Feline Acute Pancreatitis 猫急性胰腺炎 Robert J. Washabau, VMD, PhD, Dipl. ACVIM 罗伯特沃世巴, 兽医博士, 美国兽医内科医学院博士 Department of Veterinary Clinical Sciences Colle

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1 Feline Acute Pancreatitis 猫急性胰腺炎 Robert J. Washabau, VMD, PhD, Dipl. ACVIM 罗伯特沃世巴, 兽医博士, 美国兽医内科医学院博士 Department of Veterinary Clinical Sciences College of Veterinary Medicine University of Minnesota 明尼苏达大学兽医学院兽医临床科学部

2 Feline Acute Necrotizing Pancreatitis: Specific Learning Objectives 猫急性坏死性胰腺炎具体学习目标 (1) Recognize the biology of the acinar and duct cells of the exocrine pancreas. 辨认胰腺外分泌细胞和导管细胞的生物特性 (2) Understand the underlying pathogenesis (intra-acinar activation of enzyme) of acute pancreatic necrosis. 理解急性坏死性胰腺炎的潜在发病机理 ( 腺泡内酶的激活 ) (3) Understand differences between canine and feline pancreatic physiology and pathophysiology. 理解犬和猫胰腺生理学及病理生理学的区别 (4) Understand risk factors for ANP in dogs and cats. 理解犬和猫急性坏死性胰腺炎的风险因素 (5) Understand concurrence of IBD, cholangitis, and ANP ( triaditis ). 理解炎性肠病, 胆道炎及急性坏死性胰腺炎三病共发 (6) Utilize the most sensitive diagnostic tests for diagnosis of ANP. 采用最敏感的诊断的方法 (7) Integrate history, physical exam findings, laboratory data, and imaging findings in the diagnosis of ANP. 结合病史, 体检结果, 实验室检验和影像学分析手段诊断急性坏死性胰腺炎 (8) Understand the principles of therapy in ANP 理解急性坏死性胰腺炎的治疗原理

3 Acute Pancreatic Necrosis Take-Home Points 急性胰腺坏死 - 要点 Pathogenesis Intra-acinar activation and acinar cell necrosis 发病机理 - 腺泡内激活和腺泡细胞坏死 Signs Anorexia, vomiting, abdominal pain, diarrhea (dogs cats) 症状 - 厌食, 呕吐, 腹痛, 腹泻 ( 犬 > 猫 ) Lab Data WBC, ALT, ALP, glucose, cholesterol, bilirubin 化验数据 - WBC, ALT, ALP, 葡萄糖, 胆固醇, 胆红素 Etiology Cat Cholangitis, IBD, ischemia, obstruction, infection 病因 - 猫 - 胆道炎,IBD, 局部缺血, 梗阻, 感染 Etiology Dog High fat diet, drugs, IBD, endocrinopathies 病因 - 犬 - 高脂肪饮食, 药物,IBD, 内分泌疾病 Diagnosis Difficult History, PE, lab data, imaging integration 诊断 - 困难 - 病史体检化验数据影像 - 结合 Therapy Supportive and symptomatic only, not specific 治疗 - 支持性治疗的对症状的治疗, 无具体方案 Complications chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis 并发症 - 慢性非脓性胰腺炎外分泌不足糖尿病脂肪肝 Species Differences Dog vs. cat Signs, lab data, imaging 具体区别 - 犬与猫 - 症状, 化验数据, 影像

Acute Pancreatic Necrosis Resources 急性胰腺坏死 - 资料 Washabau RJ. Consultations In Feline Internal Medicine Vol. 5; 2005; 109-119. Washabau RJ. Textbook of Veterinary Internal Medicine 7 th ed.

