PANCREATITE CANINA: O DESENVOLVIMENTO DA CONDIÇÃO INFLAMATÓRIA PANCREÁTICA E A ABORDAGEM CLÍNICO-TERAPÊUTICA
DOI:
https://doi.org/10.35172/rvz.2021.v28.598Palavras-chave:
Cães, Doença gastrointestinal, Pancreatite, Patofisiologia, SubdiagnósticoResumo
A pancreatite é uma doença grave para os cães, tanto pelo seu potencial deletério quanto pela existência de subdiagnósticos, e pode ser classificada em aguda ou crônica. A doença ainda é alvo de estudos no que diz respeito a sua patofisiologia e mecanismos terapêuticos, uma vez que os sinais apresentados pelos animais são inespecíficos, variando desde apresentações brandas a graves. Pode causar alteração morfofuncional do pâncreas e órgãos adjacentes. O diagnóstico pode ser uma tarefa bastante difícil, seja pela sintomatologia variável e gravidade da doença como também pelos impasses vivenciados no momento da realização dos exames complementares. O manejo terapêutico é definido com base na sintomatologia apresentada pelos animais, variando desde a infusão de fluidos para reposição volêmica, analgésicos, antieméticos, antibióticos, alimentação especial, entre outros.
Referências
1. Watson PJ. Pancreatitis in dogs and cats: definitions and pathophysiology. J Small Anim Pract. 2015;56(1):3–12. https://doi.org/10.1111/jsap.12293.
2. Xenoulis PG, Steiner JM. Lipid metabolism and hyperlipidemia in dogs. Vet J. 2010;183(1):12–21. https://doi.org/10.1016/j.tvjl.2008.10.011.
3. Okanishi H, Nagata T, Nakane S, Watari T. “Comparison of initial treatment with and without corticosteroids for suspected acute pancreatitis in dogs”. J. Small Anim Pract. 2019;60:298–304. https://doi.org/10.1111/jsap.12994.
4. Zhan X, Wang F, Bi Y, Ji B. Animal models of gastrointestinal and liver diseases. Animal models of acute and chronic pancreatitis. Am J Physiol Gastrointest Liver Physiol. 2016; 311(3):343–355. https://doi.org/10.1152/ajpgi.00372.2015.
5. Choi S-W, Kim Y-H, Kang MS, Jeong Y, Ahn J-O, Choi JH, Chung J-Y. Serum Concentration of Inflammatory Cytokines in Dogs with Suspected Acute Pancreatitis. Vet Sci. 2021;8(3):51. https://doi.org/10.3390/vetsci8030051.
6. Sousa FG, Rabelo AL, Rodrigues AK, Silva DET, Diniz GHS, Nunes ISS, Bruno LLG, Oliveira LA, Neves SCF, Mendes ACR. Canine pancreatitis: The danger in the routine of veterinarians: Review. Pubvet.2021;15(3):1-9. https://doi.org/10.31533/pubvet.v15n03a769.1-9.
7. Watson PJ. Hepatobiliary and Exocrine Pancreatic Disorders. In: Nelson RW, Guillermo Couto C, editors. Small Animal Internal Practice. 6th ed. St. Louis, Missouri: Elsevier; 2020, p. 518-648.
8. Mansfield C, Beths T. Management of acute pancreatitis in dogs: a critical appraisal with focus on feeding and analgesia. J Small Anim Pract.2015;56(1):27–39. https://doi.org/10.1111/jsap.12296.
9. Forman MA, Steiner JM, Jane Armstrong P, Camus MS, Gaschen L, Hill SL, Mansfield CS, Steiger K. ACVIM consensus statement on pancreatitis in cats. J Vet Intern Med.2021;35(2):703–723. https://doi.org/10.1111/jvim.16053.
10. Birchard SJ, Sherding RG. Saunders Manual: Small Animal Clinic (Manual Saunders: clínica de pequenos animais). 3th ed. Brazil: Roca, 2008.
11. Mansfield C. Pancreatitis in dog. In: Bruyette D, editor. Clinical Small Animal Internal Medicine. 2nd ed. Hoboken, USA: John Wiley & Sons; 2020, p.591-600.
12. Suzuki M, Minowa K, Nakano S, Isayama H, Shimizu T. Genetic Abnormalities in Pancreatitis: An Update on Diagnosis, Clinical Features, and Treatment. Diagnostics.2021;11(1):31. https://doi.org/10.3390/diagnostics11010031.
