猫胰腺炎
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管周边淋巴细胞性炎症
Feline Pancreatitis
猫胰腺炎
• Overlap in histology 病理组织重叠
• Fibrosis not always present in interstitial form as for canine chronic pancreatitis
与犬慢性胰腺炎不同，组织纤维化不常存在于间 质内
对性有差异（不同研究显示结果不一）
• Gerhardt et al - 86% if >49 μg/L;33% if >100 μg/L - Specificity 80%
• Allen et al - Sensitivity 63.6%(range 80-120 μg/L) - Specificity 96.9%
百分之百有并发症 - Hepatomegaly,thickened intestines肝肿大，腹壁增厚等
• Again cause or consequence?病因/病果？ • Even more vague clinical signs临床病症无针对性
- n=33(Ferreri et al 2003) - Anorexia（厌食） 70%,lethargy（嗜睡） 52%,vomiting（呕 吐） 39%,diarrhoea（腹泻） 51%,weight loss（体重减轻） 21% - Jaundice（黄疸） 24%(greater than for ANP)
比间质性胰腺炎少见
- 2/3 have concurrent disease 2/3有其他疾病 - Peri-pancreatic fat necrosis 有胰脏周边脂肪坏死 • Acute suppurtive form 急性化脓性胰腺炎 • Auto-immune 自身免疫性胰腺炎
- Peri-ductular lymphocytic inflammation
• No difference in another between CP and ANP(Ferreri et al)
慢性与急性胰腺炎的血钙含量相差不大
• Causes? 病因？ • Ionised calcium preferable 测定血清游离钙离子
More specific tests 针对性化验诊断
病症
Hill&Van Winkle 1993
Case numbers 病例数 Lethargy 嗜睡 Anorexia 厌食 Dehydration 脱水
40(necropsy)
100% 97% 92%
Hypothermia 低温 68%
Vomiting 呕吐
35%
Abdominal pain 腹痛
Can we diagnose feline pancreatitis and do we need to?
临床上如何诊断猫胰腺炎，有无必要？
Dr Caroline Mansfield Murdoch University Western Australia
• ‘Diagnosis is a system of more or less accurate guessing; in which the end-point achieved is a name.These names applied to disease come to assume the importance of specific entities,whereas they are for the most part no more than insecure and therefore temporary conceptions’
炎少见
• Post-mortem survey(tertiary referral):死后剖检显示 － Overall prevalence 67%； 67%的得病率
－ 45% clinically healthy cats had pancreatic lesions;
45%的健康猫存在胰脏损伤
－Pancreatic pathology does not equal clinical pancreatitis 胰脏病变并不表示动物有临床胰腺炎
严重病例会出现低血清血蛋白
• Leucopenia worse prognosis? 白细胞减少症预后不乐观
Hypocalcaemia
低血钙症
• Poor prognostic indicator for ANP in one study (Kimmel et al)
研究显示以血钙含量作为急性坏死性胰腺炎的预后标准效 果不理想
病菌数
- Common bile and pancreatic duct
胆管＆胰腺管
- Cause or consequence?病因＆
病果？
- Vomiting increases ductal pressure
呕吐导致管内压升高
•图
Potential underlying causes
潜在性的胰腺炎病因
46
30
83% 96% NR
NR 43% 17%
50% 63% 33%
NR 43% 10%
4%
3%
11% NR NR 39%
22%
NR 16% NR 40%
16%
Clinical signs of chronic pancreatitis
慢性胰腺炎的临床病症
• Up to 100% reported with concurrent disease
Feline Pancreatitis
猫胰腺炎
• Most common type: 最普通的类型： • Non-suppurative 非化脓性（胰腺炎）
- Usually chronic 一般为慢性病 - Confined to interstitium 限于间质组织 - Associated with: 与以下疾病有关：
Why association with other disease?