4 Acute Pancreatic Necrosis Resources 急性胰腺坏死 - 资料 Washabau RJ. Consultations In Feline Internal Medicine Vol. 5; 2005; Washabau RJ. Textbook of Veterinary Internal Medicine 7 th ed.; 2010; Washabau RJ. Canine and Feline Gastroenterology 1 st ed.; 2013;

5 Acute Pancreatic Necrosis Take-Home Points 急性胰腺坏死 - 要点 Pathogenesis Intra-acinar activation and acinar cell necrosis 发病机理 - 腺泡内激活和腺泡细胞坏死 Signs Anorexia, vomiting, abdominal pain, diarrhea (dogs cats) 症状 - 厌食, 呕吐, 腹痛, 腹泻 ( 犬 > 猫 ) Lab Data WBC, ALT, ALP, glucose, cholesterol, bilirubin 化验数据 - WBC, ALT, ALP, 葡萄糖, 胆固醇, 胆红素 Etiology Cat Cholangitis, IBD, ischemia, obstruction, infection 病因 - 猫 - 胆道炎,IBD, 局部缺血, 梗阻, 感染 Etiology Dog High fat diet, drugs, IBD, endocrinopathies 病因 - 犬 - 高脂肪饮食, 药物,IBD, 内分泌疾病 Diagnosis Difficult History, PE, lab data, imaging integration 诊断 - 困难 - 病史体检化验数据影像 - 结合 Therapy Supportive and symptomatic only, not specific 治疗 - 支持性治疗的对症状的治疗, 无具体方案 Complications chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis 并发症 - 慢性非脓性胰腺炎外分泌不足糖尿病脂肪肝 Species Differences Dog vs. cat Signs, lab data, imaging 具体区别 - 犬与猫 - 症状, 化验数据, 影像

6 Cell Biology of Pancreatic Acinar Cell Secretion 胰腺细胞分泌细胞生物学 Synthesis to Secretion 从合成到分泌 (⑴) E.R. Zymogen Synthesis E.R 发酵菌合成 (2) Vectorial Transport Golgi 有向运输高尔基体 (3) Mannose Phosphorylation 甘露醇磷酯化作用 (4) Lysosomal Sequestration 溶酶体隔离 (5) Zymogen Granules 酶原粒 (6) SPINK1 PSTI (7) Exocytosis/Export 胞外分泌 / 输出 (8) Distal Activation 末梢激活 L RER Meldolesi and Steer. New England Journal of Medicine 1987; 316: N ZG CV GC

7 Cell Biology of Acute Pancreatic Necrosis 急性胰腺坏死细胞生物学 V ZG L CV RER GC N Meldolesi and Steer. New England Journal of Medicine 1987; 316:

8 Chemical Pathology - Pancreatic Necrosis Trypsin Broad range of proteolytic activity 胰蛋白酶 - 广泛的蛋白水解活性病理化学 - 胰腺坏死 Elastase blood vessel elastin digestion, vascular damage, hemorrhage 弹性蛋白酶 - 血管弹性蛋白分解, 血管损伤, 出血 Lipase, Phospholipase A fat necrosis, membrane dissolution 脂肪酶, 磷脂酶 A- 脂肪坏死, 细胞膜溶解

9 The Three Phases of Acute Pancreatic Necrosis 急性胰腺坏死的三个阶段 Initiating 初始 Acinar 腺泡 Severity 严重 Events 事项 Events 事项 Determinants 决定因素 Ischemia Blocked secretion Inflammatory Cytokines 局部缺血分泌受阻炎症性细胞因子 Inflammation Co-Localization Reactive O 2 species 炎症共定位活性 O 2 物质 Toxins Enzyme activation Altered Redox State 毒素酶激活氧化还原状态改变 Infection Cell injury Ischemia 感染细胞损伤局部缺血 Drugs 药物 Apoptosis 细胞死亡 Acute Pancreatitis 急性胰腺炎 From Steer M., J. of Surgery, 2010