13. Bishop MA, Xenoulis PG, Levinski MD, Suchodolski JS, Steiner JM. Identification of variants of the SPINK1 gene and their association with pancreatitis in Miniature Schnauzers. Am J Vet Res.2010;71(5):527-533. https://doi.org/10.2460/ajvr.71.5.527.
14. Furrow E, Armstrong PJ, Patterson EE. High prevalence of the c.74A>C SPINK1 variant in Miniature and Standard Schnauzers. J Vet Intern Med. 2012; 26(6):1295-1299. https://doi.org/10.1111/j.1939-1676.2012.01013.x.
15. Morais LK, Machado FME, Alberto H, Coelho HE. Macro and microscopic study of pancreas in dogs. PUBVET [Internet].2014[cited 2021 Apr 10];8(2):84–229. Available from: http://www.pubvet.com.br/artigo/297/estudo-macro-e-microscopico-de-pancreas-em-caes.
16. French JM, Twedt DC, Rao S, Marolf AJ. Computed tomographic angiography and ultrasonography in the diagnosis and evaluation of acute pancreatitis in dogs. J Vet Intern Med.2019;33(1):79–88. https://doi.org/10.1111/jvim.15364.
17. Kuzi S, Mazor R, Segev G, Nivy R, Mazaki-Tovi M, Chen H, Rimer D, Duneyevitz A, Yas E, Lavy E, Aroch I. Prognostic markers and assessment of a previously published clinical severity index in 109 hospitalised dogs with acute presentation of pancreatitis. Vet Rec.2019;187(2):e13. https://doi.org/10.1136/vr.105364.
18. Cridge H, Sullivant AM, Wills RW, Lee AM. Association between abdominal ultrasound findings, the specific canine pancreatic lipase assay, clinical severity indices, and clinical diagnosis in dogs with pancreatitis. J Vet Intern Med.2020;34:636–643. https://doi.org/10.1111/jvim.15693.
19. Kealy JK, McAllister H, Graham JP. Radiologia e ultrassonografia do cão e do gato. 5th ed. Brazil: Elselvier Saunders. 2012
20. Gardner TB, Vege SS, Pearson RK, Chari ST. Fluid resuscitation in acute pancreatitis. Cli Gastroenterol Hepatol.2008;6(10):1070-1076. https://doi.org/10.1016/j.cgh.2008.05.005.
21. Bhoomagoud M, Jung T, Atladottir J, Kolodecik TR, and Shugrue C., Chaudhuri A, Thrower EC, Gorelick FS. Reducing extracellular pH sensitizes the acinar cell to secretagogue-induced pancreatitis responses in rats. Gastoenterology. 2009;137(3):1083-1092. https://doi.org/10.1053/j.gastro.2009.05.041.
22. Wu BU, Hwang JQ, Gardner TH, Repas K, Delee R, Yu S, Smith B, Banks PA, Conwell DL. Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Cli Gastroenterol Hepatol.2011; 9(8):710-717. https://doi.org/10.1016/j.cgh.2011.04.026.
23. Weatherton LK, Streeter EM. Evaluation of fresh frozen plasma administration in dogs with pancreatitis: 77 cases (1995–2005). J Vet Emerg Crit Care.2009;19(6):617–622. https://doi.org/10.1111/j.1476-4431.2009.00483.x.
24. Zanoni FL. Estudo dos efeitos da solução salina hipertônica e do Ringer lactato sobre a resposta da microcirculação mesentérica e a translocação bacteriana em modelo de obstrução intestinal e isquemia em ratos [dissertation]. São Paulo (SP): University of São Paulo/USP; 2010.
25. Karanjia ND, Lutrin FJ, Chang YB, Reber HA. Low dose dopamine protects against hemorrhagic pancreatitis in cats. J Surg Res.1990;48(5):440-443. https://doi.org/10.1016/0022-4804(90)90009-q.
26. Rau SE, Barber LG, Burgess KE. Efficacy of maropitant in the prevention of delayed vomiting associated with administration of doxorubicin to dogs. J Vet Intern Med.2010;24(6):1452-1457. https://doi.org/10.1111/j.1939-1676.2010.0611.x.
27. Marks SL, Kook PH, Papich MG, Tolbert MK, Willard MD. ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats. J Vet Intern Med.2018;32(6):1–18. https://doi.org/10.1111/jvim.15337.
