Feline Acute Pancreatitis猫急性胰腺炎

Robert J. Washabau, VMD, PhD, Dipl. ACVIM罗伯特·沃世巴，兽医博士， 美国兽医内科医学院博士

Department of Veterinary Clinical SciencesCollege of Veterinary Medicine

University of Minnesota明尼苏达大学兽医学院兽医临床科学部

E-Mail: washabau@umn.edu

Feline Acute Necrotizing Pancreatitis:Specific Learning Objectives

猫急性坏死性胰腺炎具体学习目标

(1) Recognize the biology of the acinar and duct cells of the exocrine pancreas. 辨认胰腺外分泌细胞和导管细胞的生物特性(2) Understand the underlying pathogenesis (intra-acinar activation of enzyme) of acute pancreatic

necrosis.理解急性坏死性胰腺炎的潜在发病机理（腺泡内酶的激活）(3) Understand differences between canine and feline pancreatic physiology and pathophysiology.理解犬和猫胰腺生理学及病理生理学的区别(4) Understand risk factors for ANP in dogs and cats.理解犬和猫急性坏死性胰腺炎的风险因素(5) Understand concurrence of IBD, cholangitis, and ANP (“triaditis”).理解炎性肠病，胆道炎及急性坏死性胰腺炎三病共发(6) Utilize the most sensitive diagnostic tests for diagnosis of ANP.采用最敏感的诊断的方法(7) Integrate history, physical exam findings, laboratory data, and imaging findings in the diagnosis

of ANP.结合病史，体检结果，实验室检验和影像学分析手段诊断急性坏死性胰腺炎(8) Understand the principles of therapy in ANP理解急性坏死性胰腺炎的治疗原理

Acute Pancreatic Necrosis – Take-Home Points急性胰腺坏死-要点

∙ Pathogenesis – Intra-acinar activation and acinar cell necrosis发病机理-腺泡内激活和腺泡细胞坏死

∙ Signs – Anorexia, vomiting, abdominal pain, diarrhea (dogs › cats)症状-厌食，呕吐，腹痛，腹泻（犬>猫）

∙ Lab Data – ↑WBC, ↑ALT, ↑ALP, ↑glucose, ↑cholesterol, ↑bilirubin化验数据- ↑WBC, ↑ALT, ↑ALP, ↑葡萄糖, ↑胆固醇, ↑胆红素

∙ Etiology – Cat – Cholangitis, IBD, ischemia, obstruction, infection病因-猫-胆道炎，IBD，局部缺血，梗阻，感染

∙ Etiology – Dog – High fat diet, drugs, IBD, endocrinopathies病因-犬-高脂肪饮食，药物，IBD，内分泌疾病

∙ Diagnosis – Difficult – History, PE, lab data, imaging – integration诊断-困难-病史༌ 体检༌ 化验数据༌ 影像-结合

∙ Therapy – Supportive and symptomatic only, not specific治疗-支持性治疗的对症状的治疗，无具体方案

∙ Complications – chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis

并发症-慢性非脓性胰腺炎༌ 外分泌不足༌ 糖尿病༌ 脂肪肝

∙ Species Differences – Dog vs. cat – Signs, lab data, imaging具体区别-犬与猫-症状，化验数据，影像

Acute Pancreatic Necrosis – Resources急性胰腺坏死-资料

Washabau RJ. ConsultationsIn Feline Internal MedicineVol. 5; 2005; 109-119.

Washabau RJ. Textbook of Veterinary Internal Medicine7th ed.; 2010; 1704-1709.

Washabau RJ. Canine and Feline Gastroenterology1st ed.; 2013; 821-829.