10 Acute Pancreatic Necrosis Take-Home Points 急性胰腺坏死 - 要点 Pathogenesis Intra-acinar activation and acinar cell necrosis 发病机理 - 腺泡内激活和腺泡细胞坏死 Signs Anorexia, vomiting, abdominal pain, diarrhea (dogs cats) 症状 - 厌食, 呕吐, 腹痛, 腹泻 ( 犬 > 猫 ) Lab Data WBC, ALT, ALP, glucose, cholesterol, bilirubin 化验数据 - WBC, ALT, ALP, 葡萄糖, 胆固醇, 胆红素 Etiology Cat Cholangitis, IBD, ischemia, obstruction, infection 病因 - 猫 - 胆道炎,IBD, 局部缺血, 梗阻, 感染 Etiology Dog High fat diet, drugs, IBD, endocrinopathies 病因 - 犬 - 高脂肪饮食, 药物,IBD, 内分泌疾病 Diagnosis Difficult History, PE, lab data, imaging integration 诊断 - 困难 - 病史体检化验数据影像 - 结合 Therapy Supportive and symptomatic only, not specific 治疗 - 支持性治疗的对症状的治疗, 无具体方案 Complications chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis 并发症 - 慢性非脓性胰腺炎外分泌不足糖尿病脂肪肝 Species Differences Dog vs. cat Signs, lab data, imaging 具体区别 - 犬与猫 - 症状, 化验数据, 影像

11 Historical Findings: Feline Acute Necrotizing Pancreatitis 历史发现 : 猫急性坏死性胰腺炎 Finding 发现 # of Cases 数量 Incidence 发病率 Anorexia 厌食 131/159 87% Lethargy 嗜睡 129/159 81% Weight loss 体重下降 75/159 47% Vomiting 呕吐 73/159 46% Diarrhea 腹泻 19/159 12% Washabau RJ. Consult. In Feline Intern. Med. Vol. 5; 2005;

12 Physical Examination Findings: 体检发现 Feline Acute Necrotizing Pancreatitis 猫急性坏死性胰腺炎 Finding 发现 # of Cases 数量 Incidence 发病率 Dehydration 脱水 50/92 54% Hypothermia 低体温 23/54 46% Icterus 黄疸 51/138 37% Fever 发热 15/62 25% Abdominal pain 腹痛 30/159 19% Abdominal mass 腹部包块 18/159 11% Washabau RJ. Consult. In Feline Intern. Med. Vol. 5; 2005;

13 Acute Pancreatic Necrosis Take-Home Points 急性胰腺坏死 - 要点 Pathogenesis Intra-acinar activation and acinar cell necrosis 发病机理 - 腺泡内激活和腺泡细胞坏死 Signs Anorexia, vomiting, abdominal pain, diarrhea (dogs cats) 症状 - 厌食, 呕吐, 腹痛, 腹泻 ( 犬 > 猫 ) Lab Data WBC, ALT, ALP, glucose, cholesterol, bilirubin 化验数据 - WBC, ALT, ALP, 葡萄糖, 胆固醇, 胆红素 Etiology Cat Cholangitis, IBD, ischemia, obstruction, infection 病因 - 猫 - 胆道炎,IBD, 局部缺血, 梗阻, 感染 Etiology Dog High fat diet, drugs, IBD, endocrinopathies 病因 - 犬 - 高脂肪饮食, 药物,IBD, 内分泌疾病 Diagnosis Difficult History, PE, lab data, imaging integration 诊断 - 困难 - 病史体检化验数据影像 - 结合 Therapy Supportive and symptomatic only, not specific 治疗 - 支持性治疗的对症状的治疗, 无具体方案 Complications chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis 并发症 - 慢性非脓性胰腺炎外分泌不足糖尿病脂肪肝 Species Differences Dog vs. cat Signs, lab data, imaging

14 Hematological Findings: 血液学发现 Feline Acute Necrotizing Pancreatitis 猫急性坏死性胰腺炎 Finding 发现 # of Cases 数量 Incidence 发病率 Anemia 贫血 39/103 38% Hemoconcentration 血浓缩 14/82 17% Leukocytosis 白血球增多 46/99 46% Leukopenia 白血球减少 14/94 15% Washabau RJ. Consult. In Feline Intern. Med. Vol. 5; 2005;

15 Serum Biochemical Findings: 血清生化发现 Feline Acute Necrotizing Pancreatitis 猫急性坏死性胰腺炎 Finding 发现 # of Cases 数量 Incidence 发病率 ALT, AST 37/65 57% ALP 32/65 49% Bilirubin 胆红素 38/65 58% Glucose 葡萄糖 32/71 45% Cholesterol 胆固醇 28/39 72% Calcium 钙 55/85 65% Albumin 白蛋白 14/39 36%

