Pancreatitis in a cat

19 Pancreatitis in a cat




Initial presentation


Vomiting, poor appetite and lethargy


Signalment: 14-year-old male neutered Burmese cat, body weight 4.4 kg



Case history


The cat had been vomiting for 2 days and was refusing to eat. The owner had tried to encourage him to eat, but he refused any type of food. He was very lethargic and the owner thought that he had been urinating larger volumes than usual because the litter box was very wet and she had observed this cat in the litter box frequently.


The owner had owned the cat since he was a kitten. He lived with a littermate sibling, who was clinically healthy. Both the cats had been vaccinated approximately 18 months earlier, but had not been treated for endoparasites for several years. They were both primarily indoor cats, although occasionally had access to a fenced garden. Neither cat hunted nor scavenged food. They did play with toys, although the patient had arthritis in both elbows, which decreased his mobility. His previous diet was a combination of a commercial dry cat food and a commercial canned cat food.



Physical examination


Physical examination revealed the cat to be quiet and dull, but responsive. He was in slightly overweight body condition (body condition score 6/9). His oral mucous membranes were mildly jaundiced and tacky, with a capillary refill time of 2 seconds. He appeared approximately 7 to 8% dehydrated.


The sclera was mildly jaundiced bilaterally with no other ocular changes noted. Examination of the oral cavity, ears and nose showed no abnormalities. All peripheral lymph nodes were within normal limits. Auscultation of the lung fields as well as compression and percussion of the thorax were normal. The respiratory rate was elevated at 60 breaths per minute. Cardiac auscultation revealed a heart rate of 180 beats per minute with matched pulses. Rectal temperature was 39.1° C. Abdominal palpation indicated marked cranial abdominal pain. The reminder of the physical examination was unremarkable.



Problem list and discussion of problems


The cat’s problems included vomiting, poor appetite and lethargy. The poor appetite and lethargy were thought to be related to the cause of the vomiting. He also was suspected to have polyuria, although it was possible that the other cat in the household had increased urine output. He was also jaundiced.



Differential diagnosis



Differential diagnoses for vomiting



• Dietary sensitivity (allergy or intolerance)

• Dietary indiscretion

• Stomach
• gastritis

• gastric ulcers

• inflammatory bowel disease

• foreign body

• parasites

• neoplasia

• Small intestinal disease
• infectious, e.g. bacterial, viral, fungal

• gastrointestinal parasites

• inflammatory bowel disease

• infiltrative neoplasia, e.g. lymphoma, mastocytosis

• high partial obstruction, e.g. intussusception, foreign body

• Systemic disease
• uraemia

• liver failure

• sepsis

• congestive heart failure

• acidosis

• hypoadrenocorticism

• ketoacidotic diabetes mellitus

• hyperparathyroidism

• gastrinoma

• Neurological diseases (no other signs consistent with these in this cat)
• dysautonomia

• vestibular disease

• CNS disease

• Drugs, toxins (no known history of drug or toxin exposure)


Differential diagnoses for polyuria



• Diabetes mellitus

• Acromegaly (usually concurrent with diabetes mellitus in cats)

• Chronic kidney disease (sometimes acute renal failure) – the signs were too acute for chronic, unless the owner had not observed a gradual increase in urine output

• Pyelonephritis

• Electrolyte imbalances, e.g. hypercalcaemia, hypokalaemia, hyperkalaemia

• Hyperthyroidism

• Liver disorders

• Polycythaemia

• Drugs (no history of or known access to drugs or medications)

Other causes of polyuria/polydipsia, which are uncommon to extremely rare in cats, include:


• Hyperadrenocorticism

• Primary hyperaldosteronism

• Hypoadrenocorticism

• Tubular disorders (e.g. renal glucosuria)

• Central diabetes insipidus

• Psychogenic polydipsia


Differential diagnoses for jaundice


These include pre-hepatic disorder, hepatic disorders and post-hepatic disorders.


• Pre-hepatic jaundice is caused by intra- or extravascular haemolysis

• Hepatic causes of jaundice are due to liver disease, e.g.
• cholangiohepatitis complex

• hepatic lipidosis

• diffuse neoplasia

• feline infectious peritonitis

• toxins, e.g. paracetamol (acetaminophen)

• cirrhosis

• idiopathic drug reactions

• Post-hepatic causes of jaundice are caused by biliary obstruction or rupture, e.g.
• pancreatitis

• enteritis

• biliary neoplasia

• calculus

• ruptured bile duct or gallbladder


Case work-up


Intravenous fluid therapy with crystalloids at a rate to correct 8% dehydration was initiated.



Minimum data base


Haematology revealed a mild leukocytosis due to mild neutrophilia (13.52 × 109/l; reference range: 2.5–12.5 × 109/l), a left shift, with 1.5 × 109/l band neutrophils and moderate monocytosis (3.07 × 109/l; reference range: 0.15–1.7 × 109/l). A mild normocytic, normochromic anaemia was present (PCV: 0.237 l/l; reference range 0.30–0.45 l/l). A blood smear analysis revealed the presence of toxic neutrophils and reactive lymphocytes.


Serum biochemistry revealed mild hypoalbuminaemia (20 g/l; reference range 23–39 g/l) and hyperbilirubinaemia (20 µmol/l; reference range 0–15 µmol/l), elevated alanine aminotransferase (ALT) of 104 IU/l (reference range 6–83 IU/l) and moderate hypokalaemia (2.0 mmol/l; reference range 2.9–4.2 mmol/l). Alkaline phosphatase (ALP) was within the reference range at 35 IU/l (reference range 10–100 IU/l). Serum urea and creatinine were both elevated at 17.2 mol/l (reference range 2.9–9.8 mmol/l) and 161 µmol/l (reference range 40–177 µmol/l). Hyperglycaemia (26.9 mmol/l; reference range 3.94–8.83 mmol/l) was also present and serum fructosamine was 471 µmol/l (reference range 159–295 µmol/l).


Cholesterol was mildly increased at 5.5 mmol/l (reference range 2.0–3.4 mmol/l) and triglycerides were increased at 3.3 mmol/l (reference range 0.57–1.14 mmol/l).


Urinalysis revealed a urine specific gravity (USG) of 1.014 and dip stick analysis was 1+ positive for protein, 2+ positive for blood, bilirubin and leukocytes and 3+ positive for glucose. Ketone bodies were not detected. Sediment examination showed the presence of occasional red blood cells, numerous white blood cells and bacteria (cocci) and a sample submitted for bacterial culture was later found to be positive for Staphylococcus.


The cat was diagnosed at this point with diabetes mellitus and a urinary tract infection. The azotaemia present was thought to be due either to pre-renal causes (dehydration) or kidney disease or a combination of both.

Related posts:

  1. Oesophageal stricture in a cat
  2. Vomiting
  3. Linear foreign body in a cat
  4. Intussusception in a cat

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Sep 22, 2016 | Posted by in SMALL ANIMAL | Comments Off on Pancreatitis in a cat

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