Pancreatitis in Cats and Dogs

 

The Pancreas

The Pancreas is a small organ in the abdomen that is part of the endocrine system.  It produces the hormones insulin and glucagon as well as digestive enzymes that are necessary for the proper digestion of food.  The digestive aspect of the pancreatic function is known as the exocrine pancreas. In a normal pancreas the digestive enzymes are inactive until secreted into the small intestine to aid in the digestion of food.

 

 

 

What is Pancreatitis?

Pancreatitis is an inflammatory condition of the pancreas that occurs frequently in dogs and cats. Pancreatitis can be acute or chronic.

Acute pancreatitis is a sudden inflammatory condition that is completely reversible once the inciting cause is removed. Acute pancreatitis is rare in cats.

 

Chronic Pancreatitis is characterized by irreversible changes such as atrophy or fibrosis of the exocrine pancreas over a long period of time. Chronic pancreatitis can result in scar tissue forming which decreases the ability of the pancreas to function properly.

 Both forms can be mild to severe. Most mild cases have little or no necrosis or systemic effects and the patient will make a complete recovery. Extensive pancreatic necrosis and multiple organ involvement can be seen in severe cases, which often have a poor prognosis.

 

Causes of Pancreatitis

The exact cause of pancreatitis is unclear but the following are associated with the condition:

-         High fat/ Low protein diet

-         Trauma

-         Tumors

-         Other diseases such as Cushing’s or diabetes

-         Some drugs such as:

Ø      Furosemide

Ø      Metronidazole

Ø      Tetracycline

Ø      Nitrofuantoin

Ø      Sulfonamides

Ø      Cimetidine

Ø      Ranitidine

Ø      Acetaminophen

Ø      Prednisone

Ø      Azothiaprine/Immuran

-         Hormones such as estrogen

-         Organophosphates

-         Excessively high blood calcium levels

-         In cats – Toxoplasmosis, FIP, feline herpes virus, inflammation of the bile ducts or fatty liver disease

 

Risk Factors:

-         Breed (Miniature schnauzer, Miniature poodle, cocker spaniel and Siamese cats are at higher risk)

-         Obesity in dogs

-         Diabetes mellitus

-         Cushing’s syndrome

-         Chronic renal failure

-         Females are more susceptible than males

-         Middle age – geriatric

 

Symptoms:

There is no “classic case” with pancreatitis as the symptoms are widely variable as is the severity of the disease. Symptoms that may be observed are:

-         lethargy or depression

-         anorexia or lack or appetite

-         vomiting (usually in dogs but less common in cats)

-         abdominal pain (dogs may show unusual posture, cats may hide their pain more)

-         diarrhea (more common in dogs)

-         dehydration

-         jaundice (more common in dogs)

-         fever

-         restlessness due to pain

-         rapid heart rate

-         respiratory distress

 

Diagnostics:

Diagnosing pancreatitis may be difficult because the available tests are not 100% reliable.

-         Lipase and amylase are two digestive enzymes that are produced by the pancreas that can be measured in the blood. Increased levels of these enzymes can suggest pancreatitis but are not definitive. These enzymes may be elevated due to other diseases such as kidney dysfunction.  The lipase test is more reliable than the amylase. In 15-20% of dogs and cats with pancreatitis there is no elevation seen in the lipase or amylase so a normal value will not rule out pancreatitis. Also, the administration of corticosteroids can elevate the lipase and depress the amylase – results that may be mistaken for pancreatitis.

-         The TLI (Trypsin-like immunoreactivity ) test may be helpful in diagnosing acute pancreatitis in cats and dogs. This test measures serum concentration of two enzymes, trypsinogen and trypsin. Trypsinogen is produced only by the pancreas.  With pancreatitis TLI is elevated more reliably than lipase. However, reduced kidney function may cause an increase in serum TLI. Because TLI is not always elevated a normal TLI test does not rule out pancreatitis. Also, very few labs perform this test.

-         The PLI (Pancreatic Lipase Immunoreactivity) test is the most sensitive currently available diagnostic test for pancreatitis. However, it is not practical since it is only run at Texas A&M GI Laboratory.

-         Abdominal radiographs may be taken but are nonspecific in diagnosing pancreatitis in dogs and cats. Radiographs may reveal decreased contrast in the cranial abdomen and displacement of abdominal organs in affected patients, but such changes are subjective. However, abdominal radiographs are imperative to rule out other reasons for acute onset vomiting such as a foreign body obstruction.

-         Abdominal ultrasound can be an invaluable tool in diagnosing pancreatitis. Ultrasonographic findings in cats and dogs with pancreatits include:

Ø      Pancreatic enlargement

Ø      Changes in the echogenicity of the pancreas (hypoecogenicity is thought to indicate pancreatic  necrosis and hyperecogenicity pancreatic fibrosis)

Ø      Hyperecogenicity of peripancreatic fat is thought to indicate peripancreatic necrosis.

Ø      Fluid accumulation around the pancreas

Ø      A mass effect in the area of the pancreas

Ø      A dilated pancreatic duct

Ø      Swollen major duodenal papilla

 

Treatment:

Treatment consists of supportive care. Prognosis is impossible to determine, as some patients will respond rapidly and others may unfortunately succumb to the disease.

-         Treatment for dogs:

Ø      Hospitalization

Ø      IV Fluids

Ø      NPO for 3-5 days, when lipase and amylase levels are near normal small frequent amounts of water and bland diet may be started.

Ø      Broad spectrum antibiotics

Ø      Antiemetics if vomiting or nausea is present

Ø      PAIN MEDICATIONS!!!

Ø      In severe cases a plasma transfusion may be warranted.

-         Treatment for cats:

Ø      Hospitalization

Ø      IV fluids

Ø      NPO for 12-24 hours only due to the risk of hepatic lipidosis (fatty liver), then give small amounts of a low fat highly digestible diet frequently. If pancreatitis causes a cat not to eat, it may be necessary to use parenteral feeding techniques. (A feeding tube is surgically implanted into the intestine.)

Ø      Broad spectrum antibiotics

Ø      Antiemetics if vomiting ( vomiting is not as common in cats)

Ø      PAIN MEDICATIONS!!!

 

Complications of Acute Pancreatitis

-         Diabetes mellitus. The inflammation of the pancreas may cause the endocrine portion of the pancreas to become dysfunctional interfering with the production of insulin. This will likely resolve once the pancreatitis is resolved.

-         Extra care and observation will need to be given to diabetic patients with pancreatitis because they may show some insulin resistance. Also, necessary dietary adjustments for patients with pancreatitis may also require an adjustment in their insulin dose. Blood glucose levels should be watched carefully while in hospital and post treatment until blood glucose levels are stable and the insulin dosage is properly adjusted.

-         Chronic pancreatitis may occur after an acute pancreatitis episode due to scarring of the exocrine pancreas.

-         Exocrine Pancreatic Insufficiency (EPI) - The absence of pancreatic digestive enzymes. Food passes through the digestive tract without being absorbed. Signs include: soft, pale and voluminous stools, weight loss, greasy soiling of the area around the rectum and sometimes the entire hair coat. Treatment includes replacement therapy of pancreatic enzymes in the diet.

 

 

Long term Management

Weight loss in obese patients is important. When a single attack of acute pancreatitis occurs, avoiding a high fat diet may be all that is necessary to prevent another attack. Table scraps and garbage raids should be avoided. There is no harm in adding pancreatic enzymes to the patient’s diet but they may not help. If the pancreatitis recurs, a low fat diet will be necessary for the rest of the patient’s life.