28. Williams DA. Diagnosis and management of pancreatitis. J Small Anim Pract.1994;35(9):445–454. https://doi.org/10.1111/j.1748-5827.1994.tb03945.x.
29. Sun W, Watanabe Y, Toki A, Wang Z. Beneficial effects of hydrocortisone in induced acute pancreatitis of rats. Chin Med J [Internet]. 2007[cited 2021 Apr 10];120(20):1757-1761.Available from: https://pubmed.ncbi.nlm.nih.gov/18028766/.
30. Niederau C, Niederau M, Luthen R, Strohmeyer G, Ferrell LD, Grendell JH. Pancreatic exocrine secretion in acute experimental pancreatitis. Gastroenterol. 1990;99(4):1120-1127. https://doi.org/10.1016/0016-5085(90)90633-c.
31. Flint RS, Windsor JA. The role of the intestine in the pathophysiology and management of severe acute pancreatitis. World J Gastroenterol. 2003; 5(2):69-85. 10.1080/13651820310001108.
32. Kotani J, Usami M, Nomura H, Iso A, Kasahara H, Kuroda Y., Oyanagi H, Saitoh Y. Enteral nutrition prevents bacterial translocation but does not improve survival during acute pancreatitis. Arch Surg.1999;134(3):287-292. https://doi.org/10.1001/archsurg.134.3.287.
33. Qin HL, Su ZD, Hu LG, Ding ZX, Lin Q-T. Effect of early intrajejunal nutrition on pancreatic pathological features and gut barrier function in dogs with acute pancreatitis. Clin Nutri. 2002a;21(6):469-473. https://doi.org/10.1054/clnu.2002.0574.
34. Qin HL, Su ZD, Gao Q, Lin Q-T. Early intrajejunal nutrition: bacterial translocation and gut barrier function of severe acute pancreatitis in dogs. Hepatobiliary Pancreat Dis Int [Internet]. 2002b [cited 2021 Apr 10];1(1):150-154. Available from: https://pubmed.ncbi.nlm.nih.gov/14607647/.
35. Qin HL, Su ZD, Hu LG, Ding Z-X, Lin Q-T. Parenteral versus early intrajejunal nutrition: effect on pancreatitc natural course, entero-hormones release and its efficacy on dogs with acute pancreatitis. World J Gastroenterol.2003;9(10):2270-2273. https://doi.org/10.3748/wjg.v9.i10.2270.
36. Qin HL, Su ZD, Hu LG, Ding Z-X, Lin Q-T. Effect of parenteral and early intrajejunal nutrition on pancreatic digestive enzyme synthesis, storage and discharge in dog models of acute pancreatitis. World J Gastroenterol.2007;13(7):1123-1128. https://doi.org/10.3748/wjg.v13.i7.1123.
2. Xenoulis PG, Steiner JM. Lipid metabolism and hyperlipidemia in dogs. Vet J. 2010;183(1):12–21. https://doi.org/10.1016/j.tvjl.2008.10.011.
3. Okanishi H, Nagata T, Nakane S, Watari T. “Comparison of initial treatment with and without corticosteroids for suspected acute pancreatitis in dogs”. J. Small Anim Pract. 2019;60:298–304. https://doi.org/10.1111/jsap.12994.
4. Zhan X, Wang F, Bi Y, Ji B. Animal models of gastrointestinal and liver diseases. Animal models of acute and chronic pancreatitis. Am J Physiol Gastrointest Liver Physiol. 2016; 311(3):343–355. https://doi.org/10.1152/ajpgi.00372.2015.
5. Choi S-W, Kim Y-H, Kang MS, Jeong Y, Ahn J-O, Choi JH, Chung J-Y. Serum Concentration of Inflammatory Cytokines in Dogs with Suspected Acute Pancreatitis. Vet Sci. 2021;8(3):51. https://doi.org/10.3390/vetsci8030051.
6. Sousa FG, Rabelo AL, Rodrigues AK, Silva DET, Diniz GHS, Nunes ISS, Bruno LLG, Oliveira LA, Neves SCF, Mendes ACR. Canine pancreatitis: The danger in the routine of veterinarians: Review. Pubvet.2021;15(3):1-9. https://doi.org/10.31533/pubvet.v15n03a769.1-9.
7. Watson PJ. Hepatobiliary and Exocrine Pancreatic Disorders. In: Nelson RW, Guillermo Couto C, editors. Small Animal Internal Practice. 6th ed. St. Louis, Missouri: Elsevier; 2020, p. 518-648.
