Pancreatitis

Written by Dr. Patty Khuly, VMD MBA

Summary

The pancreas is both an endocrine and digestive organ with the ability to secrete hormones (like insulin) into the bloodstream and enzymes into the intestines to aid in digestion. It's also a notoriously sensitive bit of tissue.

Lying nestled between the stomach and the intestines, it has a way of swelling (usually painfully and potentially fatally) for a variety of reasons. This swelling and its effects on the body comprise the common disease we call pancreatitis.

When the pancreas becomes inflamed it fails to release its own digestive enzymes. Instead, the pancreas embarks on a process we call "autodigestion," breaking down and ultimately killing its own tissue. As a result of all this local tissue death, pancreatic enzymes and other inflammatory molecules are released into the bloodstream. Ultimately, these faraway effects of the pancreas's breakdown are the ones that prove fatal in the event of severe disease.

Diabetes can sometimes result with pancreatitis if enough of the pancreas (80% or more) is affected. That's because the pancreas also secretes insulin, which regulates blood sugar.

Pancreatitis may be considered acute or chronic: Acute pancreatitis comes on suddenly and is completely reversible. Chronic pancreatitis, however, is a slow burn process in which the organ becomes irretrievably damaged over time. Both versions can be mild or severe.

While the exact mechanism for how pancreatitis occurs is not completely understood, it's nonetheless clear that some hereditary factors are involved.

Symptoms and Identification

Painting a picture of pancreatitis (ie diagnosing it) is difficult because of how non-specific the symptoms can be. To make its identification even more complex--and contribute to its ranking among the most commonly underdiagnosed diseases in small animal medicine--dogs and cats suffer different symptoms.

In one study of 70 dogs with severe (fatal) pancreatitis, clinical signs included...

  • anorexia in 91%

  • vomiting in 90%

  • weakness in 79%

  • abdominal pain in 58%

  • dehydration in 46%

  • and diarrhea in 33%

In another review of 159 cats with pancreatitis, clinical signs included...

  • anorexia in 87%

  • lethargy in 81%

  • dehydration in 54%

  • weight loss in 47%

  • vomiting and hypothermia in 46%

  • icterus in 37%

  • fever in 25%

  • abdominal pain in 19%

  • diarrhea in 12%

  • abdominal mass in 11%

Until recently, dogs and cats with pancreatitis suffered through rounds of X-rays, ultrasounds, and blood work--if not to an invasive pancreatic biopsy. A blood test called the PLI ("pancreatic lipase immunoreactivity" test) was developed to reduce the rollercoaster of diagnostics with one simple blood analysis. In dogs, a newer, more specific test called the SPEC cPL (specific canine pancreatic lipase) test is now the blood test of choice.

Not that these new tests replace all the testing needed to establish a suspicion for pancreatitis in the first place, nor much of the follow-up testing to determine how an animal responds to therapy, but it has helped replace much of the doubt associated with diagnosis.

Affected Breeds

Though the heredity of this disease is not well understood, it's clear that some breeds of dogs and cats are predisposed. Schnauzers, in particular, and small breed dogs, in general, are more likely to suffer episodes of pancreatitis.

Treatment

The mainstay of pancreatitis treatment is aggressive, supportive care with intravenous fluids, antibiotics, anti-nausea drugs, pain medication, electrolyte supplementation and no oral food or water for a minimum of 2-3 days. This supports the entire body as the process resolves, but it is by no means universally effective. Severe pancreatitis often proves fatal, regardless of our veterinary ministrations.

For recovering patients, a low fat diet is necessary to reduce further unnecessary stimulation of the pancreas.

Veterinary Cost

Pancreatitis can be a wickedly expensive condition, especially if the severe form ails your pet. Thousands of dollars in diagnosis and intensive care treatment may be necessary for a week or more, depending on the severity of the disease.

Prevention

For pets who suffer chronic or recurrent bouts of acute pancreatitis, breeding is not recommended. These dogs should be removed from the genetic pool so as not to possibly pass along traits that may lead others to suffer this digestive disease.

To reduce the possibility of pancreatitis recurrence, dietary management is the most commonly recommended approach. Lower fat, lower protein and or low allergen diets have all been suggested for pets with evidence of pancreatitis in their history.

References

Hess RS, Saunders HM, Van Winkle TJ, et al. Clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in dogs with fatal acute pancreatitis: 70 cases (1986-1995). J Am Vet Med Assoc 1998;213:665-670.

Washabau RJ. Acute necrotizing pancreatitis. In: August JR. ed. Consultations in feline internal medicine. St. Louis, Mo: Elsevier Saunders, 2006;109-119.

Forman MA, Marks SL, De Cock HEV, et al. Evaluation of serum feline pancreatic lipase immunoreactivity and helical computed tomography versus conventional testing for the diagnosis of feline pancreatitis. J Vet Intern Med 2004;18:807-815.

Newman S, Steiner J, Woosley K, et al. Localization of pancreatic inflammation and necrosis in dogs. J Vet Intern Med 2004;18:488-493.