Anda di halaman 1dari 30

TUGAS MATA KULIAH

ILMU BEDAH KHUSUS VETERINER


TEKNIK OPERASI BIOPSI PANKREAS

KELAS 2015 D
DISUSUN OLEH :

Stefanus Andre Gunawan 1509005095


I Kadek Toto Sugita 1509005097
Archie Leander Maslim 1509005098
Reydanisa Noor Madania 1509005106
Yeyen Fami Gressia Br Surbakti 1509005108
I Nyoman Kusumajaya 1509005109

LABORATORIUM BEDAH VETERINER


FAKULTAS KEDOKTERAN HEWAN
UNIVERSITAS UDAYANA
DENPASAR
2018

i
RINGKASAN
Biopsi pankreas adalah teknik untuk mendiagnosa suatu penyakit / kelainan
pada pankreas dengan teknik sitologi dengan cara mengambil sebagian atau lesi
yang ada di pankreas. Teknik pembedahan membutuhkan peralatan bedah standar
dan dapat melihat dengan mudah dari seluruh pankreas. Tergantung pada jenis
biopsi yang dilakukan, tindakan ini dapat digunakan untuk mengetahui tingkat
invasi penyakit, yaitu apakah penyakit telah menyebar ke bagian tubuh lainnya. Ada
banyak cara untuk melakukan biopsi, tergantung pada jenis jaringan yang
dibutuhkan oleh dokter, penyakit yang diduga menyebabkan gangguan, atau hasil
dari tes awal yang mendorong dokter untuk meminta agar biopsi dilakukan.
Gangguan – gangguan yang terjadi bisa seperti kanker yang tumbuh pada organ
pankreas maupun pankreatitis yang terjadi pada hewan.

Kata Kunci: Bedah, Biopsi, Pankreas

SUMMARY
Pancreatic biopsy is a technique for diagnosing a disease / abnormality in
the pancreas by cytology techniques with taking a portion or lesion in the pancreas.
Surgical techniques require standard surgical equipment and can be seen easily
from the entire pancreas. Depending on the type of biopsy performed, this action
can be used to determine the level of disease invasion, namely whether the disease
has spread to other parts of the body. There are many ways to do a biopsy,
depending on the type of tissue needed by the doctor, the disease that is thought to
cause the disorder, or the results of an initial test that encourages the doctor to
request that a biopsy be performed. Disorders - disorders that occur can be like
cancer that grows in the pancreas organ or pancreatitis that occurs in animals.

Keyword: Surgery, Biopsy, Pancreas

ii
KATA PENGANTAR
Puji syukur penulis panjatkan kehadirat Tuhan Yang Maha Esa atas berkah
dan rahmat-Nya sehingga penyusunan paper Ilmu Bedah Khusus Veteriner ini
dapat diselesaikan tepat pada waktunya. Judul paper ini adalah “Teknik Operasi
Biopsi Pankreas”.
Paper ini dibuat untuk memenuhi tugas mata kuliah Ilmu Bedah Khusus
Veteriner. Melalui penulisan paper ini, diharapkan mahasiswa mengetahui
mengenai teknik operasi biopsi pankreas. Terima kasih penulis sampaikan kepada
seluruh dosen mata kuliah Ilmu Bedah Khsuus Veteriner yang telah membimbing
dan memberikan kuliah demi lancar dan terselesaikannya tugas paper ini.
Segala kritik dan saran sangat penulis harapkan demi perbaikan penulisan
paper ini. Demikianlah tugas ini penulis susun. Penulis berharap semoga
bermanfaat, dan dapat memenuhi tugas mata kuliah Ilmu Bedah Khusus Veteriner.
Akhir kata, penulis ucapkan terimakasih.

Denpasar, 23 September 2018

Penulis

iii
DAFTAR ISI

HALAMAN JUDUL................................................................................... i
RINGKASAN ............................................................................................. ii
KATA PENGANTAR ................................................................................ iii
DAFTAR ISI ............................................................................................... iv
DAFTAR GAMBAR .................................................................................. v
DAFTAR LAMPIRAN ............................................................................... vi
BAB I PENDAHULUAN
1.1 Latar Belakang ................................................................................. 1
1.2 Rumusan Masalah ............................................................................ 1
1.3 Tujuan Tulisan .................................................................................. 2
1.4 Manfaat Tulisan ............................................................................... 2
BAB II TINJAUAN PUSTAKA
2.1 Preoperasi ........................................................................................ 3
2.2 Teknik Operasi ................................................................................ 6
2.3 Pasca Operasi .................................................................................. 9
BAB III PEMBAHASAN
3.1 Pengertian Biopsi Pankreas .............................................................. 10
3.2 Tujuan Operasi Biopsi Pankreas ...................................................... 10

BAB IV SIMPULAN DAN SARAN


4.1 Simpulan ........................................................................................... 11
4.2 Saran ................................................................................................. 11
DAFTAR PUSTAKA ................................................................................. 12
LAMPIRAN ............................................................................................... 13

iv
DAFTAR GAMBAR

Gambar 1. Instrumen Bedah Biopsi Pankreas ............................................ 4


Gambar 2. Posisi Dorsal Recumbency ........................................................ 6
Gambar 3. Penutup Kain Drape .................................................................. 6
Gambar 4. Incisi Cranial Abdominal ......................................................... 7
Gambar 5. Jahitan Guillotine ..................................................................... 8
Gambar 6. Biopsi Pankreas ........................................................................ 8

v
DAFTAR LAMPIRAN

Case, J.B. Fox-Alvarez, W.A. 2015. Pancreatic Biopsy. Clinician’s Brief.


K. L. Cosford, C. L. Chosmon, S. L. Myers, S. M. Taylors, A. P. Carr, J. M. Steiner,
J. S. Suchodolski, F. Mantovani. 2010. Pancreatic Biopsy in Cat. Journal of
Veterinary Internal Medicine. 24, 104-113.
Webb, C.B., Trott. C. 2008. Laparoscopic Diagnosis of Pancreatic Disease in Dogs
and Cats. J Vet Intern Med 2008;22:1263–1266

vi
BAB I

PENDAHULUAN

1.1 Latar Belakang

Biopsi adalah pengambilan jaringan dari tubuh makhluk hidup untuk mendapatkan
spesimen histopatologi dalam upaya membantu menegakkan diagnosis. Biopsi merupakan
metode penting untuk membantu menegakkan diagnosis lesi yang dicurigai mengalami
keganasan, seperti pembesaran jaringan, ulkus yang kronis, kerapuhan jaringan, atau
kekerasan saat palpasi.

Tergantung pada jenis biopsi yang dilakukan, tindakan ini dapat digunakan untuk
mengetahui “tingkat invasi penyakit” – yaitu apakah penyakit telah menyebar ke bagian
tubuh lainnya. Tindakan ini juga dapat digunakan untuk mengeliminasi keberadaan kanker
atau mengetahui apakah tumor bersifat jinak. Namun, istilah biopsi sangatlah luas. Istilah
ini meliputi semua tes pada jaringan yang bertujuan untuk mendeteksi kelainan, termasuk
ukuran dan bentuk fisik sampel yang berbeda dari populasi umum.

