patients with acute pancreatitis are advised to prescribe broad-spectrum antibiotics, since it is not always possible to assess the risk of sepsis. For antibiotic therapy commonly used enrofloxacin and trimethoprim sulfate, which penetrate the pancreatic tissue and are effective against most pathogenic bacteria. Metronidazole is added to patients who have concomitant colon inflammation and bacterial overgrowth in the small intestine. This drug (in combination with ampicillin) is also effective for cholangitis. .TABLE OF CONTENTS

3.5.5 Antiemetics and prevention of gastrointestinal ulceration

Antiemetics can stop the incessant vomiting often seen in patients with pancreatitis. In this case good effect(especially in dogs) gives the use of metoclopramide. However, this drug stimulates gastric motility, which in some animals increases pain and increases the production of pancreatic enzymes. In such cases, one should apply Antiemetics from the group of phenothiazines, such as chlorpromazine. In patients with acute necrotizing pancreatitis, the risk of ulceration in the gastrointestinal tract due to localized peritonitis is increased. Their condition should be closely monitored, and if symptoms of an ulcer appear, sucralfate and acid inhibitors of gastric secretion should be used. .TABLE OF CONTENTS

3.5.6 Diet: initiation of feeding and dietary rations for long-term use

The composition of the diet for long-term feeding of sick animals depends on the history, in particular, on whether a single attack of acute pancreatitis was observed or the patient suffers from recurrent chronic pancreatitis. In the latter case, there is no other way to prevent the occurrence of exacerbations, except for the transfer of the animal to a special diet with low content fat. It is believed that in some cases, to enhance the effect, a small amount of pancreatic enzymes should be introduced into the diet. In humans, this technique relieves pain somewhat, but it is not clear how effective this is in preventing recurrence of the disease. . DipECVIM- CA , MRCVS , ILTM

reto Nyger received his degree in veterinary medicine in 1988 from Switzerland. After that, for a year he combined the work of a veterinarian and a researcher, which gave him the opportunity to receive a degree. Dr th rays, etc. Occurs without prior sensitization of the body.

excess selenium, excessia seleni (from lat. abundantia excess - selenum selenium) is an endemic disease with an excess of selenium in soils and plants. Manifested by emaciation, stunting, hypotension of the proventriculus, softening of the horns and hooves, hair loss.

Isosthenuria , isosthenuria (from rp. isos the same + sthenos strength + uron urine) - low-density urine excretion, reduced concentration function of the kidneys.

Icterus- cm. Jaundice.

Ileus , ileus (from gr. eileo twist) - mechanical obstruction of the intestine. Distinguish I. obstructive (blockage from the inside with stones, bezoars, calculi, helminths, etc.), strangulation(axial rotations, infringements, intussusceptions

Pancreatic diseases in dogs and cats

Publisher: Royal Veterinary College, University of London

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Introduction

The pancreas, adjacent to the duodenum in two segments, is located in the right anterior part of the abdominal cavity. The blood supply to the pancreas is carried out through the caudal and cranial branches of the pancreaticoduodenal artery, and partially through the visceral artery. This organ is innervated by a branch of the vagus nerve. In cats, in 80% of cases, the pancreatic duct is one and opens into the duodenum along with the bile duct. In dogs, the pancreas has two excretory ducts that open into the major and minor duodenal papilla.

The two main exocrine functions of the pancreas are the production of digestive enzymes and the secretion of bicarbonate. In addition, the islets of Langerhans, which are part of the gland, produce a number of important hormones that mediate the endocrine function of this organ. Activation of the exocrine function of the pancreas occurs in the cephalic phase of digestion (when sniffing and looking at food) and continues during the passage of food through the stomach and duodenum. Secretin and cholecystokinin, produced during the passage of chyme through the small intestine, stimulate the secretion of bicarbonate and digestive enzymes in the pancreas. Clinical diseases associated with impaired exocrine pancreatic function develop either due to insufficient production of digestive enzymes (exocrine pancreatic insufficiency), or due to premature activation of enzymes, which leads to self-digestion and destruction of the secretory tissue of the gland (pancreatitis).

