Download PDF
Tierarztl Prax Ausg K Kleintiere Heimtiere 2018; 46(06): 386-392
DOI: 10.1055/s-0038-1677391
Originalartikel – Original Articles
Georg Thieme Verlag KG Stuttgart · New York

Prognostische Bedeutung sonographischer Parameter der Pankreatitis der Katze

Eine retrospektive Untersuchung bei 42 KatzenEvaluation of sonographic parameters as prognostic risk factors in cats with pancreatitisA retrospective study in 42 cats
Katharina Moser
1   Tierklinik Haar, Haar
,
Stefanie Mitze
1   Tierklinik Haar, Haar
,
Erik Teske
2   Department of Clinical Science of Companion Animals, University of Utrecht, The Netherlands
,
Christian Stockhaus
1   Tierklinik Haar, Haar
› Author Affiliations
Further Information

Publication History

Eingegangen: 31 August 2018

Akzeptiert nach Revision: 05 September 2018

Publication Date:
18 January 2019 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Gegenstand: Die feline Pankreatitis ist eine Erkrankung mit sehr unterschiedlichen klinischen Verlaufsformen. Häufig stellt sich die Frage, inwieweit Parameter der klinischen, labordiagnostischen oder bildgebenden Untersuchungsverfahren zur Früherkennung eines progressiven, mit schlechterer Prognose verbundenen Verlaufs verwendet werden können. Nur wenige Studien untersuchten bei dieser Erkrankung prognostische Faktoren. Bei Vorliegen passender klinischer Symptomen dienen vor allem die feline pankreatische Lipase-Immunreaktivität (fPLI) und die abdominale Ultraschalluntersuchung zur Diagnose-stellung. Verschiedene sonographische Parameter wurden im Zusammenhang mit einer Pankreatitis beschrieben. Ziel der Studie war zu überprüfen, ob einzelne sonographische Kriterien bei Katzen mit Pankreatitis signifikant mit der Prognose korrelieren. Material und Methoden: In dieser retrospektiven Untersuchung (2009–2017) wurden bei 42 Katzen mit mindestens zwei klinischen Symptomen und erhöhtem Serum-fPLI-Wert (> 5,3 µg/l) die folgenden sonographischen Parameter des Pankreas untersucht: Pankreasbreite, -oberfläche, -echogenität, Echogenität des peripankreatischen Fettgewebes und Vorhandensein von Aszites. Tiere, die die ersten 30 Tage überlebten, galten als „Survivor“ (S), Tiere, die innerhalb der ersten 30 Tage starben, als „Nonsurvivor“ (NS). Ergebnisse: Sonographische Veränderungen lagen bei 33/42 (79 %) Katzen vor. Am häufigsten fanden sich hyper-echogenes peripankreatisches Fettgewebe (55 %), hypoechogenes Pankreasgewebe (45 %) und Pankreasverbreiterung (36 %). Bei keinem sonographischen Untersuchungskriterium konnte eine statistisch signifikante Korrelation mit der Zuordnung in die Gruppen S versus NS gefunden werden. Der fPLI-Wert hingegen korrelierte statistisch signifikant mit der Prognose. Schlussfolgerung: Weder vom Vorliegen sonographischer Veränderungen noch von deren Charakter oder Intensität ist ein Rückschluss auf die Prognose möglich. Im Gegensatz dazu stellt, wie in vorherigen Untersuchungen belegt, eine höhere fPLI-Konzentration einen negativen prognostischen Faktor dar.

Summary

Objective: Pancreatitis in cats can have different clinical courses. A range from asymptomatic or mild, unspecific clinical signs to severe disease with multi-organ dysfunction or even death has been described. It is sometimes difficult to evaluate the prognosis of the cat based on clinical findings, laboratory diagnostics and diagnostic imaging. There are only a few studies that have examined the outcome and prognostic factors for cats with pancreatitis. In cats presenting with signs of pancreatitis, the feline pancreatic lipase immunoreactivity (fPLI) and sonography are frequently used for establishing a diagnosis. Different sonographic parameters have been described to be asso ciated with pancreatitis. The aim of this retrospective study was to determine whether certain sonographic parameters correlate with the severity and the outcome of pancreatitis in the cat. Material and methods: In 42 cats, presented with at least two clinical signs consistent with pancreatitis and increased fPLI-values (> 5.3 µg/l), the following sonographic parameters were examined: thickness, surface and echogenicity of the pancreas, echogenicity of the peripancreatic fat tissue and the presence of ascites. Cats surviving the first 30 days were classified as survivors and those dying within 30 days as nonsurvivors. Results: Sonographic changes were found in 33/42 cats (79 %). The most frequent sonographic abnormalities were hyper-echoic peripancreatic fat (55 %), hypoechoic pancreatic tissue (45 %) and a thickened pancreas (36 %). There was no significant correlation between sonographic changes and the outcome of the cats. No significant differences in the fPLI concentration were found between the two groups. The fPLI concentration correlated significantly with the prognosis. Conclusion: Neither the presence nor the intensity of the sonographic changes correlate with the outcome of cats with pancreatitis. Contrary to this, the fPLI value is a negative prognostic factor, as has been described previously.