Ada banyak cara untuk melakukan biopsi, tergantung pada jenis jaringan yang
dibutuhkan oleh dokter, penyakit yang diduga menyebabkan gangguan, atau hasil dari tes
awal yang mendorong dokter untuk meminta agar biopsi dilakukan. Contohnya saja pada
organ pankreas yang mengalami gangguan perlu dilakukannya biopsi pankreas. Gangguan
– gangguan yang terjadi bisa seperti kanker yang tumbuh pada organ pankreas maupun
pankreatitis yang terjadi pada hewan. Oleh karena itu, pentingnya pula mengetahui
mengenai teknik bedah sebagai dasar melakukan biopsi pankreas.

1.2 Rumusan Masalah


1.2.1 Bagaimana prosedur pre-operasi biopsi pankreas hewan.
1.2.2 Bagaimana prosedur teknik operasi biopsi pankreas hewan.
1.2.3 Bagaimana hasil dan pasca operasi biopsi pankreas hewan.

1
1.3 Tujuan
1.3.1 Untuk mengetahui prosedur pre-operasi biopsi pankreas hewan.
1.3.2 Untuk mengetahui prosedur teknik operasi biopsi pankreas hewan.
1.3.3 Untuk mengetahui hasil dan pasca operasi biopsi pankreas hewan.

1.4 Manfaat Tulisan


Manfaat dari penulisan paper ini yaitu agar mahasiswa dapat mengetahui bagaimana
prosedur pre-operasi biopsi pankreas, prosedur teknik operasi biopsi pankreas, hingga hasil
dan pasca operasi biopsi pankreas hewan dilakukan, dan juga pembuatan paper ini untuk
melengkapi tugas Ilmu Bedah Khusus Veteriner tentang teknik biopsi pankreas hewan.

2
BAB II
TINJAUAN PUSTAKA

2.1 Pre Operasi

Adapun hal-hal yang perlu dipersiapkan sebelum melakukan operasi biopsi


pankreas yaitu meliputi persiapan alat, bahan, dan obat, kemudian persiapan ruang
operasi, persiapan pasien (hewan) dan persiapan operator.

a. Persiapan alat, bahan, dan obat


Alat-alat atau instrument bedah yang diperlukan dalam operasi biopsi pankreas ini
harus di sterilisasi. Pada masing-masing metode atau teknik operasi alat-alat bedah
yang diperlukan berbeda yaitu sebagai berikut.
a. Guillotine Biopsy via Laparotomy
Alat yang dibutuhkan yaitu Basic surgery pack ( seperti : needle holders,
DeBakey thumb forceps, mosquito hemostats, Metzenbaum scissors)
b. Biopsi Laparoscopi
 Videolaparoscopy (A)
 camera (B)
 insufflation tubing (C)
 lampu cable (D)
 2 5-mm trocars and cannulas (E)
 5-mm laparoscopic clamshell biopsy forceps (F)
 5-mm laparoscope 0° (G)
 5-mm laparoscopic blunt probe (H)

Namun, kedua metode tersebut membutuhkan tempat steril untuk meletakkan


sampel diagnostik (histopathology, culture), culture media, 10% formalin untuk
histopathologi dan microscope slides untuk sitologi.

3
Gambar 1. Instrument bedah pada metode Biopsi Laparoscopi
(Sumber : Case, J. Brad., et al. 2015)

Hewan diberikan premedikasi dengan atropine (0.02– 0.04 mg/kg IV) dan jika
di butuhkan dengan tambahan acepromazine (0.01–0.05 mg/kg IV). Dan anestesi dapat
di induksi dengan thiopental (15 mg/kg) yang dibantu dengan pemberian oxygen dan
dengan isoflurane 1.2–1.7%
b. Persiapan ruang operasi
Tempat operasi harus dalam keadaan bersih dan steril, letakkan alas plastik di
atas meja operasi dan suhu ruangan operasi harus stabil.
c. Persiapan pasien (hewan)
Pemeriksaan secara menyeluruh yang meliputi pulsus, frekuensi nafas,
temperatur, dan pemeriksaan seluruh sistema. Selain pemeriksaan fisik juga dilakukan
pemeriksaan laboratorium. Pada kasus-kasus yamg memerlukan konfirmasi rontgen
bisa dilakukan rotngen. Pelaksanaan operasi dilakukan jika hewan stabil tetapi jika
hewan tidak stabil maka distabilkan terlebih dahulu.

4
Hewan dengan kondisi menderita diabetes harus dievaluasi dengan cermat
sebelum operasi, termasuk hitung darah lengkap (CBC), panel biokimia serum
(termasuk glukosa darah puasa, nitrogen urea darah, dan kreatinin), urinalisis, dan
kultur urin. Konsentrasi glukosa darah idealnya harus dipertahankan antara 100 dan 300
mg / dl selama operasi. Hewan dengan diabetes harus diberi makan sehari sebelum
operasi, dan pemberian insulin harus diberikan. Hewan tersebut harus dipuasakan 6
hingga 8 jam sebelum operasi dan operasi harus dilakukan di pagi hari. Konsentrasi
glukosa darah harus diukur pagi hari saat operasi. Satu hingga dua jam sebelum operasi,
jika konsentrasi glukosa darah antara 150 dan 300 mg/ dl, maka hewan tersebut harus
diberikan setengah dari dosis pagi hari insulin secara subkutan. Glukosa darah harus
diperiksa pada saat induksi dan setiap jam sesudahnya. Jika kadar glukosa darah rendah,
0,45% garam dan 2,5% dextrose (10 hingga 15 ml / kg untuk jam pertama, kemudian 5
ml / kg setelahnya jika darah dan kehilangan cairan evaporatif kecil) harus diberikan.
Jika kadar glukosa darah normal, berikan larutan Ringer laktat (pada tingkat yang
sama). Cairan harus diubah menjadi 5% dextrose dan tambahan dosis kecil insulin
reguler diberikan jika konsentrasi glukosa darah lebih besar dari 300 mg / dl. Kunci
untuk manajemen pasien diabetes adalah seringnya pemeriksaan glukosa darah dan
apresiasi variabilitas tanggapan pasien terhadap terapi insulin.

d. Persiapan Operator
Sebelum melakukan operasi, operator maupun co-operator terlebih dahulu
melepas aksesoris yang dapat mengganggu jalannya operasi. Tangan operator dan co-
operator harus steril dalam melakukan operasi untuk menghindari timbulnya infeksi
bawaan dari luar tubuh hewan. Tangan dicuci menggunakan air bersih dan sabun.
Selanjutnya di sterilisasi menggunakan alkohol 70%. Operator dan co-operator juga
harus memperhatikan penghitungan dosis obat yang diberikan untuk tujuan
premedikasi dan anastesi sehingga dosis pemberian tepat dan pengunaan alat-alat
sterilisasi individu digunakan dengan benar serta menjalankan operasi sesuai SOP.