Acute Pancreatic Necrosis – Take-Home Points急性胰腺坏死-要点

∙ Pathogenesis – Intra-acinar activation and acinar cell necrosis发病机理-腺泡内激活和腺泡细胞坏死

∙ Signs – Anorexia, vomiting, abdominal pain, diarrhea (dogs › cats)症状-厌食，呕吐，腹痛，腹泻（犬>猫）

∙ Lab Data – ↑WBC, ↑ALT, ↑ALP, ↑glucose, ↑cholesterol, ↑bilirubin化验数据- ↑WBC, ↑ALT, ↑ALP, ↑葡萄糖, ↑胆固醇, ↑胆红素

∙ Etiology – Cat – Cholangitis, IBD, ischemia, obstruction, infection病因-猫-胆道炎，IBD，局部缺血，梗阻，感染

∙ Etiology – Dog – High fat diet, drugs, IBD, endocrinopathies病因-犬-高脂肪饮食，药物，IBD，内分泌疾病

∙ Diagnosis – Difficult – History, PE, lab data, imaging – integration诊断-困难-病史༌ 体检༌ 化验数据༌ 影像-结合

∙ Therapy – Supportive and symptomatic only, not specific治疗-支持性治疗的对症状的治疗，无具体方案

∙ Complications – chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis

并发症-慢性非脓性胰腺炎༌ 外分泌不足༌ 糖尿病༌ 脂肪肝

∙ Species Differences – Dog vs. cat – Signs, lab data, imaging具体区别-犬与猫-症状，化验数据，影像

Cell Biology of Pancreatic Acinar Cell Secretion胰腺细胞分泌细胞生物学

L

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Meldolesi and Steer. New England Journal of Medicine 1987; 316: 144-150

(⑴) E.R. Zymogen Synthesis E.R发酵菌合成(2) Vectorial Transport →

Golgi 有向运输→高尔基体(3) Mannose Phosphorylation 甘露醇磷酯化作用(4) Lysosomal Sequestration 溶酶体隔离(5) Zymogen Granules 酶原粒(6) SPINK1 → PSTI(7) Exocytosis/Export 胞外分泌/输出(8) Distal Activation 末梢激活

Synthesis to Secretion从合成到分泌

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GC

ZGV

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Cell Biology of Acute Pancreatic Necrosis急性胰腺坏死细胞生物学

Meldolesi and Steer. New England Journal of Medicine 1987; 316: 144-150

Chemical Pathology - Pancreatic Necrosis病理化学-胰腺坏死

Trypsin – Broad range of proteolytic activity

胰蛋白酶-广泛的蛋白水解活性

Elastase – blood vessel elastin digestion, vascular damage, hemorrhage

弹性蛋白酶-血管弹性蛋白分解，血管损伤，出血

Lipase, Phospholipase A – fat necrosis, membrane dissolution

脂肪酶，磷脂酶A-脂肪坏死，细胞膜溶解

The Three Phasesof Acute Pancreatic Necrosis急性胰腺坏死的三个阶段

Initiating初始→ Acinar腺泡 → Severity严重Events事项 Events事项 Determinants决定因素Ischemia Blocked secretion Inflammatory Cytokines局部缺血 分泌受阻 炎症性细胞因子Inflammation Co-Localization Reactive O2 species炎症 共定位 活性O2 物质

Toxins Enzyme activation Altered Redox State毒素 酶激活 氧化还原状态改变Infection Cell injury Ischemia感染 细胞损伤 局部缺血Drugs药物 Apoptosis细胞死亡

Acute Pancreatitis 急性胰腺炎

From Steer M., J. of Surgery, 2010

Acute Pancreatic Necrosis – Take-Home Points急性胰腺坏死-要点

∙ Pathogenesis – Intra-acinar activation and acinar cell necrosis发病机理-腺泡内激活和腺泡细胞坏死

∙ Signs – Anorexia, vomiting, abdominal pain, diarrhea (dogs › cats)症状-厌食，呕吐，腹痛，腹泻（犬>猫）

∙ Lab Data – ↑WBC, ↑ALT, ↑ALP, ↑glucose, ↑cholesterol, ↑bilirubin化验数据- ↑WBC, ↑ALT, ↑ALP, ↑葡萄糖, ↑胆固醇, ↑胆红素

∙ Etiology – Cat – Cholangitis, IBD, ischemia, obstruction, infection病因-猫-胆道炎，IBD，局部缺血，梗阻，感染

∙ Etiology – Dog – High fat diet, drugs, IBD, endocrinopathies病因-犬-高脂肪饮食，药物，IBD，内分泌疾病

∙ Diagnosis – Difficult – History, PE, lab data, imaging – integration诊断-困难-病史༌ 体检༌ 化验数据༌ 影像-结合