Schlüsselwörter:

Feline Pankreatitis - abdominale Sonographie - Prognose - fPLI

Keywords

Feline pancreatitis - abdominal sonography - prognostic factor - fPLI
 

  • Literatur

  • 1 Akol KG, Washabau RJ, Saunders HM, Hendrick MJ. Acute pancreatitis in cats with hepatic lipidosis.. J Vet Intern Med 1993; 35: 205-209.
    PubMedSearch in Google Scholar
  • 2 Armstrong PJ, Williams DA. Pancreatitis in cats.. Topics in Compan An Med 2012; 27: 140-147.
    PubMedSearch in Google Scholar
  • 3 Browne G. Pitchumoni WCS. Pathophysiology of pulmonary complications of acute pancreatitis.. World J Gastroenterol 2006; 12: 7087-7096.
    CrossrefPubMedSearch in Google Scholar
  • 4 Bazelle J, Watson P. Pancreatitis in cats: Is it acute, is it chronic, is it significant?. J Feline Med Surg 2014; 16: 395-406.
    CrossrefPubMedSearch in Google Scholar
  • 5 Dias C, Carreira LM. Serum ionized calcium as a prognosis risk factor in the clinical course of pancreatitis in cats.. J Feline Med Surg 2014; 17: 984-990.
    PubMedSearch in Google Scholar
  • 6 Etue SM, Penninck DG, Labato MA, Pearson S, Tidwell A. Ultrasono graphy of the normal feline pancreas and associated anatomic landmarks/a prospective study of 20 cats.. Vet Radiol Ultrasound 2001; 42: 330-336.
    CrossrefPubMedSearch in Google Scholar
  • 7 Ferreri J, Hardam E, Mc Lear R. Clinical differentiation of acute necrotizing from chronic suppurative pancreatitis in cats: 63 cases (1996–2001).. J Am Vet Med Assoc 2003; 223: 469-474.
    CrossrefPubMedSearch in Google Scholar
  • 8 Forman MA, Marks SL, De Cock HE. Evaluation of serum feline pancreatic lipase immunoreactivity and helical computed tomography versus conventional testing for the diagnosis of feline pancreatitis.. J Vet Intern Med 2004; 18: 807-815.
    CrossrefPubMedSearch in Google Scholar
  • 9 Gerhard A, Steiner JM, Williams DA. et al. Comparison of the sensitivity of different diagnostic tests for pancreatitis in cats.. J Vet Intern Med 2001; 15: 329-333.
    CrossrefPubMedSearch in Google Scholar
  • 10 Hecht S, Henry G. Sonographic evaluation of the normal and abnormal pancreas.. Clin Tech Small Anim Pract 2007; 22: 115-121.
    CrossrefPubMedSearch in Google Scholar
  • 11 Hess RS, Saunders HM, Van Winkle TJ, Shofer HS, Washabau RJ. Clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in dogs with fatal acute pancreatitis: 70 cases (1986–1995).. J Am Vet Med Assoc 1998; 213: 665-670.
    PubMedSearch in Google Scholar
  • 12 Hill RC, Van Winkle TJ. Acute necrotizing pancreatitis and acute suppurative pancreatitis in the cat.. J Vet Intern Med 1993; 7: 25-33.
    CrossrefPubMedSearch in Google Scholar
  • 13 Kimmel SE, Washabau RJ, Drobatz KJ. Incidence and prognostic significance of ionized hypocalcemia in feline acute pancreatitis.. J Am Vet Med Assoc 2001; 219: 1105-1109.
    CrossrefPubMedSearch in Google Scholar
  • 14 Larson MM. Ultrasound imaging of the hepatobiliary system and pancreas.. Vet Clin Small Anim 2016; 46: 453-480.
    CrossrefPubMedSearch in Google Scholar
  • 15 Marolf AJ, Kraft SL, Dunphy TR, Twedt DC. Magnetic resonance (MR) imaging and MR cholangiopancreatography findings in cats with cholangitis and pancreatitis.. J Feline Med Surg 2013; 15: 285-294.
    CrossrefPubMedSearch in Google Scholar
  • 16 Newman S, Steiner JM, Woosley K, Williams DA, Barton L. Histologic assessment and grading of the exocrine pancreas in the dog.. J Vet Diagn Invest 2006; 18: 115-118.
    CrossrefPubMedSearch in Google Scholar