5
2.2 Teknik Operasi

2.2.1 Guillotine Method Via Laparotomy

 Langkah 1
Tempatkan pasien di posisi dorsal recumbency. Selanjutnya diikuti dengan
persiapan aseptik standar, seperti pemberian alkohol 70% yang selanjutnya diberikan juga
larutan Iodine pada daerah yang akan dilakukan pembedahan. Selanjutnya, daerah yang
akan dilakukan bedah ditutupi dengan kain drape dengan daerah yang
terbuka adalah daerah yang akan dilakukan pembedah. Tujuan dilakukannya penutupan
dengan kain drape adalah untuk menjaga sterilisasi daerah yang akan dilakukan
pembedahan.

Gambar 2. Posisi Dorsal Recumbency

Gambar 3. Penutupan dengan kain drape

6
 Langkah 2
Surgical approach

Jika hanya pankreas yang akan di evaluasi, maka menginsisi cranial midline
abdomen dapat dilakukan. Neoplasia adalah diagnosis banding untuk penyakit pada
pankreas, dan biasanya dianjurkan mengeksplorasi keseluruhan abdomen untuk
mengevaluasi bukti patologi pada organ lain.

Gambar 4. Incisi pada bagian kranial abdominal

 Langkah 3
Exploration and pancreatic biopsy
Evaluasi viscera abdomen dan permukaan peritonial. Jaringan abnormal harus
dijadikan sampel untuk histopatologi. Bagian pankreas yang tepat terkandung dalam
mesenterium dari duodenum, yang digunakan untuk manipulasi pankreas secara tidak
langsung. Isolasi area 5 mm dari lesi pankreas atau bagian kanan distal (jika terjadi
penyakit menyebar), dan letakkan ligature melingkar (mirip dengan biopsi hati). Sebagai
alternatif, bursa omental dapat dibuka dan foramen epiflo untuk masuk mengakses
ekstremitas pankreas kiri untuk biopsi. Untuk mendapatkan akses ke ekstremitas pankreas
kiri, tarik ke perut, gunakan jari asisten atau sepasang tang Babcock atraumatik. Seluruh
pankreas (tungkai kiri, sudut, dan tungkai kanan) dapat terlihat jika limpa ditarik ke arah
ventral dan tengkorak. Begitu lokasi pankreas yang diinginkan telah dipilih, kencangkan
ligatur untuk menghancurkan parenkim pankreas dan ligase pembuluh pankreas kecil. Jika
terjadi penyakit pankreas, gunakan ujung distal tungkai kiri untuk pengambilan sampel
untuk menghindari saluran pankreas. Kumpulkan spesimen biopsi yang mentransmisikan
distal jaringan ke ligature dengan pisau bedah

7
Gambar 5. Jahitan Guillotine ditempatkan (panah). Tangani sampel biopsi secara
perlahan untuk menghindari penghancuran

Gambar 6. Biopsi pankreas telah dihilangkan dan tidak ada perdarahan yang
diamati

 Langkah 4
Control hemorrhage and close

Perdarahan biasanya terhindari karena ligatur melingkar. Jika terjadi pendarahan,


dapat dikendalikan dengan melakukan tekanan yang stabil selama 3 sampai 5 menit atau
steker busa gelatin hemostatik. Tutup abdomen secara rutin, jahit mulai dari peritoneum
hingga kulit menggunakan pola jahitan terputus (simple interrupted).

8
2.3 Perawatan Pasca Operasi

Adapun perawatan pasca operasi biopsi pankreas yang dapat dilakukan yaitu sebagai
berikut.

1. Terapi cairan intravena


Terapi ini adalah prioritas yang paling penting pada hewan dengan tingkat
dehidrasi yang parah, di mana pemeliharaan perfusi jaringan dan pankreas sangat
penting. Cairan yang paling umum digunakan adalah larutan Ringer laktat dan larutan
garam 0,9%. Cairan infus berfungsi untuk meningkatkan perfusi organ, dan
memperbaiki ketidakseimbangan elektrolit tubuh. Hipokalemia sering terjadi akibat
kehilangan potasium dari kombinasi diare, muntah, terapi fluida, dan kekurangan
makanan atau anoreksia. Oleh karena itu, potasium serum harus selalu diukur, dan
kalium harus ditambahkan ke cairan intravena bila diperlukan.
2. Obat nyeri yang disediakan, biasanya opioid seperti butorfanol, buprenorfin,
oxymorphone, meperidine, mengingat bahwa ini dapat menghambat motilitas
gastrointestinal yang normal
3. Jika muntah atau mual terjadi, maka antiemetik (miropitant, odansetron,
dolasetron, metoclopramide, butorfanol sebagai infus kronis)
4. Hewan biasanya tidak diberi makanan atau air selama 24-48 jam (atau kadang kadang
lebih lama), untuk memberikan saluran pencernaan dan pankreas waktu untuk
proses penyembuhan; Namun pemberian pakan dianjurkan jika hewan tidak
muntah dan tidak terasa kesakitan. Pemberian air kemudian pemberian makanan harus
dimulai dengan sejumlah kecil makanan rendah lemak (mungkin kurang dari 2 hingga
3 gram lemak / 100 kkal), makanan lunak (misalnya, nasi, ayam putih yang dihilangkan
lemaknya atau kalkun putih tanpa kulit) dan makanan yang mudah dicerna (karbohidrat
sederhana) makanan yang ditawarkan selama beberapa hari, sampai hewan tersebut
dianggap "normal" di mana saat itu diet normal secara bertahap diperkenalkan kembali.

9
BAB III
PEMBAHASAN

3.1 Pengertian Biopsi Pankreas

Biopsi pankreas adalah teknik untuk mendiagnosa suatu penyakit / kelainan pada
pankreas dengan teknik sitologi dengan cara mengambil sebagian atau lesi yang ada di
pankreas (pankreatektomi parsial). Biopsi pankreas dapat dilakukan dengan teknik
pembedahan ataupun laparoskopi. Teknik pembedahan hanya membutuhkan peralatan
bedah standar dan dapat melihat dengan mudah dari seluruh pankreas. Namun, teknik
pembedahan menghasilkan cedera jaringan yang lebih besar dan rasa sakit dibandingkan
dengan laparoskopi dan mungkin tidak disukai oleh beberapa klien atau dalam beberapa
kasus. Jika sudah dinyatakan adanya penyakit pankreatik secara difusa, maka biopsi dapat
dilakukan dengan memperoleh sedikit sampel saja. Sedangkan jika penyakit belum
diketahui dengan pasti, maka biopsi secara ganda perlu dilakukan, karena penyakit bisa
fokal ataupun multifokal (Fossum et al., 2013).