∙ Therapy – Supportive and symptomatic only, not specific治疗-支持性治疗的对症状的治疗，无具体方案

∙ Complications – chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis

并发症-慢性非脓性胰腺炎༌ 外分泌不足༌ 糖尿病༌ 脂肪肝

∙ Species Differences – Dog vs. cat – Signs, lab data, imaging具体区别-犬与猫-症状，化验数据，影像

Historical Findings:Feline Acute Necrotizing Pancreatitis

历史发现：猫急性坏死性胰腺炎

Finding发现 # of Cases数量 Incidence发病率

Anorexia厌食 131/159 87%Lethargy嗜睡 129/159 81%Weight loss体重下降 75/159 47%Vomiting呕吐 73/159 46%Diarrhea腹泻 19/159 12%

Washabau RJ. Consult. In Feline Intern. Med. Vol. 5; 2005; 109-119.

Physical Examination Findings:体检发现

Feline Acute Necrotizing Pancreatitis猫急性坏死性胰腺炎

Finding发现 # of Cases数量 Incidence发病率

Dehydration脱水 50/92 54%Hypothermia低体温 23/54 46%Icterus黄疸 51/138 37%Fever 发热 15/62 25%Abdominal pain腹痛 30/159 19%Abdominal mass腹部包块18/159 11%

Washabau RJ. Consult. In Feline Intern. Med. Vol. 5; 2005; 109-119.

Acute Pancreatic Necrosis – Take-Home Points急性胰腺坏死-要点

∙ Pathogenesis – Intra-acinar activation and acinar cell necrosis发病机理-腺泡内激活和腺泡细胞坏死

∙ Signs – Anorexia, vomiting, abdominal pain, diarrhea (dogs › cats)症状-厌食，呕吐，腹痛，腹泻（犬>猫）

∙ Lab Data – ↑WBC, ↑ALT, ↑ALP, ↑glucose, ↑cholesterol, ↑bilirubin化验数据- ↑WBC, ↑ALT, ↑ALP, ↑葡萄糖, ↑胆固醇, ↑胆红素

∙ Etiology – Cat – Cholangitis, IBD, ischemia, obstruction, infection病因-猫-胆道炎，IBD，局部缺血，梗阻，感染

∙ Etiology – Dog – High fat diet, drugs, IBD, endocrinopathies病因-犬-高脂肪饮食，药物，IBD，内分泌疾病

∙ Diagnosis – Difficult – History, PE, lab data, imaging – integration诊断-困难-病史༌ 体检༌ 化验数据༌ 影像-结合

∙ Therapy – Supportive and symptomatic only, not specific治疗-支持性治疗的对症状的治疗，无具体方案

∙ Complications – chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis

并发症-慢性非脓性胰腺炎༌ 外分泌不足༌ 糖尿病༌ 脂肪肝

∙ Species Differences – Dog vs. cat – Signs, lab data, imaging具体区别-犬与猫-症状，化验数据，影像

Hematological Findings:血液学发现

Feline Acute Necrotizing Pancreatitis猫急性坏死性胰腺炎

Finding发现 # of Cases数量 Incidence发病率

Anemia贫血 39/103 38%Hemoconcentration血浓缩 14/82 17%Leukocytosis白血球增多 46/99 46%Leukopenia白血球减少 14/94 15%

Washabau RJ. Consult. In Feline Intern. Med. Vol. 5; 2005; 109-119.

Serum Biochemical Findings:血清生化发现

Feline Acute Necrotizing Pancreatitis猫急性坏死性胰腺炎

Finding发现 # of Cases数量 Incidence发病率

↑↑ ALT, AST 37/65 57%↑↑ ALP 32/65 49%↑↑ Bilirubin胆红素 38/65 58%↑↑ Glucose葡萄糖 32/71 45%↑↑ Cholesterol胆固醇 28/39 72%↓↓ Calcium钙 55/85 65%↓↓ Albumin白蛋白 14/39 36%

Prognostic Significance of Hypocalcemia in Feline ANP低血钙症在猫ANP中的预测意义

Non-survivorAP Cats死亡

ControlsIoni

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Cal

cium

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Median中位数 = 1.00

Median中位数 = 1.12

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SurvivorAP Cats存活

Kimmel, Drobatz, and Washabau – J. Amer. Vet. Med. Assoc. 2001; 219: 1105-1109.