16 Prognostic Significance of Hypocalcemia in Feline ANP 低血钙症在猫 ANP 中的预测意义 Kimmel, Drobatz, and Washabau J. Amer. Vet. Med. Assoc. 2001; 219: Ionized Calcium (mmol/l) * Median 中位数 = 1.00 Non-survivor AP Cats 死亡 Survivor AP Cats 存活 Median 中位数 = 1.12 Controls 对照

17 Acute Pancreatic Necrosis Take-Home Points 急性胰腺坏死 - 要点 Pathogenesis Intra-acinar activation and acinar cell necrosis 发病机理 - 腺泡内激活和腺泡细胞坏死 Signs Anorexia, vomiting, abdominal pain, diarrhea (dogs cats) 症状 - 厌食, 呕吐, 腹痛, 腹泻 ( 犬 > 猫 ) Lab Data WBC, ALT, ALP, glucose, cholesterol, bilirubin 化验数据 - WBC, ALT, ALP, 葡萄糖, 胆固醇, 胆红素 Etiology Cat Cholangitis, IBD, ischemia, obstruction, infection 病因 - 猫 - 胆道炎,IBD, 局部缺血, 梗阻, 感染 Etiology Dog High fat diet, drugs, IBD, endocrinopathies 病因 - 犬 - 高脂肪饮食, 药物,IBD, 内分泌疾病 Diagnosis Difficult History, PE, lab data, imaging integration 诊断 - 困难 - 病史体检化验数据影像 - 结合 Therapy Supportive and symptomatic only, not specific 治疗 - 支持性治疗的对症状的治疗, 无具体方案 Complications chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis 并发症 - 慢性非脓性胰腺炎外分泌不足糖尿病脂肪肝 Species Differences Dog vs. cat Signs, lab data, imaging 具体区别 - 犬与猫 - 症状, 化验数据, 影像

18 Etiologies Feline Acute Necrotizing Pancreatitis 病因 - 猫急性坏死性胰腺炎 Known Associations 已知关联 Biliary Tract Disease 胆道疾病 G.I. Disease 消化道疾病 Ischemia 局部缺血 Ductal Obstruction 导管阻塞 Infection 感染 Trauma 外伤 Organophosphates 有机磷 Lipodystrophy 脂肪代谢障碍 Suggested Associations 可能关联 Hypercalcemia 血钙过多症 Drug Reactions 药物反应 Nutrition 营养

19 I.B.D., Pancreatic, Biliary Tract Disease: Contributing Factors in the Cat 炎性肠病, 胰腺炎, 胆道疾病 : 发病因素 Incidence of I.B.D I.B.D. 发病率 Clinical Symptomatology of I.B.D. I.B.D. 临床病症 Intestinal Microflora 肠道菌群 Pancreatico-biliary anatomy 胰腺 - 胆囊解剖学 Washabau R.J. J. Fel. Med. & Surg. 2001; 3: 95-98

20 Acute Pancreatic Necrosis Take-Home Points 急性胰腺坏死 - 要点 Pathogenesis Intra-acinar activation and acinar cell necrosis 发病机理 - 腺泡内激活和腺泡细胞坏死 Signs Anorexia, vomiting, abdominal pain, diarrhea (dogs cats) 症状 - 厌食, 呕吐, 腹痛, 腹泻 ( 犬 > 猫 ) Lab Data WBC, ALT, ALP, glucose, cholesterol, bilirubin 化验数据 - WBC, ALT, ALP, 葡萄糖, 胆固醇, 胆红素 Etiology Cat Cholangitis, IBD, ischemia, obstruction, infection 病因 - 猫 - 胆道炎,IBD, 局部缺血, 梗阻, 感染 Etiology Dog High fat diet, drugs, IBD, endocrinopathies 病因 - 犬 - 高脂肪饮食, 药物,IBD, 内分泌疾病 Diagnosis Difficult History, PE, lab data, imaging integration 诊断 - 困难 - 病史体检化验数据影像 - 结合 Therapy Supportive and symptomatic only, not specific 治疗 - 支持性治疗的对症状的治疗, 无具体方案 Complications chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis 并发症 - 慢性非脓性胰腺炎外分泌不足糖尿病脂肪肝 Species Differences Dog vs. cat Signs, lab data, imaging 具体区别 - 犬与猫 - 症状, 化验数据, 影像