3.2 Tujuan Operasi Biopsi Pankreas

Pelaksanaan biopsi pankreas adalah suatu standar yang mutlak perlu dilakukan dalam
mendiagnosis neoplasia pankreatik dan pankreatitis (Case dan Fox-Alvarez, 2015). Biopsi
pankreas kadang-kadang dilakukan pada anjing untuk membedakan kondisi pankreas jinak
(misalnya, pankreatitis, fibrosis pankreas) dari penyakit neoplastik. Pankreatektomi parsial
diindikasikan pada hewan dengan tumor yang mensekresikan insulin atau mensekresi
gastrin dan pada adenokarsinoma pancreas.

10
BAB IV
SIMPULAN DAN SARAN

4.1 Simpulan
Biopsi pankreas dapat dilakukan dengan teknik pembedahan ataupun
laparoskopi. Teknik pembedahan hanya membutuhkan peralatan bedah standar dan
dapat melihat dengan mudah dari seluruh pankreas. Pada pre operasi biopsy
pankreas, hewan diberikan premedikasi dengan atropine dan jika di butuhkan
dengan tambahan acepromazine. Teknik operasi yang dipakai untuk biopsi
pankreas ini adalah Guillotine Method Via Laparotomy terdiri dari 4 langkah
operasi. Adapun perawatan pasca operasi biopsi pankreas yang dapat dilakukan
yaitu terapi cairan intravena, pemberian obat analgesik (anti nyeri), pemberian obat
anti mual dan muntah, serta puasakan hewan 24-28 jam setelah operasi.

4.2 Saran
Saran memperhatikan didalam melakukan bedah digesti terutama operasi biopsi
pankreas harus memperhatikan semua aspek dan kondisi dari pasien, karena bedah
digesti biopsy pankreas memiliki kekurangan dan kelebihan dalam praktiknya.

11
DAFTAR PUSTAKA

Case, J.B. Fox-Alvarez, W.A. 2015. Pancreatic Biopsy. Clinician’s Brief.

Fossum, T.W. Dewey, C.W. Horn, C.V. Johnson, A.L. MacPhail, C.M. Radlinsky, M.G.
Schulz, K.S. Willard, M.D. Small Animal Surgery. 4th Edition. Elsevier: Missouri.

K. L. Cosford, C. L. Chosmon, S. L. Myers, S. M. Taylors, A. P. Carr, J. M. Steiner, J. S.


Suchodolski, F. Mantovani. 2010. Pancreatic Biopsy in Cat. Journal of Veterinary
Internal Medicine. 24, 104-113.

Webb, C.B., Trott. C. 2008. Laparoscopic Diagnosis of Pancreatic Disease in Dogs and Cats.
J Vet Intern Med 2008;22:1263–1266

12
LAMPIRAN JURNAL

13
PROCEDURES PRO > DIAGNOSTICS / SURGERY > PEER REVIEWED

Pancreatic Biopsy

J. Brad Case, DVM, MS, DACVS


W. Alexander Fox-Alvarez, DVM
University of Florida

Antemortem diagnosis of pancreatic Open approaches require only standard Studies in both human and veterinary
disease is a challenge. Histopathology surgical equipment and allow easy man- medicine have demonstrated laparoscopic
remains the gold standard of diagnosis ipulation of tissue and visualization of the procedures to have less tissue trauma and
for pancreatic neoplasia and pancreatitis. entire pancreas (important when sam- systemic inflammation, lower pain indi-
Pancreatic biopsy provides a definitive pling focal disease involving the left limb). ces, and reduced patient convalescence
diagnosis of pancreatitis, assuming a rep- However, open surgery results in greater when compared with analogous proce-
resentative sample is obtained. An open tissue injury and pain compared with a dures performed using an open approach.
or laparoscopic approach can be made to laparoscopic approach and may not be This decrease in the healing and inflam-
collect samples. favored by some clients or in some cases. matory demand postoperatively may be

continues

What You Will Need A


Guillotine Biopsy via Laparotomy
n Basic surgery pack (ie, needle
B C D
holders, DeBakey thumb forceps,
mosquito hemostats, Metzenbaum
scissors)

Laparoscopic Biopsy
n Videolaparoscopy tower (A), camera
(B), insufflation tubing (C), and light E
cable (D)
n 2 5-mm trocars and cannulas (E)

n 5-mm laparoscopic clamshell biopsy


forceps (F)
n 5-mm laparoscope 0° (G)

n 5-mm laparoscopic blunt probe (H)


F
Both Methods
n Sterile sample cups for separate
diagnostic samples (histopathology,
culture) G
n Culture media
H
n 10% formalin for histopathology

n Microscope slides for impression


cytology

March 2015 • Clinician’s Brief 19


PROCEDURES PRO

particularly important in patients with STEP-BY-STEP n GUILLOTINE METHOD VIA LAPAROTOMY


delayed healing from metabolic derange-
ments, such as hypoproteinemia, second- STEP 1
ary to their pancreatic disease. While this
Place patient in dorsal recumbency position and follow standard aseptic
approach provides a magnified, illumi-
nated view of the right limb of the pan- preparation.
creas, the left limb of the pancreas is
difficult to evaluate laparoscopically and
may require dissection of the omental
bursa and repositioning of the patient
(beyond the scope of this article). In addi-
tion, laparoscopy requires the use of spe-
cialized equipment and may take slightly
longer to perform for learning practi-
tioners; however, once the procedure can
be completed with confidence, the time
required can be comparable with that for
an open method.

STEP 2
When biopsying the pancreas, if not tar-
geting a specific lesion, the distal aspect Surgical approach. If only the pancreas is to be evaluated, a midline cra-
of the right or left limb of the pancreas is nial abdominal approach can be made. Neoplasia is a differential diagnosis
preferred to decrease the risk for damag- for pancreatic disease, and it is usually advisable to explore the entire
ing important vascular and pancreatic abdomen to evaluate for evidence of pathology in other organs.
structures. Care should be taken to avoid
major blood vessels (eg, caudal pancreati-
coduodenal artery and its branches).

Pancreatic biopsy is a safe procedure.


Despite concerns for adverse sequelae
after pancreatic biopsy, studies suggest
that significant clinical or biochemical
abnormalities are uncommon postopera-
tively.1-4 Patients should be monitored
closely for signs of pancreatitis.

Cranial abdominal approach to the pancreas.