对照

Acute Pancreatic Necrosis – Take-Home Points急性胰腺坏死-要点

∙ Pathogenesis – Intra-acinar activation and acinar cell necrosis发病机理-腺泡内激活和腺泡细胞坏死

∙ Signs – Anorexia, vomiting, abdominal pain, diarrhea (dogs › cats)症状-厌食，呕吐，腹痛，腹泻（犬>猫）

∙ Lab Data – ↑WBC, ↑ALT, ↑ALP, ↑glucose, ↑cholesterol, ↑bilirubin化验数据- ↑WBC, ↑ALT, ↑ALP, ↑葡萄糖, ↑胆固醇, ↑胆红素

∙ Etiology – Cat – Cholangitis, IBD, ischemia, obstruction, infection病因-猫-胆道炎，IBD，局部缺血，梗阻，感染

∙ Etiology – Dog – High fat diet, drugs, IBD, endocrinopathies病因-犬-高脂肪饮食，药物，IBD，内分泌疾病

∙ Diagnosis – Difficult – History, PE, lab data, imaging – integration诊断-困难-病史༌ 体检༌ 化验数据༌ 影像-结合

∙ Therapy – Supportive and symptomatic only, not specific治疗-支持性治疗的对症状的治疗，无具体方案

∙ Complications – chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis

并发症-慢性非脓性胰腺炎༌ 外分泌不足༌ 糖尿病༌ 脂肪肝

∙ Species Differences – Dog vs. cat – Signs, lab data, imaging具体区别-犬与猫-症状，化验数据，影像

Etiologies – Feline Acute Necrotizing Pancreatitis病因-猫急性坏死性胰腺炎

Known Associations已知关联

Biliary Tract Disease胆道疾病 G.I. Disease消化道疾病

Ischemia局部缺血 Ductal Obstruction导管阻塞

Infection感染 Trauma外伤

Organophosphates有机磷 Lipodystrophy脂肪代谢障碍

Suggested Associations可能关联

Hypercalcemia血钙过多症 Drug Reactions药物反应

Nutrition营养

I.B.D., Pancreatic, Biliary Tract Disease:Contributing Factors in the Cat

炎性肠病，胰腺炎，胆道疾病：发病因素

• Incidence of I.B.D I.B.D.发病率

• Clinical Symptomatology of I.B.D. I.B.D.临床病症

• Intestinal Microflora 肠道菌群

• Pancreatico-biliary anatomy 胰腺-胆囊解剖学

Washabau R.J. J. Fel. Med. & Surg. 2001; 3: 95-98

Acute Pancreatic Necrosis – Take-Home Points急性胰腺坏死-要点

∙ Pathogenesis – Intra-acinar activation and acinar cell necrosis发病机理-腺泡内激活和腺泡细胞坏死

∙ Signs – Anorexia, vomiting, abdominal pain, diarrhea (dogs › cats)症状-厌食，呕吐，腹痛，腹泻（犬>猫）

∙ Lab Data – ↑WBC, ↑ALT, ↑ALP, ↑glucose, ↑cholesterol, ↑bilirubin化验数据- ↑WBC, ↑ALT, ↑ALP, ↑葡萄糖, ↑胆固醇, ↑胆红素

∙ Etiology – Cat – Cholangitis, IBD, ischemia, obstruction, infection病因-猫-胆道炎，IBD，局部缺血，梗阻，感染

∙ Etiology – Dog – High fat diet, drugs, IBD, endocrinopathies病因-犬-高脂肪饮食，药物，IBD，内分泌疾病

∙ Diagnosis – Difficult – History, PE, lab data, imaging – integration诊断-困难-病史༌ 体检༌ 化验数据༌ 影像-结合

∙ Therapy – Supportive and symptomatic only, not specific治疗-支持性治疗的对症状的治疗，无具体方案

∙ Complications – chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis

并发症-慢性非脓性胰腺炎༌ 外分泌不足༌ 糖尿病༌ 脂肪肝

∙ Species Differences – Dog vs. cat – Signs, lab data, imaging具体区别-犬与猫-症状，化验数据，影像

