Pancreatitis


Written by Dr Kathryn Knipe

Pancreatitis can present in either a mild form or have life-threatening consequences and is a commonly encountered condition in both cats and dogs.

Recent advances in diagnostic tests for pancreatitis show that the previously used tests were not accurate for diagnosing this condition. Veterinarians are, therefore, becoming more aware of pancreatitis and, because our tests are more reliable, have been diagnosing it more commonly.

WHAT IS A PANCREAS?

The pancreas is an organ located in the connective tissue between the intestinal loops at the beginning of the digestive tract.

It has two primary functions:

  1. It is an endocrine organ, which means that it produces hormones which the body uses to maintain homeostasis (the normal working order of the body). The pancreas produces both Insulin and Glucagon, hormones that are critical in controlling blood glucose (commonly called blood sugar) concentrations within normal limits in the body.
  2. Its other function is as an exocrine gland; in the case of the pancreas, this refers to the various digestive enzymes that are necessary to digest food into the various nutrients the body needs to function and survive.

WHAT IS PANCREATITIS?

Pancreatitis describes inflammation of the pancreas, and it can be acute or chronic.

Acute pancreatitis is classified as sudden-onset pancreatitis, which is fully reversible.

Chronic pancreatitis refers to ongoing inflammation that leads to irreversible changes in the cellular architecture of the organ, resulting in it being prone to flare-ups and potentially making it unable to fully perform its function of producing hormones and digestive enzymes.

The initiating factor in pancreatitis appears to be the inappropriate activation of digestive enzymes within the pancreas which then start to digest the organ’s tissues. This results in significant inflammation within the pancreas, which in turn can set off a sequence of inflammation that may result in multiple organ dysfunction, which can be fatal.

Pancreatitis in dogs

In dogs, it’s recognised in both acute and chronic forms. It can occur in varying degrees of severity, ranging from mild and virtually unnoticed by the pet owner to severe disease that can result in the pet’s death.

Chronic inflammation and destruction of the pancreatic tissue may also result in the pancreas being less able to perform its vital function; this can manifest as Diabetes mellitus (“sugar diabetes”) or Exocrine Pancreatic Insufficiency (where the pancreas does not produce sufficient digestive enzymes to digest the food consumed).

Pancreatitis in cats

Pancreatitis has been found to be far more prevalent in cats than we had previously thought. In cats the disease can vary from mild (also called sub-clinical) to severe; the chronic form is thought to be more prevalent. However, it’s not easy to separate the condition into chronic and acute forms, nor is it very helpful to us in a clinical setting.  

It’s commonly encountered with many other disease conditions such as Diabetes mellitus and inflammatory conditions of the liver and intestinal tract. In cats, we refer to Triaditis, a condition which describes simultaneous inflammation of the pancreas, liver and intestinal tract; these have a close anatomical relationship to one another. Although we commonly encounter concurrent disease in these three systems, it’s not formally been recognised as a disease condition.

WHAT CAUSES PANCREATITIS?

The precise cause for pancreatitis has not been established. Most cases of pancreatitis are classified as idiopathic – meaning that we are uncertain of the specific cause.

However, there are certain predisposing factors/triggers that have been linked with an increased chance of developing pancreatitis in its various forms. These include:

Breed

In dogs, acute pancreatitis is reported to occur more commonly in Miniature Schnauzers and Yorkshire and other terriers. The chronic form has been found to occur more commonly in Cavalier King Charles Spaniels, English Cocker Spaniels, Boxers and Collie breeds. Hypertriglyceridaemia (high levels of fats in the blood) and obesity have been observed five times more commonly in Miniature Schnauzers diagnosed with pancreatitis.

In cats, the disease is most commonly diagnosed in domestic short-haired cats.

Food

Dietary indiscretion, particularly dogs scavenging for scraps and digging in the rubbish for old food, has been found to increase the incidence of the disease. Fatty meals or treats may also be linked.

Other factors

There are several other factors thought to be involved. These include certain drugs, toxins, and trauma such as blunt-force or even surgical trauma to the pancreas.

In both species, the disease has been linked to other disease conditions such as Hyperadrenocorticism (Cushing’s disease), Hypothyroidism and Diabetes mellitus (in which case it’s considered a potential cause for Diabetes rather than a consequence thereof).

