Ефективність комплексного лікування за гострого панкреатиту у собак із застосуванням кортикостероїдів

Abstract

Визначена терапевтична ефективність комплексного лікування за гострого панкреатиту у собак. Встановлено, що динаміка біохімічних показників крові собак, хворих на гострий панкреатит, що супроводжувався розвитком гепатопанкреатичного синдрому, особливо каталітична активність альфа-амілази та ліпази, була клінічно кращою за комбінованої терапії із застосуванням кортикостероїдів (преднізолон), препаратів гепатопротекторної дії (гепатовет) та інгібіторів протеолітичних ферментів (контрикал) в комплексі з регідратаційною терапією, спазмолітичними (но-шпа), протимікробними (енрофлоксацин), протиблювотними (церукал) засобами, стимуляторами обміну речовин (катозал). According to veterinary care center "ELITVET" Dnepropetrovsk since 2014, there were 38 cases of acute pancreatitis in dogs, in 2015 – 41, 2016 - 16 cases. Waste or sex-age tendency is not observed, although more cases are registered among dachshunds, Yorkshire terrier and miniature schnauzer. Group risk is the dog of middle and old age. Found that registered more acute pancreatitis in dogs older than 6 years - 68 cases, accounting for 71.6%, less disease recorded in dogs aged 3 to 6 years - 20 cases (21.0%), in rare cases, sick dogs under 3 years - 7 cases (7.4%). Study of seasonal diseases dogs with acute pancreatitis revealed that the disease is registered throughout the year, but more pronounced spring and autumn seasons. Difficulty lifetime diagnosis of pancreatitis in animals is that it requires complex studies and lengthy observation with careful collection of history. Symptoms of acute pancreatitis in dogs appeared suddenly after eating the feed and develop within hours or days. Usually a history of owners reported overfeeding or a diet with high fat, especially in dogs with overweight animals. In 90% of the observed loss of appetite, depression, dehydration, abdominal pain in the area of placement of the pancreas (costal arch on the left), vomiting. Diarrhea occurs in approximately 50% of cases. More than 40% of patients observed hyperthermia, which develops through the provision of pyrogens, development vto¬rynnoyi bacterial infection. With instrumental methods for the diagnosis of diseases of the pancreas in dogs used ultrasound. Specific changes sonographic picture of abdominal cavity for acute pancreatitis found in 60% of animals. For acute pancreatitis revealed an increase in body size (or even segmental), decreased echogenicity (or even segmental) heterogeneity of structure, appearance anehohennyh areas (necrosis), swelling parapankreatychnoyi fiber. Significant changes in dogs for acute pancreatitis were reported blood tests: increased erythrocyte sedimentation rate, high rate of hematocrit, which indicates dehydration, leukocytosis to 17,4 ± 1,2109/L, with a shift neytrofiliya core left. Equally important in the diagnosis of pancreatitis should determine the activity of α-amylase and lipase levels. For acute pancreatitis recorded a sharp increase in activity of α-amylase in the serum of patients with dogs, it was in the range of 1860.2 to 3002.4 U/L. In the blood of healthy dogs alpha-amylase activity is 400-1750 U/L. Thus, increased activity of the enzyme found in 100% of the dogs. In 12 out of 20 (60%) dogs alpha-amylase activity was more than 2500 U/L, indicating that the damage to the pancreas. To assess the functional status of pancreatic lipase activity as measured in serum, the activity of which was in the range of 409.2 to 1001.5 U/L. In clinically healthy animals lipase activity in serum is low, thus increasing the activity of the enzyme found in 100% of the dogs. It should be noted that 18 of 20 (90%) dogs lipase activity was more than 600 U/L indicates the development of pancreatitis. In the blood of dogs found increased activity of ALT and AsAT, a sign of liver dysfunction and development hepatopankreatychnoho syndrome. Activity aspartic transferase (AST) was in the range of 33.1 to 178.3 U/L. In 14 out of 20 (70%) dogs AST activity was higher than normal, and in 9 (45%) - 2-2.5 times that represent significant damage to mitochondrial membrane of hepatocytes. Activity alanine transferase (ALT) ranged from 29.5 to 128.4 U/L. A significant proportion (65%) dogs ALT activity was higher than the upper limit of normal. The most informative diagnosed hepatopathy is the simultaneous increase in activity of both enzymes in the serum, which was diagnosed in 11 of 20 (55%) dogs. The level of enzymes in the serum of animals increases as a result of structural cell disorders and increased permeability of cell membranes of hepatocytes. The course was