Evaluation of Risk Factors for Fatal Canine Acute Pancreatic Necrosis

犬致命急性胰腺坏死风险因素评估- Hess & Washabau J. Am. Vet. Med. Assoc. 1999; 214: 46-

• Older age/Overweight body condition较高年龄/超重

• Yorkshire Terriers约克郡犬

• Anti-convulsant medication抗惊厥药物

• Trimethoprim-sulfa medication甲氧苄氨嘧啶药物

• Prior G.I. tract disease消化道病史

• Endocrinopathies内分泌疾病

Acute Pancreatic Necrosis – Take-Home Points急性胰腺坏死-要点

∙ Pathogenesis – Intra-acinar activation and acinar cell necrosis发病机理-腺泡内激活和腺泡细胞坏死

∙ Signs – Anorexia, vomiting, abdominal pain, diarrhea (dogs › cats)症状-厌食，呕吐，腹痛，腹泻（犬>猫）

∙ Lab Data – ↑WBC, ↑ALT, ↑ALP, ↑glucose, ↑cholesterol, ↑bilirubin化验数据- ↑WBC, ↑ALT, ↑ALP, ↑葡萄糖, ↑胆固醇, ↑胆红素

∙ Etiology – Cat – Cholangitis, IBD, ischemia, obstruction, infection病因-猫-胆道炎，IBD，局部缺血，梗阻，感染

∙ Etiology – Dog – High fat diet, drugs, IBD, endocrinopathies病因-犬-高脂肪饮食，药物，IBD，内分泌疾病

∙ Diagnosis – Difficult – History, PE, lab data, imaging – integration诊断-困难-病史༌ 体检༌ 化验数据༌ 影像-结合

∙ Therapy – Supportive and symptomatic only, not specific治疗-支持性治疗的对症状的治疗，无具体方案

∙ Complications – chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis

并发症-慢性非脓性胰腺炎༌ 外分泌不足༌ 糖尿病༌ 脂肪肝

∙ Species Differences – Dog vs. cat – Signs, lab data, imaging具体区别-犬与猫-症状，化验数据，影像

Diagnosis of Acute Pancreatitis急性胰腺炎诊断

Pancreatic Trypsin,Amylase, Lipase

胰蛋白酶，淀粉酶，脂肪酶

Pancreatic Trypsin,Amylase, Lipase

胰蛋白酶，淀粉酶，脂肪酶

Serum Amylase Activity血清淀粉酶活性 – Insensitive不敏感Serum Lipase Activity血清脂肪酶活性– Insensitive不敏感Serum [Trypsin] 血清[胰蛋白酶]活性– Insensitive不敏感Serum [pLipase] 血清[磷脂酶]– Preferred assay首选测试

Diagnosis of Acute Pancreatitis急性胰腺炎诊断

1. History病史

2. Physical Examination体检

3. Laboratory Methods化验方法

4. Imaging Studies影像研究

5. Histology 组织学

Anatomy – Radiographic Localization解剖学-放射影像位置

Ultrasonographic Findings超声波发现

27 (64%): enlarged, irregular, and/or hypoechoic pancreas

27（64%）：肥大，不规则，或低回声胰脏

18 (43%): hyperechoic peripancreatic mesentery

18（43%）：高回声胰周肠系膜13 (31%): abdominal effusion13（31%）：腹部渗出物7 (17%): distension of the gall bladder

and common bile duct7(17%):胆囊和胆总管扩张2 (5%): thrombosis of the

pancreaticoduodenal vein 2（5%）：胰十二指肠静脉血栓

How Good Is Ultrasound?超声波有多好？

Saunders et al.• 95% Specificity特异性

• 35% Sensitivity敏感性

• Limitations局限

• JAVMA 2002; 221:1724-1731.