  • 17 Oppliger S, Hartnack S, Reusch CE, Kook PH. Agreement of serum feline pancreas-specific lipase and colorimetric lipase assays with pancreatic ultrasonographic findings in cats with suspicion of pancreatitis: 161 cases (2008–2012).. J Am Vet Med Assoc 2014; 244: 1060-1065.
    CrossrefPubMedSearch in Google Scholar
  • 18 Ruaux CG. Feline Pancreatitis.. In: Textbook of veterinary internal medicine. Ettinger SJ, Feldman EC, Cote E. ed. Philadelphia: Elsevier Saunders; 2017: 1688-1693.
    Search in Google Scholar
  • 19 Sathyanarayan G, Garg P, Prasad P, Tandon RK. Elevated level of interleukin-6 predicts organ failure and severe disease in patients with acute pancreatitis.. J. Gastroenterol Hepatol 2007; 22: 550-554.
    CrossrefPubMedSearch in Google Scholar
  • 20 Saunders HM, VanWinkle TJ, Drobatz K, Kimmel SE, Washabau RJ. Ultra-sonographic findings in cats with clinical, gross pathologic, and histologic evidence of acute pancreatic necrosis: 20 cases (1994–2001).. J Am Vet Med Assoc 2002; 15: 1724-1730.
    PubMedSearch in Google Scholar
  • 21 Steiner JM. Diagnosis of pancreatitis.. Vet Clin North Am Small Anim Pract 2003; 33: 1181-1195.
    CrossrefPubMedSearch in Google Scholar
  • 22 Steiner JM, Wilson BG, Williams DA. Development and analytical validation of a radioimmunoassay for the measurement of feline pancreatic lipase immunoreactivity in serum.. Can J Vet Res 2004; 68: 309-314.
    PubMedSearch in Google Scholar
  • 23 Stockhaus C. Die nekrotisierende Pankreatitis bei der Katze – eine retrospektive Studie.. Prakt Tierarzt 2009; 12: 1131-1137.
    PubMedSearch in Google Scholar
  • 24 Stockhaus C, Teske E, Schellenberger K, Huisinga E, Konietschke U, Mangelsdorf S, Steiner JM. Serial serum feline pancreatic lipase immunoreactivity concentrations and prognostic variables in 33 cats with pancreatitis.. J Am Vet Med Assoc 2013; 243: 1713-1718.
    CrossrefPubMedSearch in Google Scholar
  • 25 Swift NC, Marks SL, MacLachlan NJ, Norris CR. Evaluation of serum feline trypsin-like immunoreactivity for the diagnosis of pancreatitis in cats.. J Am Vet Med Assoc 2000; 217: 37-42.
    CrossrefPubMedSearch in Google Scholar
  • 26 Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N. Abdominal ultrasonography for patients with abdominal pain as a first-line diagnostic imaging modality.. Exp Ther Med 2017; 13: 1932-1936.
    CrossrefPubMedSearch in Google Scholar
  • 27 Washabau RJ. Necrosis and inflammation: feline.. In: Canine and Feline Gas troenterology.. Washabau RJ, Day MJ. eds. Philadelphia: Elsevier Saunders; 2013: 821-829.
    Search in Google Scholar
  • 28 Williams JM, Panciera DL, Larson MM, Were SR. Ultrasonographic findings of the pancreas in cats with elevated serum pancreatic lipase immuno-reactivity.. J Vet Intern Med 2013; 27: 913-918.
    CrossrefPubMedSearch in Google Scholar
  • 29 Wu BU, Banky BA. Clinical management of patients with acute pancreatitis.. Gastroenterology 2013; 144: 1272-1281.
    CrossrefPubMedSearch in Google Scholar
  • 30 Xenoulis PG. Diagnosis of pancreatitis in dogs and cats.. J Small Anim Pract 2015; 56: 13-26.
    CrossrefPubMedSearch in Google Scholar
  • 31 Zimmermann E, Hittmair KM, Suchodolski JS, Steiner JM, Tichy A, Dupré G. Serum feline-specific pancreatic lipase immunoreactivity concentra tions and abdominal ultrasonographic findings in cats with trauma resulting from high-rise syndrome.. J Am Vet Med Assoc 2013; 242: 1238-1243.
    CrossrefPubMedSearch in Google Scholar