21 Evaluation of Risk Factors for Fatal Canine Acute Pancreatic Necrosis 犬致命急性胰腺坏死风险因素评估 - Hess & Washabau J. Am. Vet. Med. Assoc. 1999; 214: 46- Older age/overweight body condition 较高年龄 / 超重 Yorkshire Terriers 约克郡犬 Anti-convulsant medication 抗惊厥药物 Trimethoprim-sulfa medication 甲氧苄氨嘧啶药物 Prior G.I. tract disease 消化道病史 Endocrinopathies 内分泌疾病

22 Acute Pancreatic Necrosis Take-Home Points 急性胰腺坏死 - 要点 Pathogenesis Intra-acinar activation and acinar cell necrosis 发病机理 - 腺泡内激活和腺泡细胞坏死 Signs Anorexia, vomiting, abdominal pain, diarrhea (dogs cats) 症状 - 厌食, 呕吐, 腹痛, 腹泻 ( 犬 > 猫 ) Lab Data WBC, ALT, ALP, glucose, cholesterol, bilirubin 化验数据 - WBC, ALT, ALP, 葡萄糖, 胆固醇, 胆红素 Etiology Cat Cholangitis, IBD, ischemia, obstruction, infection 病因 - 猫 - 胆道炎,IBD, 局部缺血, 梗阻, 感染 Etiology Dog High fat diet, drugs, IBD, endocrinopathies 病因 - 犬 - 高脂肪饮食, 药物,IBD, 内分泌疾病 Diagnosis Difficult History, PE, lab data, imaging integration 诊断 - 困难 - 病史体检化验数据影像 - 结合 Therapy Supportive and symptomatic only, not specific 治疗 - 支持性治疗的对症状的治疗, 无具体方案 Complications chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis 并发症 - 慢性非脓性胰腺炎外分泌不足糖尿病脂肪肝 Species Differences Dog vs. cat Signs, lab data, imaging

23 Diagnosis of Acute Pancreatitis 急性胰腺炎诊断 Pancreatic Trypsin, Amylase, Lipase 胰蛋白酶, 淀粉酶, 脂肪酶

24 Pancreatic Trypsin, Amylase, Lipase 胰蛋白酶, 淀粉酶, 脂肪酶 Serum Amylase Activity 血清淀粉酶活性 Insensitive 不敏感 Serum Lipase Activity 血清脂肪酶活性 Insensitive 不敏感 Serum [Trypsin] 血清 [ 胰蛋白酶 ] 活性 Insensitive 不敏感 Serum [plipase] 血清 [ 磷脂酶 ] Preferred assay 首选测试

25 Diagnosis of Acute Pancreatitis 急性胰腺炎诊断 1. History 病史 2. Physical Examination 体检 3. Laboratory Methods 化验方法 4. Imaging Studies 影像研究 5. Histology 组织学

26 Anatomy Radiographic Localization 解剖学 - 放射影像位置

27 Ultrasonographic Findings 超声波发现 27 (64%): enlarged, irregular, and/or hypoechoic pancreas 27(64%): 肥大, 不规则, 或低回声胰脏 18 (43%): hyperechoic peripancreatic mesentery 18(43%): 高回声胰周肠系膜 13 (31%): abdominal effusion 13(31%): 腹部渗出物 7 (17%): distension of the gall bladder and common bile duct 7(17%): 胆囊和胆总管扩张 2 (5%): thrombosis of the pancreaticoduodenal vein 2(5%): 胰十二指肠静脉血栓

28 How Good Is Ultrasound? 超声波有多好? Saunders et al. 95% Specificity 特异性 35% Sensitivity 敏感性 Limitations 局限 JAVMA 2002; 221:

29 Diagnosis of Acute Pancreatitis: Integration of Information 急性胰腺炎诊断 : 信息综合 1. History 病史 2. Physical Examination 体检 3. Laboratory Methods 化验方法 4. Imaging Studies 影像研究 5. Histology 组织学