Exocrine pancreatic insufficiency

The most common cause of exocrine pancreatic insufficiency (EPPI) in dogs is atrophy of the secretory acini in the pancreas. Most often, this pathology is detected in German shepherds, however, the disease can develop in dogs of other breeds, including mestizos. It is known that German Shepherds have a genetic predisposition to HELV, but the etiology of this phenomenon is unknown. The disease is progressive in nature: at a young age, the exocrine function of the pancreas is normal, the first clinical signs of the disease begin to appear in animals aged 1 to 5 years. In other cases, NEPV can be caused by chronic, recurrent inflammation (pancreatitis), which is commonly seen in cats, and pancreatic hypoplasia. NEPV and diabetes mellitus often complicate the course of chronic pancreatitis in dogs.

2.1 Pathophysiology

Clinical signs of NEPV usually appear when the secretory activity of this organ is reduced by about 90%. Insufficiency of digestive enzymes leads to disruption of the processes of digestion and absorption in the intestine. In addition, abnormal activity of digestive enzymes in the small intestine, impaired transport of nutrients, atrophy of the intestinal villi, infiltration of the intestinal mucosa with inflammatory mediator cells were found in all cases of NEPV. A common complication that accompanies the disease - a violation of the intestinal microflora - often leads to antibiotic-induced enteropathy (EAA).

2.2 Clinical symptoms and results of general physical examination

The three classic signs of NEPV are chronic unexplained diarrhea, weight loss, and polyphagia. At the same time, feces are poorly formed, stand out in large quantities and have signs of steatorrhea. Loose stools are often observed. Often in sick animals there is a tendency to coprophagia, while vomiting is rarely observed in them. Dog owners report strong flatulence and grumbling in the stomach in their pets. Outwardly, dogs with NEPV look emaciated, their muscle mass is reduced, their coat loses its luster and becomes unpleasant, oily to the touch. However, animals are physically active and mobile. If your dog is drowsy, refuses to eat, and has a fever, the diarrhea is most likely due to another illness.

2.3 Diagnostics

Many laboratory tests are used to diagnose NEPV, with the most effective method being the determination of trypsin-like immunoreactivity (TPIR) in the blood. Kits for the determination of TPIR are strictly species-specific, so only special kits should be used for dogs and cats (for example, the fTLI kit from GI-Lab, USA is used for cats). Other laboratory studies (biochemical or hematological) do not give a specific result, but they are necessary to identify concomitant diseases. If helminthic invasion or bacterial infection is suspected, fecal examinations are performed (for the presence of helminth eggs and for bacteriological cultivation).

When determining TPIR, the amount of trypsinogen in the patient's blood is measured. The only source of trypsinogen in the body is the pancreas, so the test result indirectly reflects the amount of functionally active glandular tissue. The determination of TPIR is carried out after a 12-hour fast and is very sensitive and specific. Values ​​below 2.5 µg/l clearly indicate HELV, while values ​​in the range of 2.5-5 µg/l are normal. TPIR is stable at room temperature and can remain unchanged for several days, but it rapidly degrades when heated. Therefore, samples, especially in summer, should be protected from direct sunlight. If the level of TPIR in the patient's blood is normal, the diagnosis of NEPV is excluded. TABLE OF CONTENTS

2.4 Treatment

Most dogs and cats affected by NEPV have a good clinical response to enzyme replacement therapy. Powdered enzyme replacements without special coatings are most convenient. The initial dosage is 2 teaspoons of powder for every 20 kg of animal body weight with each serving of food. It must be emphasized that enzyme substitutes must be supplied to the animal's body with each portion of food, even with treats. Otherwise, diarrhea may recur. Enzyme substitutes in the form of tablets or capsules for cats and dogs are less effective than powders. The clinical symptoms of NEPV are relieved after the initiation of enzyme replacement therapy, and subsequently the dose of enzyme replacements can be gradually reduced until the minimum effective dosage is identified. It should be borne in mind that different batches of replacement enzymes may have different enzymatic activities. In the treatment of NEPV, enzyme replacement therapy should not be supplemented with pre-treatment of feed with enzyme preparations for 30 minutes, administration of drugs that reduce the acidity of gastric juice (for example, type 2 histamine receptor antagonists) and enrich the animal's feed with bile salts or soda. Very good substitutes for pancreatic enzymes are fresh frozen porcine pancreas. When stored frozen at -20°C, they retain a large amount of active enzymes for 1 year.

For cats with NEPV, it is good to supplement enzyme replacement therapy with parenteral administration of cobalamin, since in this pathology they have impaired absorption of vitamin B12 in the digestive tract.