20  cliniciansbrief.com • March 2015


STEP 3

Exploration and pancreatic biopsy. Evaluate the abdominal viscera and perito-
neal surfaces. Abnormal tissue should be sampled for histopathology. The right
pancreatic limb is contained within the mesentery of the duodenum, which is
used for indirect manipulation of the pancreas. Expose the pancreas and evalu-
ate for gross abnormalities. Isolate a 5-mm area of the pancreatic lesion or distal
right limb (if diffuse disease), and place an encircling ligature in guillotine fashion
(similar to liver biopsy; A and B).
Alternatively, the omental bursa can be opened and the epiploic foramen
entered to access the left pancreatic limb for biopsy. To gain access to the left
pancreatic limb, retract the stomach ventrally, using an assistant’s fingers or a
pair of atraumatic Babcock forceps. The entire pancreas (left limb, angle, and
right limb) can be revealed if the spleen is retracted in a ventral and cranial direc-
tion. Once the desired pancreatic location has been selected, tighten the ligature
to crush the pancreatic parenchyma and to ligate small pancreatic vessels. If dif-
fuse pancreatic disease is present, use the distal tip of the left limb for sampling
to avoid pancreatic ducts. Collect the biopsy specimen transecting tissue distal
to the ligature with a scalpel blade.

A B

Guillotine suture being placed (arrow). Handle biopsy sample gently to Pancreatic biopsy has been removed and no bleeding is observed.
avoid crushing.

STEP 4

Control hemorrhage and close. Hemorrhage is typically avoided because of the Author Insight
encircling ligature. If residual bleeding occurs, it can be controlled using 3 to 5 Large malleable retractors and
minutes of steady digital pressure or a plug of hemostatic gelatin foam. Evaluate laparotomy sponges are useful to
the abdomen for hemorrhage. Close the abdomen routinely. retract the visceral surface of the
stomach to improve exposure during
biopsy of the left pancreatic limb.

continues

March 2015 • Clinician’s Brief 21


PROCEDURES PRO

STEP-BY-STEP n CLAMSHELL BIOPSY FORCEPS METHOD VIA LAPAROSCOPY

STEP 1

Position patient. Reverse Trendelenburg position (ie, given the possibility of concomitant inflammatory or neo-
dorsal recumbency, body tilted with head up and feet lower plastic disease and limitations of ultrasonography.
than head, at approximately 15 degrees) with leftward The approach described here can provide excellent visual-
obliquity is the authors’ preferred position for descending ization of the duodenum, liver, extrahepatic biliary system,
limb pancreatic biopsy. right kidney, and right limb of the pancreas. The left limb of
Many endoscopists, however, prefer a right lateral approach the pancreas is challenging to view laparoscopically and
as it provides an immediate view of the pancreas. The should not be attempted without significant training and
major disadvantage of the right lateral approach is the lack experience.
of ability to view the entire liver, which is often indicated

Reverse Trendelenburg and left lateral oblique position. Black lines represent the patient’s position in reverse Trendelenburg and left lateral obliquity.

STEP 2

Surgical approach. Place the initial port 1 to 2 cm caudal to the umbilicus. Port Author Insight
placement is achieved after making an incision through the skin no longer than
Following initial port insertion,
the diameter of the cannula. Continue the incision to the linea alba. A Veress nee-
place all subsequent ports under
dle, 5-Fr catheter, or Hasson method can be used to achieve pneumoperitoneum.
laparoscopic visualization. Once both
Place apposing stay sutures at the margins of the linea. Use a number 11 blade to ports have been placed, reduce the
make a 2- to 3-mm deep stab incision into the linea alba. If a Veress needle is
insufflation pressure to 8 mm Hg to
used, insert it through the incision, being sure to angle the tip approximately 30°
reduce cardiovascular and pulmonary
caudal and to the right of midline to minimize risk of splenic puncture. If a Veress
needle is not available, or if preferred, a modified Hasson method can be per-
effects of pneumoperitoneum.
formed at this point, whereby the blunt trochar and cannula unit are placed into
the incision into the abdomen at the same angle recommended for Veress needle
placement. Alternatively, the catheter technique can be used. A mosquito hemo-
stat is used to insert the tip of a 5-Fr malleable catheter into the abdominal cav-
ity. Once the catheter is inserted, flush 3-mL sterile saline through the catheter to
ensure that no resistance is felt (resistance is an indication of catheter malposi-
tion). If resistance is felt, withdraw the catheter and reinsert. Once saline is

22  cliniciansbrief.com • March 2015


flushed without resistance, attach CO2 insufflation tubing to Trocars should also be inserted in a caudolateral orientation
the catheter to pressurize the peritoneal cavity to a maxi- to reduce the risk of splenic injury. Insert the laparoscope
mum of 10–12 mm Hg. The same procedure is performed if into the cannula and observe the peritoneum to ensure no
using a Veress needle. Subsequent to pneumoperitoneum, iatrogenic trauma or hemorrhage has occurred. Place a sec-
remove the catheter (or Veress needle) and insert a blunt ond 5-mm instrument cannula under laparoscopic visualiza-
trocar-cannula assembly or threaded screw in cannula via tion 5 cm craniad in a similar fashion to the initial port.
the original stab incision. In some cases, minimal extension
(1–2 mm) of the incision may be needed to facilitate inser-
tion of the cannula.

Correct orientation of the Veress


needle during insertion.

Image of correct port position.

STEP 3

Exploration and pancreatic biopsy. Evaluate the perito-


neal cavity by pivoting the laparoscope clockwise around
the port site. Insert the blunt probe under laparoscopic visu-
alization. The laparoscope is used to visualize and guide the
probe into the cranial abdomen.
Inspect the liver and the gall bladder to document any sec-
ondary changes from the pancreatic disease. Evaluate the
pancreas carefully, looking closely for evidence of nodules
or masses. Use the blunt probe to manipulate the duode-
num, omentum, stomach, or spleen as needed to improve
visualization of the right pancreatic limb.
If distinct lesions are noted, plan to biopsy these areas. If no
gross disease or if diffuse disease is present, plan to take 1
Isolation of the distal right limb of the pancreas.
or 2 samples from the distal tip of the right pancreatic limb.

continues

March 2015 • Clinician’s Brief 23


PROCEDURES PRO

After determining an avascular location for biopsy, insert the clamshell


biopsy forceps in place of the blunt probe.
Position the forceps to isolate the desired biopsy site, then close the for-
ceps and maintain pressure for 60–90 seconds. Gentle axial rotation of
the forceps will help release the biopsy sample from the parenchyma. A
caudal tug on the sample while keeping the forceps closed will remove
the sample. Observe the biopsy site for hemorrhage. Repeat this step as
desired for sample collection.

Author Insight A blunt probe is used to retract the duodenum, provid-


If an avascular location at the tip of the right limb cannot be ing better exposure of the pancreas.
identified, consider an open approach with biopsy of the distal
left limb.

Author Insight
The clamshell forceps can be held open and the lower jaw can be
used to gently manipulate the pancreas into position for biopsy.

Clamshell biopsy forceps ready to engage chosen


biopsy sample.