Diagnosis of Acute Pancreatitis:Integration of Information

急性胰腺炎诊断：信息综合

1. History病史

2. Physical Examination体检

3. Laboratory Methods化验方法

4. Imaging Studies影像研究

5. Histology 组织学

Acute Pancreatic Necrosis – Take-Home Points急性胰腺坏死-要点

∙ Pathogenesis – Intra-acinar activation and acinar cell necrosis发病机理-腺泡内激活和腺泡细胞坏死

∙ Signs – Anorexia, vomiting, abdominal pain, diarrhea (dogs › cats)症状-厌食，呕吐，腹痛，腹泻（犬>猫）

∙ Lab Data – ↑WBC, ↑ALT, ↑ALP, ↑glucose, ↑cholesterol, ↑bilirubin化验数据- ↑WBC, ↑ALT, ↑ALP, ↑葡萄糖, ↑胆固醇, ↑胆红素

∙ Etiology – Cat – Cholangitis, IBD, ischemia, obstruction, infection病因-猫-胆道炎，IBD，局部缺血，梗阻，感染

∙ Etiology – Dog – High fat diet, drugs, IBD, endocrinopathies病因-犬-高脂肪饮食，药物，IBD，内分泌疾病

∙ Diagnosis – Difficult – History, PE, lab data, imaging – integration诊断-困难-病史༌ 体检༌ 化验数据༌ 影像-结合

∙ Therapy – Supportive and symptomatic only, not specific治疗-支持性治疗的对症状的治疗，无具体方案

∙ Complications – chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis

并发症-慢性非脓性胰腺炎༌ 外分泌不足༌ 糖尿病༌ 脂肪肝

∙ Species Differences – Dog vs. cat – Signs, lab data, imaging具体区别-犬与猫-症状，化验数据，影像

Therapy of Acute Necrotizing Pancreatitis急性坏死性胰腺炎治疗

1. Eliminate Inciting Agent消除刺激物

2. N.P.O. – short duration 禁食-短期

3. Intravenous Fluids 静脉液体

4. Supportive Therapy –plasma, 10 ml/kg 支持性治疗-血浆，10ml/kg

5. Relieve Pain – fentanyl, buprenorphine 缓解痛症-芬太尼，丁丙诺菲

6. Anti-Emetics - NK1 , α1, 5-HT3 antagonists 止吐药物- NK1 , α1, 5-HT3 拮抗剂

Other Therapeutic Considerations:Acute Pancreatic Necrosis

其他治疗注意事项：急性胰腺坏死7. Calcium Gluconate Supplementation

葡萄糖酸钙补充

8. H1/H2 Histamine Receptor Antagonists H1/H2组织胺受体拮抗剂

9. Low dose dopamine infusion- 5 μg/kg/min.

低剂量多巴胺注射- -5 μg/kg/min10. Broad Spectrum Antibiotics

广谱抗生素

11. Ductal Decompression 导管减压

Acute Pancreatic Necrosis – Take-Home Points急性胰腺坏死-要点

∙ Pathogenesis – Intra-acinar activation and acinar cell necrosis发病机理-腺泡内激活和腺泡细胞坏死

∙ Signs – Anorexia, vomiting, abdominal pain, diarrhea (dogs › cats)症状-厌食，呕吐，腹痛，腹泻（犬>猫）

∙ Lab Data – ↑WBC, ↑ALT, ↑ALP, ↑glucose, ↑cholesterol, ↑bilirubin化验数据- ↑WBC, ↑ALT, ↑ALP, ↑葡萄糖, ↑胆固醇, ↑胆红素

∙ Etiology – Cat – Cholangitis, IBD, ischemia, obstruction, infection病因-猫-胆道炎，IBD，局部缺血，梗阻，感染

∙ Etiology – Dog – High fat diet, drugs, IBD, endocrinopathies病因-犬-高脂肪饮食，药物，IBD，内分泌疾病

∙ Diagnosis – Difficult – History, PE, lab data, imaging – integration诊断-困难-病史༌ 体检༌ 化验数据༌ 影像-结合

∙ Therapy – Supportive and symptomatic only, not specific治疗-支持性治疗的对症状的治疗，无具体方案

∙ Complications – chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis

并发症-慢性非脓性胰腺炎༌ 外分泌不足༌ 糖尿病༌ 脂肪肝

∙ Species Differences – Dog vs. cat – Signs, lab data, imaging具体区别-犬与猫-症状，化验数据，影像