Pathologies in the pancreas in dogs have become more frequent in recent years. It is difficult to identify them at the initial stage. The most common anomaly is considered to be pancreatitis in dogs. The difficulty is explained by the fact that the pancreas provides the digestive system with the necessary hormones and enzymes. Violations can be detected only in the presence of characteristic symptoms. It is impossible to visually establish pathology by signs. With the help of modern techniques and laboratory tests, it is possible to determine the nature of the pathology, the severity and possible mechanisms of treatment.

Any dysfunction of the pancreas is fraught with serious complications. The sooner the owner notices any deterioration in the health of the dog, the sooner the disease will be detected, the easier and more effective the treatment.

Varieties of inflammatory processes in the pancreas of dogs

Animals need to eat right too.

The pancreas is considered extremely important for the digestive system. It is endowed with two important functions - endocrine and exocrine. The first is responsible for the synthesis of insulin for the absorption of glucose. The second is for the production of enzymes that promote the absorption of proteins, fats, carbohydrates.

Pancreatitis leads to a violation of carbohydrate metabolism, on which water, salt, protein and fat metabolism depends. Other vital systems also suffer from this pathology. The dog's body lacks useful substances by about 60%. Against this background, the dog begins to develop exhaustion.

endocrine insufficiency

Pancreas (pancreas) of the dog is difficult to traditional methods of examination due to the complex anatomical location in the body of a quadruped. You can learn about its performance and condition only by the disturbed functions of the organs that are interconnected with it.

Exocrine insufficiency is manifested in a deficiency of enzymes, the inability of the stomach to digest food, and maintain normal intestinal pH. Under such conditions, in addition to digestive disorders, there is an increased reproduction of microbes, provoking the development of dysbacteriosis and the deterioration of all digestive processes. Exhaustion increases even when the dog eats heavily.

Symptoms

Pancreatic problems in a dog associated with exocrine insufficiency can be identified by the following signs:

• nausea;
• polyuria;
• glycosuria;
• diarrhea - rumbling and offensive;
• polydipsia;
• pancreatogenic stool - sour smell, voluminous foamy masses with remnants of undigested food.

Diagnostics

It is not often possible to make an accurate diagnosis of a dog during life. If during the initial examination the veterinarian manages to consider the described symptoms, he has every reason to suspect pancreopathy in the animal. To make a final medical conclusion, the four-legged animal is prescribed several functional tests.

Sectional view of pancreatitis

Atrophy of the pancreas

The atrophied pancreas resembles a parchment sheet - thin and transparent, preserving the ducts. The German Shepherd suffers from this disease more often than other breeds. The etiopathogenesis of the disease is unknown. Dogs are born with a healthy organ, atrophy begins to appear in the first few months of life, but can develop in the middle period of life.

The reasons for the development of pancreatic atrophy have not yet been established and have not been studied for certain.

Symptoms

Typical symptoms of this pathology:

• the strongest feeling of hunger, before eating their own feces;
• progressive wasting despite increased nutrition;
• frequent bowel movements;
• increased amount of feces;
• the consistency of feces is frothy, clay-yellow in color with a sour smell;
• rumbling or splashing sounds are made from the peritoneum.

On palpation, the large intestine is palpable full of feces. The coat of a sick animal is ruffled, does not hold well, the skin is dry, scaly.

Attacks of exacerbation of pathologies in the pancreas of a dog are accompanied by a strong pain syndrome. Physical well-being can be facilitated by a subcutaneous injection of No-Shpy. The injection is replaced with a tablet if the dog is able to swallow it.

Treatment

Symptoms of pancreatic disease in a dog associated with atrophy of the organ, if they can be detected in time, are treated. The diet of a sick animal should consist of lean meat and foods that do not contain carbohydrates or fats. A specially selected replacement therapy is recommended. The dog is prescribed drugs based on enzymes - "Panzinorm" or "Pancreatin" with painkillers - and an antibiotic. If treatment does not give the desired result, euthanasia is recommended for the animal.

View of a dog feeling unwell

insulinoma

Infrequently, this pathology is also diagnosed. Insulinoma in dogs is a hormonally active neoplasm. It develops in the form of islets of Langerhans, consists of beta cells. It produces insulin in excess, and this is fraught with chronic hypoglycemia, accelerated glucose synthesis.

Symptoms

The disease is accompanied by:

• ataxia;
• epileptic convulsions;
• muscle tremor;
• insulin shock (hypoglycemic coma) in the last stages of the course.