30 Acute Pancreatic Necrosis Take-Home Points 急性胰腺坏死 - 要点 Pathogenesis Intra-acinar activation and acinar cell necrosis 发病机理 - 腺泡内激活和腺泡细胞坏死 Signs Anorexia, vomiting, abdominal pain, diarrhea (dogs cats) 症状 - 厌食, 呕吐, 腹痛, 腹泻 ( 犬 > 猫 ) Lab Data WBC, ALT, ALP, glucose, cholesterol, bilirubin 化验数据 - WBC, ALT, ALP, 葡萄糖, 胆固醇, 胆红素 Etiology Cat Cholangitis, IBD, ischemia, obstruction, infection 病因 - 猫 - 胆道炎,IBD, 局部缺血, 梗阻, 感染 Etiology Dog High fat diet, drugs, IBD, endocrinopathies 病因 - 犬 - 高脂肪饮食, 药物,IBD, 内分泌疾病 Diagnosis Difficult History, PE, lab data, imaging integration 诊断 - 困难 - 病史体检化验数据影像 - 结合 Therapy Supportive and symptomatic only, not specific 治疗 - 支持性治疗的对症状的治疗, 无具体方案 Complications chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis 并发症 - 慢性非脓性胰腺炎外分泌不足糖尿病脂肪肝 Species Differences Dog vs. cat Signs, lab data, imaging 具体区别 - 犬与猫 - 症状, 化验数据, 影像

31 Therapy of Acute Necrotizing Pancreatitis 急性坏死性胰腺炎治疗 1. Eliminate Inciting Agent 消除刺激物 2. N.P.O. short duration 禁食 - 短期 3. Intravenous Fluids 静脉液体 4. Supportive Therapy plasma, 10 ml/kg 支持性治疗 - 血浆,10ml/kg 5. Relieve Pain fentanyl, buprenorphine 缓解痛症 - 芬太尼, 丁丙诺菲 6. Anti-Emetics - NK 1, α 1, 5-HT 3 antagonists 止吐药物 - NK 1, α 1, 5-HT 3 拮抗剂

32 Other Therapeutic Considerations: Acute Pancreatic Necrosis 其他治疗注意事项 : 急性胰腺坏死 7. Calcium Gluconate Supplementation 葡萄糖酸钙补充 8. H 1 /H 2 Histamine Receptor Antagonists H 1 /H 2 组织胺受体拮抗剂 9. Low dose dopamine infusion - 5 μg/kg/min. 低剂量多巴胺注射 - -5 μg/kg/min 10. Broad Spectrum Antibiotics 广谱抗生素 11. Ductal Decompression 导管减压

33 Acute Pancreatic Necrosis Take-Home Points 急性胰腺坏死 - 要点 Pathogenesis Intra-acinar activation and acinar cell necrosis 发病机理 - 腺泡内激活和腺泡细胞坏死 Signs Anorexia, vomiting, abdominal pain, diarrhea (dogs cats) 症状 - 厌食, 呕吐, 腹痛, 腹泻 ( 犬 > 猫 ) Lab Data WBC, ALT, ALP, glucose, cholesterol, bilirubin 化验数据 - WBC, ALT, ALP, 葡萄糖, 胆固醇, 胆红素 Etiology Cat Cholangitis, IBD, ischemia, obstruction, infection 病因 - 猫 - 胆道炎,IBD, 局部缺血, 梗阻, 感染 Etiology Dog High fat diet, drugs, IBD, endocrinopathies 病因 - 犬 - 高脂肪饮食, 药物,IBD, 内分泌疾病 Diagnosis Difficult History, PE, lab data, imaging integration 诊断 - 困难 - 病史体检化验数据影像 - 结合 Therapy Supportive and symptomatic only, not specific 治疗 - 支持性治疗的对症状的治疗, 无具体方案 Complications chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis 并发症 - 慢性非脓性胰腺炎外分泌不足糖尿病脂肪肝 Species Differences Dog vs. cat Signs, lab data, imaging

