The Perils of Pancreatitis

Around here, things have a tendency to happen in clusters. We’ll see a stream of urinary obstructions one week and a slow-moving herd of cruciate surgeries the next. Recently, we had a run on canine pancreatitis. Thankfully, all of our patients did well, but pancreatitis can be a very scary disease with a number of complications. What is pancreatitis, you ask? Well, let me start by explaining what the pancreas is and what it does in the body.

The pancreas is a light pink flat glandular organ that neighbors the stomach and duodenum (the first part of the small intestine). It works two jobs to pay the bills. First, it secretes digestive enzymes to help break down starches and fats. The pancreas packages these enzymes into granules and sends them down the pancreatic duct into the duodenum where they start aiding digestion. The other job of the pancreas is to produce insulin and glucagon, both involved in regulation of glucose metabolism. Both of these jobs are important in maintaining a healthy metabolism, but it is the digestive enzymes that concern us at the moment. Check out this link for a picture of a normal pancreas.

At its most basic, pancreatitis means “inflammation of the pancreas.” Why is it inflamed? Many times it is hard to pinpoint the initial trigger, but something disrupts the normal function of the pancreas. The digestive enzymes are normally packaged up in safe inactive granules for transport to the duodenum. In pancreatitis, those granules are activated early inside the pancreas itself! It doesn’t take much imagination to picture activated digestive enzymes in a place they are not supposed to be digesting. This causes a huge amount of localized inflammation as well as many systemic effects. Even mild pancreatitis is a very painful condition. This is a picture of acute pancreatitis.

Pancreatitis cases typically present with a history of high fat foods, dietary indiscretion (i.e. getting into the garbage), abdominal trauma, or certain medications. And it isn’t always well understood why certain risk factors cause or predispose an animal to pancreatitis. Dogs (and cats) can be lethargic and inappetent. They will typically have a fever, painful abdomen, vomiting and diarrhea. Animals with acute pancreatitis understandably look and feel rotten.

So how do we diagnosis it? Historically, this condition has been diagnosed based on clinical signs, bloodwork, and diagnostic imaging (x-rays or ultrasound). Elevations of two pancreatic enzymes called amylase and lipase were considered suspicious of pancreatitis, but other conditions can cause similar elevations. Recently, a new test called spec cPL (specific canine pancreatitic lipase) has given us a very specific and sensitive way to diagnosis this condition. A feline version of this test has also been released. This test can help detect 80-90% of pancreatitis cases, and we are able to perform this test in our hospital for a fast, reliable diagnosis. 

Once we have a diagnosis, the next step is obviously treating the animal. Treatment for pancreatitis is mainly supportive therapy. We want the pancreas to rest and recover. Eating any food will stimulate the pancreas further, so nothing can be given orally for 48-72 hours. To prevent dehydration, patients are placed on intravenous fluid support. Medications are given to decrease nausea/vomiting and diarrhea. Pain medication is very important to keep our patients comfortable and antibiotics are also typically administered. Once a patient is well enough to start eating again, a bland low-fat diet is fed to further minimize pancreatic stimulation. 

Mild pancreatitis typically has a good/fair prognosis. Many animals recover from mild pancreatitis with no further difficulties. Occasionally, an animal may be predisposed to recurrent or chronic pancreatitis. Careful monitoring and special low-fat diets can help manage these cases. Any damage to the pancreas can also potentially lead to scarring which can damage the insulin secreting cells, leading to decreased insulin secretion and possibly diabetes mellitus. Cats often get three interrelated syndromes that include pancreatitis, cholangiohepatitis (inflammation of the liver) and inflammatory bowel disease (IBD). This is referred to as “triaditis” and can further complicate diagnosis and treatment. Severe pancreatitis carries a more guarded prognosis. These animals can develop a number of life-threatening complications including pancreatic necrosis or abscesses, disseminated intravascular coagulation (DIC), renal failure, or respiratory failure. More intensive care is often needed for these cases, such as blood or plasma transfusions. 

What can you do to prevent pancreatitis in your pet? Avoid fatty foods like cheese, ice cream, gravy, or pot roasts. Even a small amount of food can trigger pancreatitis in some animals. Avoiding people food altogether is generally a good practice for any animal in my opinion. Many dog treats are also very high in fat, so be very cautious with how much you give. “Killer,” your 10lb Chihuahua, does NOT need to eat an entire “Jumbone” in one sitting, ok? Even overdosing some fatty acid supplements can do it. However, some animals are predisposed to pancreatitis no matter what precautions you take, and we usually recommend these pets stay on low-fat diets long term. Some, but not all cases of pancreatitis are preventable. This is a painful, potentially life threatening disease. While most cases that come through our hospital do recover and go home, some do not. It is not always simply or easily treated. So please, be aware what you feed your pet and do what you can to prevent it. The less we see pancreatitis, the better.