STEP 4

Control hemorrhage and close. Hemorrhage is typically


minimal, and the biopsy site should be observed for 3 min-
utes to ensure hemostasis. If minor hemorrhage occurs,
place a small piece of hemostatic foam into the biopsy
site. Evaluate all biopsy sites for hemorrhage and photo-
document hemostasis and lesions. Release residual gas
from the peritoneal cavity prior to closure. Remove all ports
and close incisions routinely. n cb

References
1. Prospective evaluation of laparoscopic pancreatic biopsies in 11
healthy cats. Cosford KL, Shmon CL, Myers SL, et al. JVIM 24:104-113,
2010. Laparoscopic image after biopsy showing adequate hemostasis at the
2. Laparoscopic diagnosis of pancreatic disease in dogs and cats. biopsy site.
Webb CB, Trott C. JVIM 22:1263-1266, 2008.
3. Evaluation of pancreatic forceps biopsy by laparoscopy in
healthy beagles. Harmoinen J, Saari S, Rinkinen M, Westermarck E.
Vet Ther 3:31-36, 2002.
4. Effect of pancreatic tissue sampling on serum pancreatic
enzyme levels in clinically healthy dogs. Cordner AP, Armstrong PJ,
Newman SJ, et al. J Vet Diagn Invest 22:702-707, 2010.

24  cliniciansbrief.com • March 2015


J Vet Intern Med 2008;22:1263–1266

L a p a r o s c o p i c D i a g n o s i s o f Pa n c r e a t i c D i s e a s e in Do g s a n d C a t s
C.B. Webb and C. Trott

Background: Histopathology is the gold standard for the diagnosis of pancreatic disease. Laparoscopy offers a minimally
invasive route by which to obtain pancreatic biopsies.
Hypothesis: Laparoscopy is a safe and effective technique for evaluating the pancreas in small animal patients.
Animals: Medical records of 18 dogs and 13 cats examined between 1999 and 2007 that underwent laparoscopy during
which observation or biopsy of the pancreas was recorded.
Methods: The database for the Laparoscopy Laboratory at Colorado State University was searched for records that con-
tained ‘‘pancreatitis,’’ ‘‘pancreas,’’ or ‘‘pancreatic.’’ The presenting complaints, imaging studies, and histopathologic findings of
animals were recorded. All hospital admissions were searched for animals with the same presenting complaints and of those it
was determined which animals had exploratory surgery and their pancreas biopsied.
Results: Thirteen cats and 18 dogs underwent laparoscopy for presumptive pancreatic disease or had the appearance of the
pancreas described, pancreatic biopsies obtained, or both. In 14 animals a laparoscopic biopsy of the pancreas resulted in a
histopathologic diagnosis when the sonographic findings or the gross assessment failed to do so. In 35% of the animals a biopsy
of the pancreas was not obtained despite findings consistent with pancreatic disease. Those animals examined for vomiting or
anorexia were significantly more likely to have a biopsy of the pancreas obtained through laparoscopy versus surgery (P o
.0001).
Conclusions and Clinical Importance: Laparoscopy and pancreatic biopsy is useful for evaluation of pancreatic disease.
Key words: Histopathology; Pancreatic biopsy; Ultrasonography.

laparoscopy is a safe and effective technique for evaluat-


he diagnosis of exocrine pancreatic insufficiency is
T relatively straightforward while the diagnosis of
other exocrine pancreatic diseases remains problematic.1
ing the pancreas in dogs and cats.

The introduction of the pancreatic-lipase immunoreac-


tivity (PLI) assay offers a noninvasive blood test reported Materials and Methods
to be a sensitive and accurate indicator of exocrine pan-
creatic disease.2–4 But even in animals in which an Selection of Cases
increase in PLI suggests pancreatic inflammation, the The electronic database for the Laparoscopy Laboratory at Col-
source of that inflammation remains unidentified and orado State University (CSU) was searched for cases that contained
could be acute nonsuppurative or chronic lympoplas- ‘‘pancreatitis,’’ ‘‘pancreas,’’ or ‘‘pancreatic’’ in the patient Problem
macytic pancreatitis, pancreatic tissue necrosis, culture- List or Laparoscopic Diagnosis/Findings section of the Laparos-
confirmed infection, pancreatic pseudocyst or abscess, copy Case Report; a standardized document completed by the
neoplasia, or pancreatitis secondary to another disease clinician performing the laparoscopic procedure. The CSU elec-
tronic medical record was then accessed for each animal identified in
process such as inflammatory bowel disease or bile duct
the laparoscopy search. Information was recorded from the lap-
obstruction. Noninvasive imaging studies such as radio- aroscopy report and the medical record corresponding to the time of
graph, ultrasonography, or computed tomography have the laparoscopic procedure and included signalment, presenting
variable degrees of sensitivity and specificity, are often complaint, radiographs and ultrasonographic imaging report, lap-
dependent on the experience of the person performing aroscopic diagnosis, complications associated directly with the lap-
the study, and cannot provide a tissue diagnosis.5–10 The aroscopic procedure, and histopathology of the pancreatic biopsy
gold standard for the diagnosis of exocrine pancreatic when taken. All ultrasound imaging studies and histopathologic as-
disease in animals remains histopathology. sessments were reviewed by board-certified radiologists and
Laparoscopy offers a minimally invasive route by pathologists, respectively. This study was not designed to assess the
which to obtain pancreatic biopsies and allows direct variability in interpretation between different radiologists or pa-
thologists, but instead to identify the information available to the
evaluation of the pancreas and surrounding tissues, aid-
clinician performing the laparoscopy on each animal.
ing in the diagnosis of exocrine pancreatic disease. The Thirty-one animals where the pancreas was evaluated during a
purpose of this retrospective study was to determine if laparoscopic procedure were identified between 1999 and 2007. It
was determined whether the laparoscopic procedure was used to vi-
sualize or biopsy the pancreas. The relative degree of congruity
between laparoscopic and ultrasonographic results for each individ-
From the Department of Clinical Sciences, College of Veterinary
Medicine and Biomedical Sciences, Colorado State University, Fort ual animal was also determined.
Collins, CO. For the same time period the CSU electronic medical records
Corresponding author: Dr Craig B. Webb, DVM, PhD, Depart- were searched for any hospital admissions of dogs or cats with any
ment of Clinical Sciences, College of Veterinary Medicine and of the 5 presenting complaints identified most frequently by the
Biomedical Sciences, Colorado State University, Fort Collins, CO Laparoscopy Laboratory data base search (vomiting, anorexia,
80523; e-mail: cbwebb@colostate.edu. weight-loss, elevated liver enzymes, and icterus). It was determined
Submitted December 3, 2007; Accepted June 30, 2008. how many of those animals had exploratory abdominal surgery (not
Copyright r 2008 by the American College of Veterinary Internal including those that had surgery to remove a foreign body or for
Medicine gastric dilatation and/or volvulus), and of those, how many had a
10.1111/j.1939-1676.2008.0176.x pancreatic biopsy (Table 1).
1264 Webb and Trott

Table 1. Summary of pancreatic biopsies for cats and dogs from 1999 through 2007.
Presenting Hospital Laparoscopy Pancreatic Surgical Pancreatic
Complaint Admissions Search Criteria Biopsy (LAP) Explore Biopsy (SX)
Vomiting 2,418 19 13 42 2
Anorexia 133 16 13 4 0
Wt loss 323 6 5 3 1
" Liver enzymes 186 10 5 4 1
Icteric 5 3 3 0 0

The total number of cats and dogs who presented for each of the 5 most common presenting complaints identified by the search of the
Laparoscopy Laboratory database for pancreatic disease is summarized. The number of those animals that underwent laparoscopy or ex-
ploratory abdominal surgery are presented as well as the number of pancreatic biopsies that were obtained with those procedures.
LAP, number of pancreatic biopsies obtained during a laparoscopy procedure; SX, number of pancreatic biopsies obtained during ab-
dominal exploratory surgery; wt, weight.