8. Mansfield C, Beths T. Management of acute pancreatitis in dogs: a critical appraisal with focus on feeding and analgesia. J Small Anim Pract.2015;56(1):27–39. https://doi.org/10.1111/jsap.12296.
9. Forman MA, Steiner JM, Jane Armstrong P, Camus MS, Gaschen L, Hill SL, Mansfield CS, Steiger K. ACVIM consensus statement on pancreatitis in cats. J Vet Intern Med.2021;35(2):703–723. https://doi.org/10.1111/jvim.16053.
10. Birchard SJ, Sherding RG. Saunders Manual: Small Animal Clinic (Manual Saunders: clínica de pequenos animais). 3th ed. Brazil: Roca, 2008.
11. Mansfield C. Pancreatitis in dog. In: Bruyette D, editor. Clinical Small Animal Internal Medicine. 2nd ed. Hoboken, USA: John Wiley & Sons; 2020, p.591-600.
12. Suzuki M, Minowa K, Nakano S, Isayama H, Shimizu T. Genetic Abnormalities in Pancreatitis: An Update on Diagnosis, Clinical Features, and Treatment. Diagnostics.2021;11(1):31. https://doi.org/10.3390/diagnostics11010031.
13. Bishop MA, Xenoulis PG, Levinski MD, Suchodolski JS, Steiner JM. Identification of variants of the SPINK1 gene and their association with pancreatitis in Miniature Schnauzers. Am J Vet Res.2010;71(5):527-533. https://doi.org/10.2460/ajvr.71.5.527.
14. Furrow E, Armstrong PJ, Patterson EE. High prevalence of the c.74A>C SPINK1 variant in Miniature and Standard Schnauzers. J Vet Intern Med. 2012; 26(6):1295-1299. https://doi.org/10.1111/j.1939-1676.2012.01013.x.
15. Morais LK, Machado FME, Alberto H, Coelho HE. Macro and microscopic study of pancreas in dogs. PUBVET [Internet].2014[cited 2021 Apr 10];8(2):84–229. Available from: http://www.pubvet.com.br/artigo/297/estudo-macro-e-microscopico-de-pancreas-em-caes.
16. French JM, Twedt DC, Rao S, Marolf AJ. Computed tomographic angiography and ultrasonography in the diagnosis and evaluation of acute pancreatitis in dogs. J Vet Intern Med.2019;33(1):79–88. https://doi.org/10.1111/jvim.15364.
17. Kuzi S, Mazor R, Segev G, Nivy R, Mazaki-Tovi M, Chen H, Rimer D, Duneyevitz A, Yas E, Lavy E, Aroch I. Prognostic markers and assessment of a previously published clinical severity index in 109 hospitalised dogs with acute presentation of pancreatitis. Vet Rec.2019;187(2):e13. https://doi.org/10.1136/vr.105364.
18. Cridge H, Sullivant AM, Wills RW, Lee AM. Association between abdominal ultrasound findings, the specific canine pancreatic lipase assay, clinical severity indices, and clinical diagnosis in dogs with pancreatitis. J Vet Intern Med.2020;34:636–643. https://doi.org/10.1111/jvim.15693.
19. Kealy JK, McAllister H, Graham JP. Radiologia e ultrassonografia do cão e do gato. 5th ed. Brazil: Elselvier Saunders. 2012
20. Gardner TB, Vege SS, Pearson RK, Chari ST. Fluid resuscitation in acute pancreatitis. Cli Gastroenterol Hepatol.2008;6(10):1070-1076. https://doi.org/10.1016/j.cgh.2008.05.005.
21. Bhoomagoud M, Jung T, Atladottir J, Kolodecik TR, and Shugrue C., Chaudhuri A, Thrower EC, Gorelick FS. Reducing extracellular pH sensitizes the acinar cell to secretagogue-induced pancreatitis responses in rats. Gastoenterology. 2009;137(3):1083-1092. https://doi.org/10.1053/j.gastro.2009.05.041.
22. Wu BU, Hwang JQ, Gardner TH, Repas K, Delee R, Yu S, Smith B, Banks PA, Conwell DL. Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Cli Gastroenterol Hepatol.2011; 9(8):710-717. https://doi.org/10.1016/j.cgh.2011.04.026.
23. Weatherton LK, Streeter EM. Evaluation of fresh frozen plasma administration in dogs with pancreatitis: 77 cases (1995–2005). J Vet Emerg Crit Care.2009;19(6):617–622. https://doi.org/10.1111/j.1476-4431.2009.00483.x.
