Case Study

Pancreatitis with post hepatic obstruction in a 5 year old MN DSH cat

A 5-year-old MN DSH was presented for anorexia, lethargy, and vomiting. The only significant finding on physical examination was icterus. On CBC, thrombocytopenia and lymphopenia were present. Elevated serum proteins, hyperglobulinemia, elevated liver enzyme activity, bilirubinemia, hyperglycemia, and hyperamylasemia were evident on serum biochemistry. FIV/FELV test was negative, and T4 was within normal limits. Titers for FCV were 1:400 (1:1600-positive), IgG toxoplasmosis was 1:64, and IgM toxoplasmosis was negative. The pet was treated with Denosyl, vitamin B, hetastarch, and Lactated Ringer`s. Repeat biochemistry showed ongoing hyperglobulinemia, elevated liver enzyme activity, bilirubinemia, and hyperglycemia with normalization of the hyperamylasemia.

Sonographic Differential Diagnosis

Extra hepatic bile duct obstruction due to severe acute pancreatitis.

Image Interpretation

The left limb of the pancreas showed severe and acute changes with hyperechoic saponified fat and a hypoechoic center. This area appeared painful to the patient. The right limb of the pancreas showed moderate hyperechoic changes with hyperechoic and reactive mesentery. The reactive mesentery was present in the right cranial aspects of the abdomen. The biliary tree appeared dilated along its length with a mildly tortuous appearance. The bile duct measured 0.52cm in several locations. CBD measures 0.71cm at the level of the duodenal papilla.

DX

Severe acute pancreatitis with post-hepatic obstruction

Outcome

The pet remained hospitalized with the smooth-muscle relaxant medication Centrine (Aminopentamide) added to the treatment regimen. However, he remained lethargic, and inappetent. Prednisone and Pet-Tinic were subsequently added to the therapy. Repeat serum chemistry showed hypoalbuminemia, hyperglobulinemia, elevated liver enzyme activity, and bilirubinemia. anemia, leukocytosis, neutrophilia, and thrombocytopenia were present on CBC. The pet started to improve after prednisone had been added to the therapy.

Clinical Differential Diagnosis

Icterus – hepatic pathology (cholangio-hepatitis complex, infection (bacterial, protozoal), lipidosis, neoplasia), pancreatitis, diabetes, FIP, Hemoplasmosis (Mycoplasma haemofelis).