Case Study

Hepatitis, Chronic Active Pancreatitis in a 9 year old MN DSH cat

A 9-year-old MN DSH was presented for evaluation of lethargy, inappetence, and diarrhea. On physical examination, moderate dental tartar, poor body condition (BCS 2/5) and a dull unkempt hair coat was evident. On urinalysis moderate leukosuria, mild hematuria, and normal SG with moderate leukocytes, 2+ protein, 6.5 pH, urine specific gravity 1.035 with a small amount of blood. Abnormalities on CBC and serum biochemistry were neutrophilia with toxic changes, hyperglycemia, hyperglobulinemia, elevated fPL, and low folate and low B12. Negative FeLV, negative FIV, and negative heartworm assay.

A 9-year-old MN DSH was presented for evaluation of lethargy, inappetence, and diarrhea. On physical examination, moderate dental tartar, poor body condition (BCS 2/5) and a dull unkempt hair coat was evident. On urinalysis moderate leukosuria, mild hematuria, and normal SG with moderate leukocytes, 2+ protein, 6.5 pH, urine specific gravity 1.035 with a small amount of blood. Abnormalities on CBC and serum biochemistry were neutrophilia with toxic changes, hyperglycemia, hyperglobulinemia, elevated fPL, and low folate and low B12. Negative FeLV, negative FIV, and negative heartworm assay. On survey radiographs mild hepatomegaly was evident.

Sonographic Differential Diagnosis

Inflammatory hepatopathy. Suspect aggressive pancreatitis or strong potential for carcinoma, other neoplasia. Underlying FIP or neoplasia may be playing a role

Image Interpretation

Irregular omental changes were noted as well as hypoechoic, irregular pancreas primarily in the left pancreatic limb. This measured 1.0 cm in width. There was excessive extension to the region of the left kidney where some areas of coalesced free fluid was noted. Fine-needle aspirates of this region of the pancreas is highly recommended as this may represent pancreatic neoplasia such as carcinoma. Other possibilities are aggressive pancreatitis and FIP or other neoplasia. The liver was coarse and heterogenous with increased portal markings. This is most consistent with inflammatory hepatopathy. Some nodular changes are concerning. Fine-needle aspirates would be warranted as a cursory evaluation to ensure emerging neoplasia is not an issue. Coarse, hyperechoic nodular changes were noted. This may represent a granulomatous type lesion. A mild to moderate amount of free fluid was noted in this patient. This was associated with the cranial abdomen primarily. Irregular pancreas with free fluid

DX

Probable hepatitis/cholangiohepatitis, probable chronic active pancreatitis/steatitis.

Outcome

The patient was doing very well after hospitalization and went home.

Clinical Differential Diagnosis

Pancreatic pathology – pancreatitis, neoplasia; GI tract pathology- neoplasia, IBD, obstruction with focal perforation; Abdominal pathology- neoplasia, FIP, peritonitis; Hyperthyroidism

UA PH

6.5

UA PH

6.5

Sampling

Fine-needle aspirates of the left pancreatic limb, liver and abdominal fluid with immediate cytospin cytology and culture would be highly recommended given that this is not a typical presentation for normal pancreatitis in a cat. Cytology of the liver and pancreas were performed. The liver revealed probable hepatitis/cholangiohepatitis. The pancreas revealed probable chronic active pancreatitis/steatitis. Abdominal fluid was submitted and no aerobic growth was noted.