Exocrine Pancreatic Disease Classification外分泌胰腺疾病分类

Ferreri & Washabau J.AV.M.A., 2003; 223: 469

Health健康

Acute Necrotizing Pancreatitis急性坏死性胰腺炎

Pancreatic NodularHyperplasia胰腺节状增生

PancreaticNeoplasia胰脏肿瘤

Acute Suppurative Pancreatitis

急性化脓性胰腺炎

ChronicPancreatitis慢性胰腺炎

PancreaticInsufficiency胰腺机能不全

Cat猫Dog犬

Feline Hepatic Lipidosis猫脂肪肝

Obligate Carnivores – Biochemical Differences专食肉动物-生化差异

1. Essentiality of dietary arginine 饮食精氨酸重要性

2. Low levels of hepatic ornithine 低水平肝鸟氨酸

3. High dietary protein requirements 高饮食蛋白质需求

4. Lack of hepatic enzyme adaptation to low protein 缺乏肝脏酶对低蛋白适应性

5. Insufficiency of hepatic glutamate reductase 肝脏谷氨酸盐还原酶机能不全

6. Insufficiency of intestinal ornithine transcarbamylase 肠道鸟氨酸转氨甲酰酶机能不全

7. Differences in lipoprotein metabolism (HDLs) 脂蛋白新陈代谢差异

8. Differences in orotic acid metabolism 乳清酸代谢差异

“Acute Pancreatitis/Hepatic Lipidosis in Cats”“猫的急性胰腺炎/脂肪肝”

- Akol K, Washabau R, Saunders M, Hendrick M -J. Vet. Intern. Med. 1993; 7: 205-210

· Lipidosis and pancreatitisoccur concurrently.

脂肪沉积和胰腺炎同时发生∙ Lab findings are similar 化验结果相似· Cats with A.P. have worse

prognosis. 患有急性胰腺炎的猫预后更差

Acute Pancreatic Necrosis – Take-Home Points急性胰腺坏死-要点

∙ Pathogenesis – Intra-acinar activation and acinar cell necrosis发病机理-腺泡内激活和腺泡细胞坏死

∙ Signs – Anorexia, vomiting, abdominal pain, diarrhea (dogs › cats)症状-厌食，呕吐，腹痛，腹泻（犬>猫）

∙ Lab Data – ↑WBC, ↑ALT, ↑ALP, ↑glucose, ↑cholesterol, ↑bilirubin化验数据- ↑WBC, ↑ALT, ↑ALP, ↑葡萄糖, ↑胆固醇, ↑胆红素

∙ Etiology – Cat – Cholangitis, IBD, ischemia, obstruction, infection病因-猫-胆道炎，IBD，局部缺血，梗阻，感染

∙ Etiology – Dog – High fat diet, drugs, IBD, endocrinopathies病因-犬-高脂肪饮食，药物，IBD，内分泌疾病

∙ Diagnosis – Difficult – History, PE, lab data, imaging – integration诊断-困难-病史༌ 体检༌ 化验数据༌ 影像-结合

∙ Therapy – Supportive and symptomatic only, not specific治疗-支持性治疗的对症状的治疗，无具体方案

∙ Complications – chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis

并发症-慢性非脓性胰腺炎༌ 外分泌不足༌ 糖尿病༌ 脂肪肝

∙ Species Differences – Dog vs. cat – Signs, lab data, imaging具体区别-犬与猫-症状，化验数据，影像

Feline Acute Pancreatitis: Species Differences猫急性胰腺炎：物种差异

Washabau RJ. J. Fel. Med. Surg. 2001; 3: 95-98.

Feline猫 Canine犬Vomiting呕吐 46% 90%Diarrhea腹泻 12% 33%Fever发热 25% 32%Abd. Pain腹痛 19% 58%

Feline Acute Pancreatitis: Species Differences猫急性胰腺炎：物种差异

Washabau RJ. J. Fel. Med. Surg. 2001; 3: 95-98

Feline猫 Canine犬↑ WBC’s 46% 62%↓ Ca2+ 65% 5%Radiography Not useful Somewhat useful放射影像 没有用处 稍有用

I.B.D. Strong assoc. Weak assoc.I.B.D. 强关联 弱关联