PRACTICAL RELEVANCE: Feline triaditis describes concurrent pancreatitis, cholangitis and inflammatory bowel disease (IBD). The reported prevalence is 17-39% in ill referral patients. While the aetiology is poorly understood, it is known to include infectious, autoimmune and physical components. What is not known is whether different organs are affected by different diseases, or the same process; indeed, triaditis may be part of a multiorgan inflammatory disease. Feline gastrointestinal tract anatomy plays its role too. Specifically, the short small intestine, high bacterial load and anatomic feature whereby the pancreatic duct joins the common bile duct before entering the duodenal papilla all increase the risk of bacterial reflux and parenchymal inflammation. Inflammation may also be a sequela of bowel bacterial translocation and systemic bacteraemia. DIAGNOSTIC CHALLENGES: Cholangitis, pancreatitis and IBD manifest with overlapping, vague and non-specific clinical signs. Cholangitis may be accompanied by increased serum liver enzymes, total bilirubin and bile acid concentrations, and variable ultrasonographic changes. A presumptive diagnosis of pancreatitis is based on increased serum pancreatic lipase immunoreactivity or feline pancreas-specific lipase, and/or abnormal pancreatic changes on ultrasonography, though these tests have low sensitivity. Diagnosis of IBD is challenging without histopathology; ultrasound findings vary from normal to mucosal thickening or loss of layering. Triaditis may cause decreased serum folate or cobalamin (B12) concentrations due to intestinal disease and/or pancreatitis. Triaditis can only be confirmed with histopathology; hence, it remains a presumptive diagnosis in most cases. EVIDENCE BASE: The literature on feline triaditis, pancreatitis, cholangitis and IBD is reviewed, focusing on histopathology, clinical significance and diagnostic challenges. Current management recommendations are provided. Further studies are needed to understand the complex pathophysiology, and in turn improve diagnosis and treatment.
- Klíčová slova
- IBD, Triaditis, cholangitis, inflammatory bowel disease, pancreatitis,
- MeSH
- cholangitida diagnóza epidemiologie etiologie veterinární MeSH
- idiopatické střevní záněty diagnóza epidemiologie etiologie veterinární MeSH
- kočky MeSH
- komorbidita MeSH
- nemoci koček diagnóza epidemiologie etiologie MeSH
- pankreatitida diagnóza epidemiologie etiologie veterinární MeSH
- prevalence MeSH
- zvířata MeSH
- Check Tag
- kočky MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
UNLABELLED: Pancreatitis of biliary etiology accounts for 30-60 % of all cases of acute pancreatitis. A number of randomized studies have been completed to assess the role of acute endoscopic retrograde cholangiopancreatography (ERCP) and papilosphincterotomy in the therapy of biliary pancreatitis. Analysis of the respective studies has shown that urgent endoscopy is clearly indicated for the patients with a severe form of acute biliary pancreatitis as well as for those with an ongoing acute cholangitis or obstructive icterus. The author believes that based on a detailed analysis of the results, urgent endoscopic retrograde cholangiopancreatography can also be recommended for patients with a mild form of the illness provided the procedure is performed within 12 hours of admission to a hospital by an experienced endoscopist. KEY WORDS: biliary pancreatitis - endoscopic retrograde cholangiopancreatography - papilosphincterotomy.
- MeSH
- akutní nemoc MeSH
- cholangiopankreatografie endoskopická retrográdní * MeSH
- cholangitida diagnóza terapie MeSH
- hospitalizace MeSH
- lidé MeSH
- pankreatitida diagnóza terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Although the effectivity of an urgent ERCP was confirmed, some aspects relating to this method are still discussed. Timing of this procedure has not been established yet. Whereas there is no doubt about indication with decompression of the common bile duct in acute cholangitis, views on the effectiveness of examination incl. papillotomy in case of acute pancreatitis are not uniform. The authors demonstrate a group of 538 patients who had urgent ERCP within the last three years with a successful cannulation rate of 93%. The experience of large centres is confirmed as the great efficiency and effectivity of this procedure when the standard conditions and processes are respected.
Since the year 1989 the authors, surgeons, performed more then 1600 ERCP. In the period of 1992 to 1995 urgent ERCP was indicated in one hundred cases when block of papila Vateri, cholangitis or acute pancreatitis were suspected. Our results in ERCP were: cholangitis with common bile duct stones 14, pancreatitis acuta biliaris 53, pancreatitis acuta nonbiliiaris 28, other diagnosis 1. In 4 cases, ERCP was unsuccessful. Endoscopic papillosphincterotomy (EPS) was indicated in all patients after the successful ERCP with pancreatitis or cholagitis. We achieved success in urgent EPS in 92%. No patient died owing to ERCP or EPS. From our point of view urgent ERCP and EPS are important diagnostical and therapeutical methods in patients with cholangitis and pancreatitis biliaris which may be performed as soon as possible. (in our cases all patients undergo ERCP and EPS no later than six hours after their admission to the hospital). In case of nonbiliaris pancreatitis we prefer and have good results with EPS too, but our number of these patients is too small to be generalized. (Tab. 5, Ref. 13.).
- MeSH
- cholangiopankreatografie endoskopická retrográdní * MeSH
- cholangitida diagnóza chirurgie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhlé příhody MeSH
- pankreatitida komplikace diagnóza chirurgie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- sfinkterotomie endoskopická MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
The authors describe their experience with urgent endoscopic procedures of the papilla Vater. They consider septic cholangitis and acute pancreatitis indications for endoscopic papillotomy. The authors made a total of 27 operations, incl. 22 on account of pancreatitis and five on account of cholangitis. One female patient with necrotizing pancreatitis caused by a protracted sepsis and multiorgan failure, died. Otherwise there were no serious complications; after the majority of operations a steep drop of pathological laboratory values was recorded. One of the most important factors for successful endoscopic intervention is in the authors' opinion rapid action. With regard to the favourable initial results the authors recommend a detailed multi-centre prospective randomized study.
- MeSH
- akutní nemoc MeSH
- cholangiopankreatografie endoskopická retrográdní MeSH
- cholangitida diagnóza chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhlé příhody MeSH
- pankreatitida diagnóza chirurgie MeSH
- sfinkterotomie endoskopická * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