accompanied by the development of acute pancreatitis pankreato-renal syndrome. It is characterized by azotemia, increased urea and creatinine in serum. One indicator of renal disease in animals is increasing urea in serum 14 of 20 dogs (70%). In 10 of 20 dogs (50%) of urea content was significantly higher than normal and was in the range of 25.9 to 45.2 mM/L. Renal function in dogs as determined by the content of creatinine in serum, the limits of which were in the range of 64.5 to 434.2 mM/L. In 13 out of 20 (65%) dogs creatinine was higher than normal, indicating abuse filtration function of the glomerulus. Severe hiperazotemiya in 8 out of 20 (40%) animals combined with a simultaneous increase in the activity of AST, ALT, which is evidence of them hepatopankreonefrotychnoho syndrome, because the urea content depends not only on the functional state of the liver where it is synthesized, but the kidney through which it is excreted. During treatment noted a gradual decrease in the concentration of these substances. However, in some animals, their concentration was higher than in healthy dogs. The use of complex treatment regimens dogs suffering from acute pancreatitis with symptoms of the syndrome hepatopankreatychnoho positive effect on the general state of the animals. All experimental dogs after treatment were lively and active. Comparative assessment of the effectiveness of complex therapy with corticosteroids and hepatoprotectors established differences in their clinical performance and normalize the catalytic activity of enzymes. In particular, the use of prednisolone and hepatovetu (experimental group) in dogs with acute pancreatitis, accompanied by the development hepatopankreatychnoho syndrome contributed to the normalization of the gastrointestinal tract for 3-4 days, stopped diarrhea, appetite recovered, and the animals of the control group - in 5 6 day. Biochemical status showed a tendency to normalization of homeostasis. Palpation of the stomach and intestines in 4 of 20 (20%) in the control group of dogs diagnosed with slight tension of the abdominal wall, the remaining dogs - abdominal wall was soft, not painful. The value of hematocrit in dogs during treatment decreased from 54,4±1,73 to 47,4±1,05% (p <0.01). If at the beginning of the experiment increase hematocrit value was diagnosed in 50% of animals at the end of the experiment, only one (5%) dogs in the control group. The study of enzyme activity in animals are used not only to diagnosis but also to monitor the effectiveness of the treatment process. The catalytic activity of α-amylase and lipase gradually decreased during treatment, but rather it was in dog experimental group. Thus, in the fifth day of treatment activity of α-amylase in dog experimental group was 1038,6±100,26 U/L, while the control group of dogs 1326,6 ± 123,41 U/L. Reduced activity of α-amylase occurred in all animals, including dogs, 100% of the experimental group it was in the normal range, 2 of 10 (20%) dogs in the control group - a slightly higher (Lim 1785,5-1788,1 U/L) . The catalytic activity of lipase on the fifth day of treatment was significantly lower in dogs experimental group compared with the control, and amounted respectively 181,6±13,35 U/L (p <0.01) and 244,1±16,32 U/L. Reduced activity of lipase occurred in all animals, including dogs, 100% of the experimental group it was in the normal range, 4 of 10 (40%) dogs in the control group - a slightly higher (Lim 284,4-312,5 U/L). Conclusions and prospects for further development. Consequently, the results of our study we can conclude that the course of acute pancreatitis in dogs accompanied by the development hepatopankreonefrotychnoho syndrome, which is characterized by changes in clinical status dogs manifested diarrhea, vomiting, tenderness epihastro-duodenal area; changes in laboratory parameters of blood - increased ESR, hematocrit, neutrophil leukocytosis with a shift to the left, increasing the activity of alpha-amylase, lipase, AST, ALT kreatynine. Use with therapeutic purpose dogs suffering from acute pancreatitis with symptoms hepatopankreatychnoho syndrome corticosteroids (prednisone), drugs hepatoprotective action (hepatovet) and inhibitors of proteolytic enzymes (contrical) in combination with rehydration therapy, antispasmodic (no-spa), antimicrobial (enrofloxacin) antiemetic (tserukal) drugs, stimulants metabolism (katozal) contributed to the reduction of normalization of clinical status and indicators of the functional status of the pancreas. In particular, the fifth day of treatment activity of α-amylase and lipase were lower in dogs experimental group compared with the control, respectively 287.9 and 62.5 U/L (p <0.01).