Statistical Analysis 1 Miniature Schnauzer with a prior history of diabetes


mellitus, and 1 mixed-breed dog with a prior history of
A contingency table was used to compare the prevalence of
pancreatic biopsy during laparoscopy versus abdominal surgery
pancreatitis.
in patients presenting for vomiting or anorexia. Probability and
significance (P o .05) by a Fischer’s exact test was determined by Abdominal Radiographs and Abdominal Ultrasound
standard statistical software.a
Eight of 31 (26%) animals had radiographs taken
shortly before the laparoscopic procedure. In 3 animals
Results the radiographs were of the thorax to rule-out metastatic
Animals disease and were reported as normal. In 5 animals the ra-
diographs were of the abdomen; 2 were normal, the other
This search identified 31 animals in which 1 or more of 3 identified hepatomegaly.
the 3 key words were included in 1 or more of the iden- In 26/31 (84%) animals an abdominal ultrasound was
tified sections of the Laparoscopy Case Report. There performed shortly before the laparoscopic procedure. In
were 13 cats (9 domestic shorthair, 2 domestic longhair, 1 8 animals the pancreas was not mentioned or could not
Maine Coon, and 1 Siamese) and 18 dogs (6 mixed-breed be found and recorded as ‘‘not seen’’ by the ultrasonog-
and 12 purebred canines, with only the Labrador Re- rapher, in 5 animals the pancreas was reported to be
triever being represented twice). The mean age of the cats normal. Abnormalities of the pancreas listed in the re-
was 11.8  3.1 years; the mean age of the dogs was 7.8  maining ultrasonographic reports included pancreatic
4.6 years. enlargement (7 animals) or other changes that were con-
Pancreatitis appeared in the Problem List in 6/31 sidered consistent with pancreatitis (10 animals), changes
(19%) animals. Other Problem List entries identified by that were thought to be consistent with pancreatic neopl-
the search criteria included an ultrasonographic descrip- asia (3 animals), or an abnormal pancreatic echogenicity
tion of the pancreas as enlarged (3 animals) or thickened (4 animals). Nonpancreatic abnormalities were noted in
(1 animal). At least 1 of the search criteria terms ap- the liver (14 animals), kidneys (6 animals), gallbladder (4
peared in the Laparoscopic Diagnosis section of the animals), stomach or intestines (3 animals), omental fat
record for every animal. Pancreatitis appeared in the or mesenteric lymph nodes (3 animals), spleen (2 ani-
Laparoscopic Diagnosis in 13/31 (42%) animals with 3 mals), and prostate (1 animal).
of those being described as chronic. Other descriptions
associated with the 3 search criteria terms in the Lap-
Histopathology of the Pancreas
aroscopic Diagnosis portion of the record included
edematous (10 animals), enlarged (8 animals), omental Histopathology of pancreatic tissue was obtained
adhesions involving the pancreas (5 animals), nodular (6 in 20/31 animals (65%). In 7 animals the pancreatic
animals), neoplasia (3 animals), saponification (2 ani- tissue was normal. Pancreatic abnormalities noted on the
mals), and hypoplasia (2 animals). The pancreas was histopathology report included pancreatitis (4 animals),
described as normal in 5/31 (16%) animals. nodular hyperplasia (3 animals), fibrosis (3 animals),
atrophic exocrine acini (3 animals), inflammatory
Presenting Complaint infiltrates including lymphocytes, neutrophils and/or
plasma cells (2 animals), neoplasia; either carcinoma (2
The most common presenting complaint was vomiting animals) or adenocarcinoma (1 animal), or lobular
(19 animals), followed by anorexia (16 animals), elevated atrophy (2 animals).
liver enzymes (10 animals), weight loss (6 animals),
and icterus (5 animals). Only 2 animals had diarrhea as
Compilation of Results
part of their presenting complaint. Other presenting com-
plaints described in single animals included fever, melena, In 11/18 dogs (61%) and 9/13 cats (69%) that under-
abdominal effusion, PU/PD, hepatic encephalopathy, in- went laparoscopy a biopsy was taken of the pancreas and
continence, and phenobarbital administration. There was a histopathologic diagnosis was obtained.
Laparoscopy and Pancreatic Disease 1265