为何慢性胰腺炎与其他疾病相关？
• Hepatic lipidosis 脂肪肝
• Cholangiohepatitis&inflammato ry bowel disease 胆管肝炎&炎性
肠病 相关因素：
- Bacterial numbers in SI 小肠内
• Trauma/ischaemia 创伤/缺血 • Toxoplasma gondii 弓形虫 • Flukes 肝吸虫 • FIP 传染性腹膜炎 • Nutritional? 营养不良？ • Organophosphate poisoning 有机磷中毒 • Hypercalcaemia 高钙血症 • Reflux 胃反流 • Lipodystrophy 脂肪代谢障碍
Diagnosis of feline pancreatitis
猫胰腺炎的诊断
• Routine haematology and biochemistry
常规血液与生化检验 - No specific changes 无异常 - Important to do in order to treat appropriately 但确诊的话必须做化验
• Minimal inflammation
少量炎症性病变
• No peri-pancreatic necrosis
无胰周边坏死
• Histopathological diagnosis
需病理组织学化验
Feline Pancreatitis
猫胰腺炎
• Acute necrotising pancreatitis 急性坏死性胰腺炎 - Similar to dogs 与犬急性坏死性胰腺炎相似 - Less common than interstitial disease
- Renal failure 肾衰 - Inflammatory bowel disease 炎性肠炎
Clinical signs of ANP
ANP的临床症状
• Abdominal pain and vomiting much less apparent than the canine form
腹痛和呕吐比犬ANP少见
• Despite similar degree of peri-pancreatic necrosis 但胰周边坏死度与犬的相似
• Systemic cytokine activation less studied in the cat 猫的体内细胞因子研究不多
Clinical sign
一般有其他并发症
• Concurrent disease increases mortality significantly 并发疾病大大提高死亡率
常见并发症有：
- Hepatic lipidosis (66% mortality)脂肪肝（66% 死亡率） - Cholangiohepatitis 胆管肝炎
• Reflects underlying disease 有助于了解潜在病因 • Reflects electrolyte and hydration status
反映电解质与脱水状况
• Severe cases more likely to have low serum albumin(Forman et al)
• Clinically severe means ANP and mild means CP
严重的临床病变表示急性坏死性胰腺炎，轻度病 变则表示慢性胰腺炎
Hale Waihona Puke Baidu
ANP
急性坏死性胰腺炎
• This condition has a poor prognosis 预后不良 • Concurrent disease common in ANP
自发性胰腺炎病例中这些酶很少升高＆非有效诊断
Pancreatic-specific enzymes
胰特异性酶
• Trypsin-like immunorectivity 胰蛋白酶免疫检 测
• Species-specific assay(fTLI) 品种特异性化验（猫） • Available USA 在美国较普遍 • Measures circulating trypsinogen and trypsin
• 诊断是一个猜疑的过程，最终得出一个名称。但这些名称 只是对疾病本质的假设，是不稳定的，暂时性的概念。
•
Sir Thomas Lewis,1944
Feline Pancreatitis
猫胰腺炎
• How common is it? 到底有多普遍？ • Less commonly diagnosed than in dogs 比犬胰腺
25%
Palpable abdominal mass 腹内肿块 Diarrhoea 腹泻 Dyspnoea 呼吸困难 Ataxia 运动失调
Weight loss 体重减轻 Jaundice 黄疸
23%
15% 20% 15% NR
NR
Kimmel et al 2001 Ferreriet al 2003
测定血液中的胰蛋白酶原和胰蛋白
• Increased in experimentally induced pancreatitis
在实验性感染病例中胰蛋白酶有所升高
fTLI in real life (ref range < 100 μg/L) 实际病例中猫胰蛋白酶免疫检测
• Sensitivity&specificity variable 敏感性与针
Inflammatory bowel disease 炎性肠病 Cholangiohepatitis 胆管肝炎 Interstitial nephritis 间质性肾炎
Non-suppurative (chronic)
非化脓性胰腺炎（慢性）
• Large degree fibrosis
大量纤维化病变
Serum lipase & amylase 血清脂肪酶＆淀粉酶 • Experimentally lipase increases amylase doesn’t
试验显示胰腺炎猫的脂肪酶有上升，但是淀粉酶无变化 - Likely reflects diet 可能直接反映饮食结构