34 Exocrine Pancreatic Disease Classification 外分泌胰腺疾病分类 Ferreri & Washabau J.AV.M.A., 2003; 223: 469 Acute Suppurative Pancreatitis 急性化脓性胰腺炎 Pancreatic Nodular Hyperplasia 胰腺节状增生 Acute Necrotizing Pancreatitis 急性坏死性胰腺炎 Health 健康 Pancreatic Neoplasia 胰脏肿瘤 Dog 犬 Chronic Pancreatitis 慢性胰腺炎 Cat 猫 Pancreatic Insufficiency 胰腺机能不全

35 Feline Hepatic Lipidosis 猫脂肪肝

36 Obligate Carnivores Biochemical Differences 专食肉动物 - 生化差异 1. Essentiality of dietary arginine 饮食精氨酸重要性 2. Low levels of hepatic ornithine 低水平肝鸟氨酸 3. High dietary protein requirements 高饮食蛋白质需求 4. Lack of hepatic enzyme adaptation to low protein 缺乏肝脏酶对低蛋白适应性 5. Insufficiency of hepatic glutamate reductase 肝脏谷氨酸盐还原酶机能不全 6. Insufficiency of intestinal ornithine transcarbamylase 肠道鸟氨酸转氨甲酰酶机能不全 7. Differences in lipoprotein metabolism (HDLs) 脂蛋白新陈代谢差异

37 Acute Pancreatitis/Hepatic Lipidosis in Cats 猫的急性胰腺炎 / 脂肪肝 - Akol K, Washabau R, Saunders M, Hendrick M - J. Vet. Intern. Med. 1993; 7: Lipidosis and pancreatitis occur concurrently. 脂肪沉积和胰腺炎同时发生 Lab findings are similar 化验结果相似 Cats with A.P. have worse prognosis. 患有急性胰腺炎的猫预后更差

38 Acute Pancreatic Necrosis Take-Home Points 急性胰腺坏死 - 要点 Pathogenesis Intra-acinar activation and acinar cell necrosis 发病机理 - 腺泡内激活和腺泡细胞坏死 Signs Anorexia, vomiting, abdominal pain, diarrhea (dogs cats) 症状 - 厌食, 呕吐, 腹痛, 腹泻 ( 犬 > 猫 ) Lab Data WBC, ALT, ALP, glucose, cholesterol, bilirubin 化验数据 - WBC, ALT, ALP, 葡萄糖, 胆固醇, 胆红素 Etiology Cat Cholangitis, IBD, ischemia, obstruction, infection 病因 - 猫 - 胆道炎,IBD, 局部缺血, 梗阻, 感染 Etiology Dog High fat diet, drugs, IBD, endocrinopathies 病因 - 犬 - 高脂肪饮食, 药物,IBD, 内分泌疾病 Diagnosis Difficult History, PE, lab data, imaging integration 诊断 - 困难 - 病史体检化验数据影像 - 结合 Therapy Supportive and symptomatic only, not specific 治疗 - 支持性治疗的对症状的治疗, 无具体方案 Complications chronic non-suppurative pancreatitis, exocrine insufficiency, diabetes mellitus, hepatic lipidosis 并发症 - 慢性非脓性胰腺炎外分泌不足糖尿病脂肪肝 Species Differences Dog vs. cat Signs, lab data, imaging 具体区别 - 犬与猫 - 症状, 化验数据, 影像

39 Feline Acute Pancreatitis: Species Differences 猫急性胰腺炎 : 物种差异 Washabau RJ. J. Fel. Med. Surg. 2001; 3: Feline 猫 Canine 犬 Vomiting 呕吐 46% 90% Diarrhea 腹泻 12% 33% Fever 发热 25% 32% Abd. Pain 腹痛 19% 58%

40 Feline Acute Pancreatitis: Species Differences 猫急性胰腺炎 : 物种差异 Washabau RJ. J. Fel. Med. Surg. 2001; 3: Feline 猫 Canine 犬 WBC s 46% 62% Ca 2+ 65% 5% Radiography Not useful Somewhat useful 放射影像没有用处稍有用 I.B.D. Strong assoc. Weak assoc. I.B.D. 强关联弱关联

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