Histopathology of the pancreas was available for 11 tained. For those animals where a pancreatic biopsy was
dogs. In 9 of the dogs, an ultrasound was performed be- not obtained, possible explanations include the search
fore laparoscopy, and in 2/9 (22%) the ultrasound report parameters themselves, the clinicians judgment regarding
was in agreement with the pancreatic histopathology. the likelihood of pancreatic disease, or even the clinicians
In 7/9 (78%), the laparoscopic appearance was in accor- position regarding the safety or yield of laparoscopy-
dance with the histopathologic diagnosis. Histopatho- assisted pancreatic biopsies.12 There were 4 animals
logy of the pancreas was available for 9 cats. In 6 of the where both sonographic findings and gross observation
cats, an ultrasound was performed before laparoscopy, were consistent with a diagnosis of pancreatitis, but no
and in 3/9 (33%) the ultrasound report was in agreement pancreatic biopsy was obtained. There were an addi-
with the pancreatic histopathology. In 5/9 (56%), the tional 6 animals where ultrasound was either not
laparoscopic appearance was in accordance with the performed or no pancreatic abnormalities were reported,
histopathologic diagnosis. but gross observation was consistent with pancreatitis,
In 14 animals, a laparoscopy-assisted biopsy of the and yet still no pancreatic biopsy was taken.
pancreas resulted in a histopathologic diagnosis of dis- Histopathology identified 3 animals with pancreatic
ease where either the sonographic findings or the gross neoplasia: in 1 of those animals the sonographic findings
assessment failed to do so or were wrong, for example, were suggestive of pancreatic disease, but in the other 2
finding pancreatic carcinoma in cases of suspected pan- animals the pancreas was either not mentioned or de-
creatitis. scribed as normal. There were 6 animals where the
Comparing laparoscopy to exploratory surgery, con- sonographic findings were reported as being consistent
tingency tables showed a significantly greater probability with pancreatitis while histopathology revealed either
that a biopsy of the pancreas would be obtained for normal pancreas or pancreatic hyperplasia. Both scenar-
animals examined for vomiting (P o .0001) or anorexia ios illustrate the important role that laparoscopy-assisted
(P 5 .007) that underwent laparoscopy (Table 2). biopsy of pancreatic tissue could have on decisions re-
There were no reports of any complications associated garding an animal’s prognosis or medical management.
with the laparoscopy-assisted pancreatic biopsy proce- None of the laparoscopic reports recorded the number
dure in any of the 31 laparoscopy reports reviewed. of pancreatic biopsies taken, or if multiple biopsies were
obtained, from what regions of the pancreas. Review of
the histopathologic blocks showed that in only 4 animals
Discussion was more than 1 piece of pancreas submitted, and never
Laparoscopy offers a minimally invasive route by more than 2. Several reports show that histological sec-
which pancreatic biopsies can be obtained. Results of tions of pancreatic biopsies obtained at necropsy reveal
this retrospective study suggests that laparoscopy is a that pancreatic disease is often not diffuse.13,14 Although
safe and potentially underutilized diagnostic tool in ani- it could be assumed that the clinician biopsied an area of
mals where exocrine pancreatic disease is a prominent tissue that appeared grossly abnormal, it cannot be as-
differential diagnosis, as in dogs and cats examined for sumed that a single or very small number of biopsies
vomiting, anorexia, or both.11 A biopsy of the pancreas would necessarily identify focal pathology in all animals.
was obtained in 65% of the animals identified by the Some of the animals where pancreatic histopathology
search criteria used in this study. That leaves 35% of the was described as normal may still have had pancreatic
animals where a histopathologic diagnosis was not ob- pathology that went undetected.
The number of cats and dogs that present for vomit-
ing, anorexia, weight loss, or elevated liver enzymes far
Table 2. Contingency tables. exceeds the number of cats and dogs for which laparos-
copy is performed as a diagnostic procedure. Expla-
LAP SX
nations for this disparity include the diagnostic pursuit
a
Vomiting of differentials for which laparoscopy would not be indi-
Biopsy 13 3 16 cated such as renal failure, diabetes, or hyperthyroidism;
No biopsy 6 31 37 the opportunity for more extensive intervention possible
19 34 53
with abdominal surgery such as removal of a mass; the
Anorexiab
cost of the procedure; or the morbidity and risks associ-
Biopsy 13 0 13
No biopsy 3 4 7 ated with laparoscopy. Contingency tables show that
16 4 20 dogs and cats presented for vomiting or anorexia are sig-
nificantly more likely to have a pancreatic biopsy if they
Contingency tables showing the number of pancreatic biopsies undergo laparoscopy than if they undergo abdominal ex-
that were obtained during laparoscopy compared with exploratory ploratory surgery, even excluding those cases in which
abdominal surgery for all hospital admissions between 1999 and surgery was performed for the express purpose of remov-
2007. A separate table is shown for the 2 most common presenting ing a foreign body or correcting a gastric dilatation and/
complaints identified by the search of the laparoscopy database,
or volvulus. This may be a reflection of the fact that pan-
vomiting, and anorexia.
a
Pb with LAP 5 68%, Pb with SX 5 9%, P o .0001. creatic disease is, for most part, considered a medical
b
Pb with LAP 5 81%, Pb with SX 5 0%, P 5 .007. condition, and at this institution diagnostic laparoscopy
Pb, probability; LAP, laparoscopy; SX, exploratory abdominal is performed by members of the small animal medicine
surgery; Biopsy, biopsy of the pancreas. staff.
1266 Webb and Trott

Being cognizant of shortcomings in the current use of puted tomography versus conventional testing for the diagnosis of
laparoscopy should help guide the more effective and feline pancreatitis. J Vet Intern Med 2004;18:807–815.
productive utilization of this tool in the diagnosis of pan- 5. Manczur F, Vörös K. Gastrointestinal ultrasonography
creatic disease. Inherent weaknesses in retrospective of the dog: A review of 265 cases (1996–1998). Acta Vet Hung 2000;
48:9–21.
studies that are particularly relevant to these results in-
6. Moon ML, Biller DS, Armbrust LJ. Ultrasonographic ap-
clude the dependence on different clinicians filling out
pearance and etiology of corrugated small intestine. Vet Radiol
forms and the reliance on thorough and accurate report- Ultrasound 2003;44:199–203.
ing of observations. The unwritten assumption that the 7. Jaeger JQ, Mattoon JS, Bateman SW, et al. Combined use of
pancreas is most likely normal if not observed during a ultrasonography and contrast enhanced computed tomography to
sonographic study or not noted in a laparoscopy report evaluate acute necrotizing pancreatitis in two dogs. Vet Radiol Ul-
are 2 examples of potentially lost data points. trasound 2003;44:72–79.
8. Hess RS, Saunders HM, Van Winkle TJ, et al. Clinical, clin-
icopathologic, radiographic, and ultrasonographic abnormalities in
dogs with fatal acute pancreatitis: 70 cases (1986–1995). J Am Vet
Footnote Med Assoc 1998;213:665–670.
9. Saunders HM, Van Winkle TJ, Drobatz K, et al. Ultrasono-
a
SAS/STAT statistical software, Cary, NC graphic findings in cats with clinical, gross pathologic, and
histologic evidence of acute pancreatic necrosis: 20 cases (1994–
2001). J Am Vet Med Assoc 2002;221:1724–1730.
10. Gerhardt A, Steiner JM, Williams DA, et al. Comparison
References of the sensitivity of different diagnostic tests for pancreatitis in cats.
J Vet Intern Med 2001;15:329–333.
1. Zoran DL. Pancreatitis in cats: Diagnosis and management of 11. Washabau RJ. Feline acute pancreatitis—Important species
a challenging disease. J Am Anim Hosp Assoc 2006;42:1–9. differences. J Feline Med Surg 2001;3:95–98.
2. Steiner JM, Williams DA. Development and validation of a ra- 12. Marmoinen J, Saari S, Rinkinen M, et al. Evaluation of pan-
dioimmunoassay for the measurement of caning pancreatic lipase creatic forceps biopsy by laparoscopy in healthy beagles. Vet Ther
immunoreactivity in serum of dogs. Am J Vet Res 2003;64:1237–1241. 2002;3:31–36.
3. Steiner JM, Wilson BG, Williams DA. Development and an- 13. De Cock HE, Forman MA, Farver TB, et al. Prevalence and
alytical validation of a radioimmunoassay for the measurement of histopathologic characteristics of pancreatitis in cats. Vet Pathol
feline pancreatic lipase immunoreactivity in serum. Can J Vet Res 2007;44:39–49.
2004;68:309–314. 14. Newman S, Steiner J, Woosley K, et al. Localization of pan-
4. Forman MA, Marks SL, De Cock HE, et al. Evaluation of creatic inflammation and necrosis in dogs. J Vet Intern Med 2004;
serum feline pancreatic lipase immunoreactivity and helical com- 18:488–493.