Case Study

Pancreatitis and diabetes in a 9 year old MN DSH cat

A 9-year-old MN DSH presented for evaluation of polyuria with a history of elevated triglycerides. On urinalysis an inappropriately low specific gravity and glycosuria was present. Lymphopenia was evident on CBC, and hypertriglyceridemia was present on serum biochemistry. T4 was within normal limits and fructosamine was elevated. A week later, the cat became lethargic, anorexic, and hyperglycemic.

DX

Pancreatitis

Sonographic Differential Diagnosis

Acute on chronic pancreatitis likely, but there is a potential for pancreatic carcinoma.

Image Interpretation

Extensive mixed hypoechoic pancreatic parenchymal changes are noted with areas of coalesced fluid.

Outcome

In addition the cat was diagnosed with diabetes mellitus. The cat was treated with ampicillin, cimetidine, SQ fluids, and was sent home on oral antibiotics and a bland diet. A few days after the abdominal ultrasound the owner reported that the pet’s appetite has improved but pet was still PU/PD. Both fructosamine and glucose were elevated. Vetsulin was started at one unit twice daily. Fructosamine and glucose levels were frequently checked over the course of several months but remained elevated until the dose of insulin was raised to 10 units BID. During this time the pet remained on a bland diet (Hills I/D). Nine months after the ultrasound, the triglycerides had decreased, and the owner reported that the pet was no longer PU/PD at home.

Clinical Differential Diagnosis

Diabetes mellitus. Pancreatic disease (pancreatitis, neoplasia).

Sampling

Ultrasound-guided FNA of the pancreas was completed, and cytology revealed chronic suppurative inflammation and mild epithelial cell dysplasia, compatible with the clinical suspicion of pancreatitis.