Treatment

A dog with this pathology undergoes a partial pancreatectomy - surgery. Before him, the dog must be on a therapeutic diet. The surgery is performed under general anesthesia.

The pancreas is very important for the life of a dog. The main functions of the life of the dog are assigned to it and you can’t joke with it. Any inflammation of the pancreas in dogs should be treated competently and in a timely manner, so you need to be attentive to even the slightest deterioration in the well-being of the animal.

Dehydration drip

pancreatitis

The etiology of this disease has not yet been established and is not fully understood. Acute pancreatitis in dogs is organ necrosis, which can be caused by enzymatic autolysis and impregnation of the same pathogenic muscle cells.

Symptoms

Signs of pancreatitis in dogs appear suddenly, develop rapidly (from several hours to several days). In mild forms, they are concerned about:

• vomit;
• nausea;
• ascites;
• growing pain;
• apathy;
• jaundice;
• heat;
• anemia;
• foul-smelling diarrhea.

Visual inspection of the animal by a veterinarian

Symptoms of pancreatitis in a dog with severe form:

• severe, unbearable pain that can cause a state of shock or collapse;
• salivation with bradycardia;
• the dog assumes a pleading pose: it stretches its forelimbs forward, the torso (belly) is placed on the floor or the ground, and the back part is slightly raised.

Palpation reveals acute pain in the peritoneum, especially on its walls. Laboratory analysis of urine and blood shows high levels of amylase, and immediately - almost in the first minutes of the development of the disease.

Necrotizing pancreatitis is considered the last stage - pancreatic cells die off. Total pancreatic necrosis leads to the death of the animal.

The disease can end in a complete recovery of the dog or acquire another recurrent form of the course - chronic pancreatitis, which is no less dangerous. In severe and advanced forms: in the presence of peritonitis, a state of shock or collapse, the disease is fraught with a fatal outcome in the first day and even hours of the development of the disease.

It must be remembered that pancreatitis in a puppy is more difficult to tolerate, the consequences will be more severe. Therefore, babies are at risk.

Medical treatment of pancreatitis

Diagnostics

Proper diagnosis is only half the path that an animal will have to go to recovery. The problem with lab tests is different in tetrapods than in humans. In a person with pancreatitis, the amount of lipase and amylase immediately increases. In a quadruped with the same diagnosis, the values ​​of amylase with lipase may be within the normal range.

To establish an accurate medical conclusion, the dog is additionally assigned:

• ultrasound examination of the peritoneum;
• x-ray;
• biopsy from the inner walls;
• laboratory analysis of urine.

In addition to these studies, the dog is subjected to a visual examination by a veterinarian. Then, only the sick animal is prescribed drugs, the scheme and duration of administration are determined.

Feeding a sick animal

Treatment

1. On the first day of the discovery of the disease, the dog is put on a starvation diet. It is permissible to give the dog only water, in small quantities.
2. You can treat a sick dog with antibiotics only in cases where it is advised by a veterinarian.
3. To avoid dehydration, the animal is placed on an intravenous drip with saline.
4. In the acute course of pancreatitis, painkillers, antiemetic and antibacterial drugs, as well as anti-inflammatory drugs are prescribed.

Treatment for pancreatitis in dogs at home should be ordered by a veterinarian after an accurate diagnosis has been made. The treatment regimen and drugs should be prescribed by a specialist after passing all tests and diagnostics. You need to understand that this disease is very dangerous and experimenting with the health of the dog is unacceptable.

Complications and consequences

The symptoms and treatment of pancreatitis in dogs must be determined in time. This disease is very insidious and fraught with consequences:

1. In advanced stages, pancreatitis can turn into pancreatic necrosis, then into peritonitis. And here you can not do without surgical intervention. Otherwise, the dog will die.
2. Sometimes veterinarians can state complications such as blood poisoning, sepsis.
3. Very rarely, but there are cases of constriction of bile ducts.
4. Another complication of chronic pancreatitis is the development of diabetes mellitus.

Regular medical examinations as a prevention of the development of pancreatitis

It is dangerous to let all the inflammation of the pancreas of a dog take its course. It is easier to prevent than to treat later - every owner of a four-legged must know this. You need to be attentive to your pet, look closely at his well-being more often, and conduct preventive medical examinations. At the slightest deterioration, it is urgent to show it to the veterinarian.