Acute on chronic pancreatitis with bilateral pyelectasia and IBD in a 12 year old FS DSH cat

History

This 12 year old FS DSH cat presented for vomiting, lethargy and anorexia of 4 days duration.

Physical Exam: Depressed, lethargic,weight loss, grade 1-2/6 systolic ht mm, severely prolonged skin turgor, appr 10% dehydrated, tacky mm, cachexic, generalized muscle atrophy, doughy potbellied abdomen, poor coat, thyroid slip palpated and severe dental disease.

CBC: severe leukocytosis(43,000) , neutrophilia(33,000), mild lymphocytosis and monocytosis, HCT-41%

Chemistry: BG=621, BUN-73, creat-1.5, phos-6.4, Ca-8.8, TP-7.1, t. bili-1.1

This 12 year old FS DSH cat presented for vomiting, lethargy and anorexia of 4 days duration.

Physical Exam: Depressed, lethargic,weight loss, grade 1-2/6 systolic ht mm, severely prolonged skin turgor, appr 10% dehydrated, tacky mm, cachexic, generalized muscle atrophy, doughy potbellied abdomen, poor coat, thyroid slip palpated and severe dental disease.

CBC: severe leukocytosis(43,000) , neutrophilia(33,000), mild lymphocytosis and monocytosis, HCT-41%

Chemistry: BG=621, BUN-73, creat-1.5, phos-6.4, Ca-8.8, TP-7.1, t. bili-1.1

Urine Analysis: SG=1.028, ph-6, 3+ serum ketones, lg amount of glucose, trace protein

FPLI-abnormal, T4=0.5 low. Blood gas: ICa-1.11 slightly low, BE=12,lactate=0.63, pH=7.47, this blood gas was performed 48hr post admit.

DX

Acute on chronic pancreatitis with pyelectasia in both kidneys. Urine culture would be warranted. IBD gastrointestinal pattern. Stress induced adrenal glands

Image Interpretation

The kidneys revealed thickened cortices and mild pyelectasia. The right kidney measured 4.6 cm. The left kidney measured 4.49 cm with pelvic calculus. A cortical infarct was noted in the left kidney and is likely deriving from calculus movement. Power Doppler assessment of the kidneys appeared to be adequate. The adrenal glands were uniform, yet bilaterally swollen and hypoechoic. This is most consistent with stress-induced hyperplasia. The spleen was mildly enlarged with undulating capsular contour. This is consistent with reactive spleen owing to immune stimulus or early infiltrative disease such as mast cell disease or lymphoma. The liver presented a mildly dilated cystic duct with uniform, hypoechogenicity. The gastrointestinal presentation revealed mild uniform prominence of the gastric mucosa as well as areas of “ropey” small intestinal wall with slight disruption of the normal 1:3 muscularis/mucosal ratio. The intestinal mucosa was slightly irregular, thickened and hyperechoic suggestive of low grade, chronic inflammation. The pancreas was enlarged, hypoechoic and irregular. This is strongly suggestive for chronic active pancreatitis. The pancreas at the left base measured approximately 2.0 cm in width with swollen contour and pericapsular inflammatory pattern.

Outcome

The pancreatitis and potential urinary tract infection are likely the primary issues in
this patient. Pain management, broad spectrum antibiotics and plasma expanders would
all be indicated. Blood pressure measurements would also be warranted. FNA of the
left pancreatic base is recommended to assess inflammatory cell type and to refine
therapy. 25g FNA of the spleen is recommended. Full
thickness tissue biopsies of the intestine via open laparotomy would be necessary to rule out the possibility of lymphoma.