What is important to note is that pancreatitis is not the result of primary bacterial infection. Thus, the use of antibiotics to treat the disease is inappropriate, unless other evidence of bacterial infection or sepsis in the body have been found.

WHAT ARE THE SYMPTOMS AND SIGNS OF PANCREATITIS?

In dogs, the clinical symptoms of acute pancreatitis are vomiting, abdominal pain (your dog may groan or cry), lethargy and dehydration; sometimes diarrhoea and a fever are seen.

Chronic cases of pancreatitis can be more difficult to recognise with symptoms such as occasional poor appetite, lethargy and behaviour changes; these symptoms can be mild and non-specific.

In cats, the most commonly observed symptoms are decreased appetite, lethargy, dehydration and sometimes vomiting; abdominal pain is rarely recognised.

HOW DO WE DIAGNOSE PANCREATITIS?

One of the problems with diagnosing this disease is that, other than the clinical symptoms being rather non-specific and easily confused with symptoms of other diseases (particularly of the liver and gastro-intestinal tract), there are no changes on our commonly performed blood tests that specifically indicate a diagnosis of pancreatitis.

This means that the disease needs to be suspected first and then specifically tested for.

It’s important that we do test for this disease if we suspect it because undiagnosed and unmanaged cases of pancreatitis can lead to the development of other problems down the line, such as Diabetes mellitus, Exocrine Pancreatic Insufficiency and acute exacerbations of chronic pancreatitis.

Once your veterinarian suspects pancreatitis, they will need to do some tests. These include:

Blood panel. They will likely want to perform a minimum blood panel to exclude other causes that may require certain specific treatments.

Pancreatic lipase test. Many veterinarians use a SNAP cPLi or fPLi (canine or feline pancreatic lipase) test to screen for pancreatitis. This is a quick test using a drop of blood. If the test is negative, we usually exclude the pancreas as the cause of the clinical symptoms, although in cases with low-grade chronic pancreatitis, repeated testing may be necessary. If the test is positive, your vet will still need to send a blood test to the laboratory to confirm the diagnosis. In cases with low-grade chronic pancreatitis, repeated testing may be necessary to establish a diagnosis.

Abdominal ultrasound. In the hands of an experienced ultrasonographer, this is a good way of diagnosing, especially, acute pancreatitis. It also provides an opportunity to evaluate the rest of the abdominal organs for signs of other diseases which may be causing your pet’s symptoms. Some veterinarians may prefer to refer your pet to a specialist centre or contact an external specialist ultrasonographer to perform the procedure, as correct identification of pancreatic disease by ultrasound can be tricky.

Surgery. The most reliable method for obtaining a correct diagnosis of pancreatitis is to surgically collect a sample from the pancreas for microscopic evaluation. Unfortunately, most animals with acute pancreatitis are quite ill and in pain, so they’re usually not good candidates for surgery. But if chronic pancreatitis is suspected, with very vague clinical symptoms, this may well be your vet’s diagnostic method of choice. Although it may seem drastic, it could well save your pet’s life.

CAN PANCREATITIS BE TREATED?

Unfortunately, there’s no simple answer. Several factors, from the cause and whether it’s acute or chronic to how quickly the correct treatment was started, all affect the outcome.

Acute Pancreatitis Treatment

The recommendation is for early, aggressive therapy, as the condition can worsen quickly and have dire consequences. Your pet will likely be admitted to hospital and may need to be placed on a drip and receive tube feeding.

Your vet will likely treat commonly seen symptoms, such as abdominal pain and nausea.

Poor perfusion of the pancreas (poor blood supply because of dehydration and shock brought about by inflammatory pathways) forms a cornerstone of the way in which pancreatitis progresses. A drip helps to maintain good hydration of organs.

Many animals with acute pancreatitis don’t want to eat, but it’s very important that they stay nourished. Early enteral nutrition has been shown to result in shorter hospital stays; your pet will receive their nutrition either through regular syringe-feeding or by placing a feeding tube which can be placed through the nose into the oesophagus. This decreases the stress associated with force-feeding. 

Some vets may place an oesophagostomy tube – a larger bore tube placed through the skin in your pet’s neck and into the lower oesophagus. Although these tubes require a full anaesthetic to place, they can be maintained for longer and are particularly useful in cats which may refuse to eat for longer than dogs. Cats are prone to hepatic lipidosis if they don’t eat, where too much stored body fat is broken down to supply nutrients, leading to the liver being flooded with fat break-down products so that it can’t perform its function.

