Case Study

Chronic active pancreatitis in a 17 year old FS DSH cat

This 17-year-old FS DSH was presented for anorexia, lethargy, vocalization and mild weight loss. The physical exam revealed a painful cranial abdomen and poor body condition. The CBC and blood chemistry demonstrated mildly elevated BUN, mildly elevated creatinine, mildly elevated ALT, mildly elevated SAP, mildly elevated total bilirubin and mildly elevated CPK with mild anemia and moderate leukocytosis with a left shift. Urinalysis was normal with a urine specific gravity of 1.036.

This 17-year-old FS DSH was presented for anorexia, lethargy, vocalization and mild weight loss. The physical exam revealed a painful cranial abdomen and poor body condition. The CBC and blood chemistry demonstrated mildly elevated BUN, mildly elevated creatinine, mildly elevated ALT, mildly elevated SAP, mildly elevated total bilirubin and mildly elevated CPK with mild anemia and moderate leukocytosis with a left shift. Urinalysis was normal with a urine specific gravity of 1.036.

DX

Chronic active pancreatitis

Sonographic Differential Diagnosis

Suspect mild to moderate, acute exacerbation of chronic pancreatitis with mild peripancreatic inflammation. Mild, diffuse common bile duct dilation. Common bile duct dilation in an older feline patient could be multifactorial with potential causes including referred inflammation with atony secondary to pancreatitis, primary cholangitis, residual dilation secondary to a prior inflammatory process or a combination thereof.

Image Interpretation

Mild to moderate generalized pancreatic enlargement is present. The pancreatic serosal margins are mildly undulating and the parenchyma is heteroechoic, suggesting fibrosis with serosal contracture. The pancreatic duct is also dilated and tortuous. The peripancreatic omentum and mesentery are mildly echogenic. In the second video, a dilated and tortuous common bile duct is visible between the descending duodenum and proximal aspect of the right limb of the pancreas. The common bile duct is likely dilated at the level of the duodenal papilla.