What is pancreatitis?
The pancreas is an organ that sits just beneath the
stomach and the first part of the small intestine. It is responsible for
producing enzymes that aid in digestion and is also the source of insulin
production. Pancreatitis refers to an inflammation of this organ. It can
happen to dogs and cats of any age, breed or sex. If severe, pancreatitis
can lead to irreversible changes in the pancreas and impaired function
long term.
The cause of pancreatitis in dogs and cats is not very
well understood. There are a few things that we know can predispose to the
development of pancreatitis such as fatty diets, certain drugs, underlying
diseases, parasites and trauma however, there is also some research that
indicates there are genetic factors at play as well.
What are the signs of pancreatitis?
Dogs with pancreatitis may be depressed, lose their
appetite, have vomiting or diarrhea. They may also exhibit pain in the
abdomen – this may be manifested as restlessness, panting or unwillingness
to lie down. Cats can be a little more vague with signs ranging from poor
appetite and fever to an elevated heart rate. Unlike dogs, they are less
likely to have abdominal pain and vomiting.
Pancreatitis is often divided into acute or chronic
cases. Acute cases are usually more severe and may be associated with more
dramatic signs. Chronic pancreatitis, which is more common in cats, may
have more subtle symptoms and may often be associated with or mistaken for
other illnesses.
How do we diagnose pancreatitis?
The diagnosis of pancreatitis can be a bit difficult as
there is no one test that is specific for this problem. Generally your
veterinarian will start with a suspicion of pancreatitis based on history,
symptoms or physical exam findings. However, since pancreatitis can mimic
numerous gastrointestinal or metabolic problems, further testing is
generally required. Abdominal radiographs and routine blood tests are
usually the first step in obtaining a diagnosis. There are certain signs
that may be seen on radiographs that would increase the index of suspicion
for pancreatitis however patients with this disorder can have completely
normal radiographs. Other supportive clues may be found in routine blood
tests. Elevation in pancreatic enzyme levels may be supportive of a
diagnosis but these values may be normal in patients with pancreatitis.
Pancreatic enzymes may be elevated due to other diseases such as kidney
disease. Blood tests will also allow your veterinarian to make sure there
are no other metabolic problems.
Another diagnostic test that can prove to be very useful
in the diagnosis of pancreatitis is abdominal ultrasound. This allows us
to directly visualize the pancreas and other abdominal organs. It may be
possible to see changes within the pancreas that indicate inflammation.
Your veterinarian may choose to do a blood test that is
a bit more specific to the pancreas called a TLI (trypsin-like
immunoreactivity). This may help aid in a diagnosis in those cases in
which the answer is unclear. One disadvantage of this test is that it may
take 5-10 days to receive the results. In some situations, biopsy of the
pancreas may be required as it is difficult to differentiate pancreatitis
from pancreatic cancer without a biopsy.
How do we treat pancreatitis?
The treatment of pancreatitis can vary greatly depending
on the severity and duration of the illness. Patients with mild
pancreatitis may be treated conservatively at home while those with severe
disease will require hospitalization and intensive care.
One of the mainstays of therapy in dogs with this
disease is to rest the GI system and pancreas by withholding food. In
patients with severe signs where there may be a need for prolonged
fasting, other routes of nutritional support may be required. For example,
intravenous feeding (total parenteral nutrition) or feeding through a tube
placed in the lower intestine. Cats may develop other problems if fasted
for too long so nutritional support is generally needed sooner in these
patients.
Intravenous fluid therapy, antibiotics and anti-nausea
medication are also used as part of the therapeutic regime. Because
pancreatitis can sometimes be very painful, pain medication may be needed
as well to help keep your pet comfortable during treatment.
Dogs with severe pancreatitis may also benefit from a
plasma transfusion. Plasma contains factors that help ameliorate severe
inflammation. These may become depleted in severe cases and can be
replaced with plasma transfusions aiding in recovery and potentially
reducing the amount of time your pet will need to stay in the hospital.
Unfortunately, these cases can be very unpredictable and
despite aggressive therapy severe cases may not respond to any form of
therapy. This seems to be particularly true of cats with severe acute
pancreatitis. It is difficult to predict at the onset of treatment which
patients will respond and which won’t respond.
What are the long term effects of pancreatitis?
In some instances, if the pancreatitis is severe or
longstanding, there can be long term side effects. The one seen most often
is diabetes mellitus. Because insulin is produced in the pancreas, severe
disease and subsequent scarring of this organ may result in insufficient
insulin production which leads to diabetes.
Animals that have recovered from pancreatitis are also
more prone to developing it again in the future. For this reason your
veterinarian will help develop a long term diet plan that will help
minimize the risk of this occurring.