24. Zanoni FL. Estudo dos efeitos da solução salina hipertônica e do Ringer lactato sobre a resposta da microcirculação mesentérica e a translocação bacteriana em modelo de obstrução intestinal e isquemia em ratos [dissertation]. São Paulo (SP): University of São Paulo/USP; 2010.
25. Karanjia ND, Lutrin FJ, Chang YB, Reber HA. Low dose dopamine protects against hemorrhagic pancreatitis in cats. J Surg Res.1990;48(5):440-443. https://doi.org/10.1016/0022-4804(90)90009-q.
26. Rau SE, Barber LG, Burgess KE. Efficacy of maropitant in the prevention of delayed vomiting associated with administration of doxorubicin to dogs. J Vet Intern Med.2010;24(6):1452-1457. https://doi.org/10.1111/j.1939-1676.2010.0611.x.
27. Marks SL, Kook PH, Papich MG, Tolbert MK, Willard MD. ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats. J Vet Intern Med.2018;32(6):1–18. https://doi.org/10.1111/jvim.15337.
28. Williams DA. Diagnosis and management of pancreatitis. J Small Anim Pract.1994;35(9):445–454. https://doi.org/10.1111/j.1748-5827.1994.tb03945.x.
29. Sun W, Watanabe Y, Toki A, Wang Z. Beneficial effects of hydrocortisone in induced acute pancreatitis of rats. Chin Med J [Internet]. 2007[cited 2021 Apr 10];120(20):1757-1761.Available from: https://pubmed.ncbi.nlm.nih.gov/18028766/.
30. Niederau C, Niederau M, Luthen R, Strohmeyer G, Ferrell LD, Grendell JH. Pancreatic exocrine secretion in acute experimental pancreatitis. Gastroenterol. 1990;99(4):1120-1127. https://doi.org/10.1016/0016-5085(90)90633-c.
31. Flint RS, Windsor JA. The role of the intestine in the pathophysiology and management of severe acute pancreatitis. World J Gastroenterol. 2003; 5(2):69-85. 10.1080/13651820310001108.
32. Kotani J, Usami M, Nomura H, Iso A, Kasahara H, Kuroda Y., Oyanagi H, Saitoh Y. Enteral nutrition prevents bacterial translocation but does not improve survival during acute pancreatitis. Arch Surg.1999;134(3):287-292. https://doi.org/10.1001/archsurg.134.3.287.
33. Qin HL, Su ZD, Hu LG, Ding ZX, Lin Q-T. Effect of early intrajejunal nutrition on pancreatic pathological features and gut barrier function in dogs with acute pancreatitis. Clin Nutri. 2002a;21(6):469-473. https://doi.org/10.1054/clnu.2002.0574.
34. Qin HL, Su ZD, Gao Q, Lin Q-T. Early intrajejunal nutrition: bacterial translocation and gut barrier function of severe acute pancreatitis in dogs. Hepatobiliary Pancreat Dis Int [Internet]. 2002b [cited 2021 Apr 10];1(1):150-154. Available from: https://pubmed.ncbi.nlm.nih.gov/14607647/.
35. Qin HL, Su ZD, Hu LG, Ding Z-X, Lin Q-T. Parenteral versus early intrajejunal nutrition: effect on pancreatitc natural course, entero-hormones release and its efficacy on dogs with acute pancreatitis. World J Gastroenterol.2003;9(10):2270-2273. https://doi.org/10.3748/wjg.v9.i10.2270.
36. Qin HL, Su ZD, Hu LG, Ding Z-X, Lin Q-T. Effect of parenteral and early intrajejunal nutrition on pancreatic digestive enzyme synthesis, storage and discharge in dog models of acute pancreatitis. World J Gastroenterol.2007;13(7):1123-1128. https://doi.org/10.3748/wjg.v13.i7.1123.
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2021-10-05
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Gaia de Sousa F, Ribeiro Mendes AC. PANCREATITE CANINA: O DESENVOLVIMENTO DA CONDIÇÃO INFLAMATÓRIA PANCREÁTICA E A ABORDAGEM CLÍNICO-TERAPÊUTICA. RVZ [Internet]. 5º de outubro de 2021 [citado 29º de abril de 2024];28:1-11. Disponível em: https://rvz.emnuvens.com.br/rvz/article/view/598
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