The pancreas lies in the abdomen adjacent to the stomach and small intestine. The organ is vital for digestion and metabolism. The pancreas produces digestive enzymes delivered through the pancreatic duct to the small intestine. These enzymes aid in the digestion of fats, proteins, and carbohydrates. The pancreas also makes various hormones secreted into the blood stream. Two of the main hormones made are glucagon and insulin, which regulate metabolism and blood sugar levels.
When the pancreas is working normally, the digestive enzymes become active only when they reach the small intestine. In a pet with pancreatitis, the enzymes activate prematurely, seeping into the pancreas and surrounding tissue, causing damage and inflammation. The enzymes begin to digest the tissue which causes extreme irritation and pain. This inflammatory disease is known as pancreatitis.
Pancreatitis commonly occurs in the dogs and cats. Pancreatitis can occur spontaneously, but there are several known factors that can increase the risk of a patient developing the disease.
Genetics – Certain dog breeds including Miniature Schnauzers, Poodles, Cocker Spaniels, and Yorkshire Terriers are predisposed to pancreatitis. In cats, Siamese have a slight increased incidence.
Diet – A common cause of pancreatitis in dogs is ingestion of a large high-fat meal. Pork products are often a contributing factor. Cats may have food sensitivities that increase their risk.
Metabolic Diseases – Diseases that alter fat metabolism in the body can also increase the risk of developing pancreatitis. Those diseases include obesity, diabetes, hyperlipidemia, and thyroid conditions.
Medications – Certain drugs can predispose a dog to pancreatitis including some antibiotics, chemotherapy drugs, and some seizure medications.
Inflammation – Chronic inflammation in the abdomen from hepatitis or inflammatory bowel disease of the intestines can spread to the pancreas increasing the risk of developing pancreatitis.
Pancreatitis in dogs can be divided into two categories, acute and chronic. Acute pancreatitis happens when inflammation in the pancreas occurs suddenly, and symptoms are acute. Chronic pancreatitis occurs when inflammation in the pancreas continues over longer periods of time and symptoms may wax and wane in severity.
Patients suffering from pancreatitis may display any of the following symptoms:
Veterinarians use a combination of history, physical examination findings, laboratory tests, and imaging to diagnose pancreatitis. On physical exam, patients suffering from pancreatitis may be depressed, dehydrated, and are found to have tense painful abdomens on palpation. Initial blood tests may reveal an elevated white blood cell count, mild changes in liver enzymes, electrolyte abnormalities secondary to dehydration, and elevated lipase or amylase.
If pancreatitis is suspected based on physical exam and initial blood work, a blood test known as pancreas specific lipase may be performed. This blood test identifies a marker specific to the pancreas that increases with inflammation. A rapid in-clinic version of the test known as a snap fPL for cats or snap cPL for dogs gives a same day qualitative result that helps identify pancreatitis. A more detailed send out version of the test is also available that provides a precise qualitative number that can be monitored to manage pancreatitis over time.
Imaging is another important test for diagnosing pancreatitis. X-rays may show changes associated with inflammation in the abdomen. X-rays are also an important tool to rule out other common causes of decreased appetite and vomiting in pets, including intestinal blockage. An abdominal ultrasound can be important to diagnose and evaluate patients with pancreatitis. Ultrasound examination can identify changes to the pancreas including inflammation, irritation of surrounding tissue, pancreatic enlargement, or fluid accumulation.
The successful management of pancreatitis will depend on early diagnosis and prompt medical therapy. The four main goals of pancreatitis treatment are the management of dehydration, nausea, pain and nutrition. For mild cases of pancreatitis, this may be achieved through outpatient at-home treatments. For more severe cases of pancreatitis, hospitalization for intravenous fluid support, injectable medications and feeding tubes may be required.
Hydration – Replacing fluids and correcting electrolyte imbalances are important for patients suffering from pancreatitis. In less severe cases, subcutaneous fluids can be given under the skin in the veterinary clinic or at home. In more severe cases, patients may need to be hospitalized for intravenous fluid therapy.
Anti-nausea medications – Maropitant (Cerenia) is recommended for patients with pancreatitis. Even if vomiting is not seen, a reduced appetite is commonly related to nausea. Anti-nausea medications may also help decrease abdominal pain in animals. For less severe cases Cerenia may be administered by pill form at home. For cases needing in hospital care, Cerenia can be given by injection.
Gastric Acid Suppression – Medications such as omeprazole and famotidine may decrease the risk of stomach or intestinal ulceration or esophagitis.
Pain Control – Pancreatitis is a very painful condition. Abdominal pain should be assumed to be present and aggressively treated. Cerenia the anti-nausea medication may be used for mild abdominal pain. Intermittent buprenorphine may be given to animals with moderate abdominal pain. Animals with severe pain that are hospitalized are often treated with a constant-rate infusion of pain medications lidocaine and fentanyl.
Nutrition – Pets suffering from pancreatitis should resume eating as soon as possible. In dogs, feeding an ultra-low-fat diet is crucial for treatment success. In cats, a moderately fat-restricted diet is recommended. Prescription foods such as Hills ID or Purina EN low fat are designed for pancreatitis patients. Patients that won’t start eating may need to have feeding tubes placed.
The prognosis for dogs with pancreatitis depends on the severity of the illness. The earlier patients receive diagnosis and treatment, the more positive the outcome. Patients that suffer from an acute mild form of the disease may respond to outpatient treatment and can recover without any long-term consequences.
Patients with severe pancreatitis may need days of specialty intensive care in an emergency referral hospital and can have a guarded to poor prognosis. Patients that suffer from chronic or repeat episodes of pancreatitis may develop scarring and damage to the pancreas that can interfere with future function of the organ. Diabetes may develop due to impaired insulin production, which requires daily treatments of insulin injections. Or, it could mean exocrine pancreatic insufficiency (EPI), or an insufficient production of pancreatic digestive enzymes, leading to long-term need to supplement with digestive enzymes.
All patients with a history of pancreatitis are at increased risk for future recurrence. Owners of pets at risk for the disease should be vigilant to manage their pet’s diets carefully long term.