The topic this month is pancreatitis, which can occur in both cats and dogs.
The pancreas is located near the stomach and liver, and it produces enzymes to assist in food digestion and hormones such as glucagon and insulin. The digestive enzymes are secreted into the small intestine, and the hormones enter the bloodstream. When the pancreas becomes inflamed, the condition is called pancreatitis. The disease occurs usually in middle aged to older dogs, and especially when they are overweight, as this puts them at a higher risk. There appears to be no gender predisposition. This multi-organ (liver, pancreas and intestines) inflammatory process is sometimes referred to as “triaditis.” This occurs because inflammation associated with acute pancreatitis allows digestive enzymes to spill into the abdominal cavity.
Pancreatitis may be acute or chronic. The pancreas when functioning properly makes insulin, which controls blood sugar levels and makes enzymes that help your pet digest food properly so that nutrients can be absorbed. When inflammation occurs, it may affect insulin production causing diabetes, and lack of digestive enzymes may cause malnutrition due to non-absorption of food. With acute pancreatitis the inflammation in the pancreas generally occurs suddenly with symptoms/signs varying from mild to life-threatening complications.
Chronic pancreatitis is when the inflammation is longstanding and may result in permanent damage to the pancreas leading to digestive problems (such as exocrine pancreatic insufficiency – a lack of digestive enzymes) or diabetes mellitus. The inflammation allows digestive enzymes from the pancreas to spill into the abdominal cavity resulting in secondary damage to the liver, bile ducts, gallbladder, and intestines. Clinical signs may be mild and intermittent, making it more difficult to detect. Pets with chronic pancreatitis can have intermittent “acute” episodes also.
Possible causes of pancreatitis can include: (A) Genetics: Some breeds are much more likely to develop pancreatitis than others, including the miniature Schnauzer, Australian terrier, Siberian Husky, West Highland White Terrier, Bichon Frise, Cavalier King Charles spaniel, and Poodle. Siamese cats are more likely to develop pancreatitis than other cat breeds. However, any breed of dogs or cat can develop pancreatitis. (B) Diet: Dietary indiscretion – getting into something they shouldn’t, eating unusual food items like trash, fed table scraps, eating high-fat foods: bacon, bacon grease, fat trimmed off meat or bones, ham, turkey or chicken skin, “treats”/snacks high in fat, or meats that have been seasoned. (C) Trauma: Hit in the area of the abdomen. (D) Medications: Some drugs, such as corticosteroids, azathioprine also known as Imuran, an immunosuppressive medication that treats a variety of diseases, potassium bromide (anticonvulsant drug), L-asparaginase (a chemotherapy agent), and some antibiotics. It is not possible to predict which animals will develop pancreatitis due to these medications. (E) Infections: FYI – bacterial infections of the pancreas are much less common in cats and dogs than in people. (F) Disease: Certain hormonal diseases such as hypothyroidism and Cushing’s disease (hyperadrenocorticism), and immune diseases where the immune system attacks the pancreas. Other infections: (a) in cats: such as toxoplasmosis – an infection with a parasite called Toxoplasma gondii, and calicivirus – a virus that is a major cause of upper respiratory infections and oral disease and; (b) in dogs – babesiosis – a rare, sometimes severe, disease caused by the bite of a tick infected with Babesia microti – a microscopic parasite that infects red blood cells.
Signs / symptoms: When a dog or cat is suffering from pancreatitis, a pet may have a loss of or decrease in appetite, vomiting, diarrhea, or abdominal pain. A dog may show abdominal pain by standing in a “prayer position” where the dog stretches the body, raising their hind end up in the air and “bow their head” down towards their front legs. This position relieves abdominal discomfort that’s associated with an inflamed pancreas, or they may start crying when picked up or when the abdomen is touched. Cats with pancreatitis show a more subtle/vague set of signs, such as a reduced or absent appetite, lethargy, and an increase in hiding behavior. About 50% of cats will have vomiting or weight loss, and some cats will develop diarrhea as well. Abdominal pain, while a very common sign in dogs, is only reported in about 10-30% of cats with pancreatitis, but this may be related to cats’ stoic nature and ability to hide signs of pain from their owners and veterinarians. Some cats with chronic pancreatitis may show very mild or almost unnoticeable signs, while cats with severe, acute pancreatitis can become suddenly critically ill. Some pets may have a fever, or below-normal body temperature. In severe cases, the pet may have a yellow tint to the gums, whites of the eyes, or skin, which is called jaundice. Pancreatitis is also associated with many other diseases in cats, such as chronic intestinal disease, liver or gallbladder disease, and diabetes. Chronic pancreatitis might be considered/evaluated for in cats who are not responding well to treatment for other chronic illnesses.
How a diagnosis is obtained: (A) A physical examination of the pet to evaluate for abdominal pain, dehydration ( due to vomiting/ diarrhea), jaundice, and other disease processes. (B) The pet owner provides information about any changes in their pet’s normal habits/behavior. (C) Blood tests, including: (a) for dogs – a PLI (pancreatic lipase immunoreactivity), pancreas-specific lipase test called canine pancreatic lipase immunoreactivity, known simply as cPLI, and; (b) for cats: feline pancreatic lipase immunoreactivity, or fPLI. These tests are specific for the pancreas, and concentrations are usually increased with pancreatic inflammation. One form of this test (SNAP fPL) may be available in the vet’s office providing a rapid test with a same-day result; otherwise, the blood test is done in a laboratory, and (d) possibly abdominal imaging: x-rays and/or abdominal ultrasound. An ultrasound can help identify changes to the pancreas in up to 2/3 of cats with pancreatitis, including pancreatic inflammation, inflammation of surrounding tissue, pancreatic enlargement or fluid surrounding the area. These changes are usually more obvious in cases of acute pancreatitis. A combination of the above tests may be required to diagnose pancreatitis or another disease that can cause similar clinical signs but may require different treatment for other possible conditions such as an ingested foreign body/material, stomach/intestinal blockage, etc…
Treatment of pancreatitis is primarily supportive care/treatment of symptoms regardless of whether the patient has acute or chronic pancreatitis, such as replacement of fluids and electrolytes if dealing with dehydration, management of vomiting and/or pain, and possibly stomach-protectant medications as indicated. In mild cases, it may include a short-term diet change. For acute pancreatitis, a “bland” low-fat diet for dogs and highly digestible diets for cats may be recommended for several weeks, depending on severity. The veterinarian will also discuss prevention of another bout of pancreatitis, which may include lifelong changes including diet, supplements or medications. Proper nutritional therapy not only helps the pet recover more quickly from pancreatitis but prevents other complications of prolonged anorexia/loss of appetite, such as hepatic lipidosis/fatty liver disease. Some cases of pancreatitis will heal completely, while others may show damage that accumulates over time, particularly if your pet has had multiple episodes of pancreatitis or severe pancreatitis. In exceptionally severe cases, long-term diseases such as chronic kidney disease, diabetes mellitus or exocrine pancreatic insufficiency (EPI) may develop and may require lifelong treatment. Even with excellent treatment, severe cases of pancreatitis can result in death. Your veterinarian’s goals are to help you and your pet do well during an episode of pancreatitis and also to help prevent or minimize future occurrences. Seek prompt veterinary care if you think your pet may have pancreatitis. Early intervention is critical in helping your pet feel better and in preventing worsening of symptoms.
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