The preferred diet for dogs is an easily digestible, ultra-low-fat food; cats shouldn’t have their fat intake limited as their metabolism is very different from a dog’s and are usually placed on a hypo-allergenic or novel protein diet.

Due to the close association of the bile duct and the pancreatic duct in the body, we sometimes see cases of biliary tract obstruction secondary to pancreatitis. These cases may require surgery to correct this.

Chronic Pancreatitis Treatment

Chronic pancreatitis requires lifelong management.

In cases of chronic pancreatitis or flare-ups of chronic pancreatitis that are not as serious, your veterinarian may choose to treat your pet as an outpatient. This means they’ll give the necessary treatments (for example, injections for nausea and patches for pain relief) and you take them home to nurse.  

This is especially beneficial for pets that get stressed in hospital and don’t want to eat.

Be sure to keep your vet informed if your pet isn’t improving so that prompt action can be taken to prevent further deterioration. This will likely mean admitting a patient who is not responding to treatment to hospital for a drip and more intensive management of pain, nausea as well as feeding.

You and your vet can work together to identify anything that might be triggering/predisposing your pet and which could be eliminated, such as any medication that could be contributing to the problem, or any foods, treats or even toxins your pet is being exposed to. Try to keep a record of your pet’s eating habits, behaviour changes and medications.

Dogs should be changed onto an ultra-low-fat diet and cats onto a hypoallergenic diet. However, as pancreatitis is often associated with other conditions, particularly in cats, your pet may already be on a prescription diet for that condition – and it may not be ideal to a chronic pancreatitis sufferer.

Your vet will evaluate which condition is more detrimental (worse) and recommend food for that condition – in most cases, this will be the pancreatitis as it will have the most severe consequences if not managed appropriately. It may be necessary to consult with a veterinary nutritionist to formulate an appropriate diet for your pets that meets all its requirements.

PANCREATITIS PROGNOSIS

This is the question every pet owner asks, but the answer, again, isn’t simple. The severity and extent of inflammation and necrosis (tissue death) in the pancreas, duration of the disease, presence of concurrent diseases and whether or not your pet develops complications all impact on prognosis.

If your veterinarian has recommended a certain diet, it’s up to you to stick to it – do not deviate from this without consulting them first; that includes pet table scraps and treats not designed for pets. If they recommend or prescribe treatments and medications, keep providing them.

In conclusion, there are a few points that are worth highlighting:

If your pet is prone to intestinal upsets, abdominal pain and nausea, pancreatitis is one of the conditions that your pet may be suffering from.

It’s important to be aware of any risk factors that make your pet more prone to pancreatitis (such as being a certain breed, taking certain medications or having hypertriglyceridaemia) and to limit these factors wherever possible.

Always follow your vet’s recommendations for treatment for all diseases, but particularly for severe diseases such as pancreatitis. Although your pet may not appear to be critically ill to you, if it has pancreatitis and isn’t treated appropriately, it may have fatal consequences for your pet.

Be aware that pancreatitis is, in my experience, one of the more expensive conditions to treat as these patients require several tests as well as intensive management. You need to commit fully to providing the best care for your pet.

My recommendation – for all animals – is always that your pet should eat a scientifically formulated pet food of the highest quality that you can afford (whether store-bought or home-prepared). Beware of raw diets and home-cooked diets: the foods must be prepared with high-quality ingredients fit for human consumption and not with offal or other waste foods from human food production. If you prepare their meals at home, always use low-fat, high-quality meat ingredients that don’t include bones, skin and excess fat.

Ensure that you’re adding the correct micronutrients to the diet and that there is enough fibre. Feeding your pet boiled chicken and rice daily does not make for a healthy, balanced diet, just as it would not for you or me.

It’s always best to prepare for every eventuality – before they happen – by getting veterinary insurance for your pet to cover such hospital bills.

If your pet has a history of frequent abdominal pain and intestinal upsets, talk to your veterinarian about chronic pancreatitis. Something as simple as changing their diet may make an enormous difference to your pet’s quality of life and longevity.

Wishing your pets health and happiness.