• Seldom increased in spontaneous disease & not helpful in the diagnosis
Feline Pancreatitis
猫胰腺炎
• Overlap in histology 病理组织重叠
• Fibrosis not always present in interstitial form as for canine chronic pancreatitis
与犬慢性胰腺炎不同，组织纤维化不常存在于间 质内
对性有差异（不同研究显示结果不一）
• Gerhardt et al - 86% if >49 μg/L;33% if >100 μg/L - Specificity 80%
• Allen et al - Sensitivity 63.6%(range 80-120 μg/L) - Specificity 96.9%
百分之百有并发症 - Hepatomegaly,thickened intestines肝肿大，腹壁增厚等
• Again cause or consequence?病因/病果？ • Even more vague clinical signs临床病症无针对性
- n=33(Ferreri et al 2003) - Anorexia（厌食） 70%,lethargy（嗜睡） 52%,vomiting（呕 吐） 39%,diarrhoea（腹泻） 51%,weight loss（体重减轻） 21% - Jaundice（黄疸） 24%(greater than for ANP)
比间质性胰腺炎少见
- 2/3 have concurrent disease 2/3有其他疾病 - Peri-pancreatic fat necrosis 有胰脏周边脂肪坏死 • Acute suppurtive form 急性化脓性胰腺炎 • Auto-immune 自身免疫性胰腺炎
- Peri-ductular lymphocytic inflammation
• No difference in another between CP and ANP(Ferreri et al)
慢性与急性胰腺炎的血钙含量相差不大
• Causes? 病因？ • Ionised calcium preferable 测定血清游离钙离子
More specific tests 针对性化验诊断
病症
Hill&Van Winkle 1993
Case numbers 病例数 Lethargy 嗜睡 Anorexia 厌食 Dehydration 脱水
40(necropsy)
100% 97% 92%
Hypothermia 低温 68%
Vomiting 呕吐
35%
Abdominal pain 腹痛
Can we diagnose feline pancreatitis and do we need to?
临床上如何诊断猫胰腺炎，有无必要？
Dr Caroline Mansfield Murdoch University Western Australia
• ‘Diagnosis is a system of more or less accurate guessing; in which the end-point achieved is a name.These names applied to disease come to assume the importance of specific entities,whereas they are for the most part no more than insecure and therefore temporary conceptions’
炎少见
• Post-mortem survey(tertiary referral):死后剖检显示 － Overall prevalence 67%； 67%的得病率
－ 45% clinically healthy cats had pancreatic lesions;
45%的健康猫存在胰脏损伤
－Pancreatic pathology does not equal clinical pancreatitis 胰脏病变并不表示动物有临床胰腺炎
严重病例会出现低血清血蛋白
• Leucopenia worse prognosis? 白细胞减少症预后不乐观
Hypocalcaemia
低血钙症
• Poor prognostic indicator for ANP in one study (Kimmel et al)
研究显示以血钙含量作为急性坏死性胰腺炎的预后标准效 果不理想
病菌数
- Common bile and pancreatic duct
胆管＆胰腺管
- Cause or consequence?病因＆
病果？
- Vomiting increases ductal pressure
呕吐导致管内压升高
•图
Potential underlying causes
潜在性的胰腺炎病因
46
30
83% 96% NR
NR 43% 17%
50% 63% 33%
NR 43% 10%
4%
3%
11% NR NR 39%
22%
NR 16% NR 40%
16%
Clinical signs of chronic pancreatitis
慢性胰腺炎的临床病症
• Up to 100% reported with concurrent disease
Feline Pancreatitis
猫胰腺炎
• Most common type: 最普通的类型： • Non-suppurative 非化脓性（胰腺炎）
- Usually chronic 一般为慢性病 - Confined to interstitium 限于间质组织 - Associated with: 与以下疾病有关：
Why association with other disease?
