Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, and Small Animal Clinic, The University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic.
Veterinary Thought Exchange, East Ayrshire, UK.
J Feline Med Surg. 2020 Nov;22(11):1047-1067. doi: 10.1177/1098612X20965831.
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.
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.
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.
猫三联炎描述了同时发生的胰腺炎、胆管炎和炎症性肠病（IBD）。在患病转诊患者中，其报道的患病率为 17-39%。虽然其病因尚不清楚，但已知包括感染、自身免疫和物理因素。目前尚不清楚的是，不同的器官是否受到不同疾病的影响，或者是相同的过程；事实上，三联炎可能是多器官炎症性疾病的一部分。猫的胃肠道解剖结构也起到了一定的作用。具体来说，小肠短、细菌负荷高以及胰腺导管在进入十二指肠乳头之前与胆总管汇合的解剖特征，都会增加细菌反流和实质炎症的风险。炎症也可能是肠道细菌易位和全身菌血症的后遗症。
胆管炎、胰腺炎和 IBD 的表现具有重叠、模糊和非特异性的临床症状。胆管炎可能伴有血清肝酶、总胆红素和胆汁酸浓度升高，以及可变的超声变化。胰腺炎的推测诊断基于血清胰腺脂肪酶免疫反应性或猫胰腺特异性脂肪酶升高，以及/或超声检查异常的胰腺变化，尽管这些检查的敏感性较低。没有组织病理学检查，IBD 的诊断具有挑战性；超声检查结果从正常到黏膜增厚或层次丢失不等。三联炎可能由于肠道疾病和/或胰腺炎导致血清叶酸或钴胺素（B12）浓度降低。只有通过组织病理学才能确诊三联炎；因此，在大多数情况下，这仍然是一个推测性诊断。
对猫三联炎、胰腺炎、胆管炎和 IBD 的文献进行了回顾，重点关注组织病理学、临床意义和诊断挑战。提供了当前的管理建议。需要进一步的研究来了解复杂的病理生理学，从而改善诊断和治疗。