为何慢性胰腺炎与其他疾病相关？
• Hepatic lipidosis 脂肪肝
• Cholangiohepatitis&inflammato ry bowel disease 胆管肝炎&炎性
肠病 相关因素：
- Bacterial numbers in SI 小肠内
• Trauma/ischaemia 创伤/缺血 • Toxoplasma gondii 弓形虫 • Flukes 肝吸虫 • FIP 传染性腹膜炎 • Nutritional? 营养不良？ • Organophosphate poisoning 有机磷中毒 • Hypercalcaemia 高钙血症 • Reflux 胃反流 • Lipodystrophy 脂肪代谢障碍
Diagnosis of feline pancreatitis
猫胰腺炎的诊断
• Routine haematology and biochemistry
常规血液与生化检验 - No specific changes 无异常 - Important to do in order to treat appropriately 但确诊的话必须做化验
• Minimal inflammation
少量炎症性病变
• No peri-pancreatic necrosis
无胰周边坏死
• Histopathological diagnosis
需病理组织学化验
Feline Pancreatitis
猫胰腺炎
• Acute necrotising pancreatitis 急性坏死性胰腺炎 - Similar to dogs 与犬急性坏死性胰腺炎相似 - Less common than interstitial disease
- Renal failure 肾衰 - Inflammatory bowel disease 炎性肠炎
Clinical signs of ANP
ANP的临床症状
• Abdominal pain and vomiting much less apparent than the canine form
腹痛和呕吐比犬ANP少见
• Despite similar degree of peri-pancreatic necrosis 但胰周边坏死度与犬的相似
• Systemic cytokine activation less studied in the cat 猫的体内细胞因子研究不多
Clinical sign
一般有其他并发症
• Concurrent disease increases mortality significantly 并发疾病大大提高死亡率
常见并发症有：
- Hepatic lipidosis (66% mortality)脂肪肝（66% 死亡率） - Cholangiohepatitis 胆管肝炎
• Reflects underlying disease 有助于了解潜在病因 • Reflects electrolyte and hydration status
反映电解质与脱水状况
• Severe cases more likely to have low serum albumin(Forman et al)
• Clinically severe means ANP and mild means CP
严重的临床病变表示急性坏死性胰腺炎，轻度病 变则表示慢性胰腺炎
Hale Waihona Puke Baidu
ANP
急性坏死性胰腺炎
• This condition has a poor prognosis 预后不良 • Concurrent disease common in ANP
自发性胰腺炎病例中这些酶很少升高＆非有效诊断
Pancreatic-specific enzymes
胰特异性酶
• Trypsin-like immunorectivity 胰蛋白酶免疫检 测
• Species-specific assay(fTLI) 品种特异性化验（猫） • Available USA 在美国较普遍 • Measures circulating trypsinogen and trypsin
• 诊断是一个猜疑的过程，最终得出一个名称。但这些名称 只是对疾病本质的假设，是不稳定的，暂时性的概念。
•
Sir Thomas Lewis,1944
Feline Pancreatitis
猫胰腺炎
• How common is it? 到底有多普遍？ • Less commonly diagnosed than in dogs 比犬胰腺
25%
Palpable abdominal mass 腹内肿块 Diarrhoea 腹泻 Dyspnoea 呼吸困难 Ataxia 运动失调
Weight loss 体重减轻 Jaundice 黄疸
23%
15% 20% 15% NR
NR
Kimmel et al 2001 Ferreriet al 2003
测定血液中的胰蛋白酶原和胰蛋白
• Increased in experimentally induced pancreatitis
在实验性感染病例中胰蛋白酶有所升高
fTLI in real life (ref range < 100 μg/L) 实际病例中猫胰蛋白酶免疫检测
• Sensitivity&specificity variable 敏感性与针
Inflammatory bowel disease 炎性肠病 Cholangiohepatitis 胆管肝炎 Interstitial nephritis 间质性肾炎
Non-suppurative (chronic)
非化脓性胰腺炎（慢性）
• Large degree fibrosis
大量纤维化病变
Serum lipase & amylase 血清脂肪酶＆淀粉酶 • Experimentally lipase increases amylase doesn’t
试验显示胰腺炎猫的脂肪酶有上升，但是淀粉酶无变化 - Likely reflects diet 可能直接反映饮食结构
• Seldom increased in spontaneous disease & not helpful in the diagnosis