Anatomy

The pancreas is a small structure located near the stomach and attached to the wall of the small intestine.
The pancreas has two major functions. It produces hormones to aid in the maintenance of a proper blood sugar
(glucose) level. The hormones are secreted into the blood stream. It also produces important enzymes to aid in
the digestion of protein and fats (lipids). These enzymes travel from the pancreas to the small intestine through
a small tube called the pancreatic duct.

Hormonal or endocrine function (insulin and glucagon)

The glucose-regulating hormones produced by the pancreas are insulin and glucagon. When starches and carbohydrates are eaten, they are broken down into the sugar glucose. The glucose is absorbed through the wall of the digestive tract and passes into the bloodstream. Insulin allows glucose to leave the bloodstream and enter the body's tissues. Glucose can then be utilized as energy for the cells. When glucose levels are high, glucagon causes it to be stored in the liver and muscles as glycogen. If not enough insulin is produced, diabetes mellitus (sugar diabetes) can occur.

Digestive or exocrine function (trypsin, chymotrypsin and lipases)

The pancreas produces the protein-digesting enzymes trypsin and chymotrypsin. Fat digestion is aided by 
enzymes called lipases, also produced by the pancreas. Without these enzymes, dogs would not be able 
to break down important dietary components. When the pancreas does not produce adequate amounts 
of these enzymes the condition is called pancreatic insufficiency.
 
 
 

Pancreatitis (Inflammation)
Holly Frisby, DVM
Veterinary Services Department, Drs. Foster & Smith, Inc. 
 

  The pancreas is a V-shaped organ located behind the stomach and the first section of the 
small intestine, the duodenum. It has two main functions: it aids in metabolism of sugar
in the body through the production of insulin, and is necessary for the digestion 
of nutrients by producing pancreatic enzymes. These enzymes help the body promote the
digestion and absorption of fats. Acute pancreatitis is a sudden onset of pancreatic inflammation.

Causes

Multiple factors can contribute to the development of pancreatitis. Certain medications, infections; metabolic disorders including hyperlipidemia (high amounts of lipid in the blood) and hypercalcemia (high amounts of calcium in the blood); and trauma and shock can be associated with the development of pancreatitis. Middle-aged dogs appear to be at increased risk of developing pancreatitis; as a breed, Schnauzers and Yorkshire terriers appear to be more prone to pancreatitis. Nutrition also plays a role. Dogs with diets high in fat, or dogs who 'steal' or are fed greasy 'people food' seem to have a high incidence of the disease.

Symptoms

Common symptoms of the acute form of pancreatitis in dogs include a very painful abdomen, abdominal distention, lack of appetite, depression, dehydration, a 'hunched up' posture, vomiting, diarrhea and yellow, greasy stool. Fever often accompanies these symptoms. Animals with more severe disease can develop heart arrhythmias, sepsis (body-wide infection), difficulty breathing, and a life-threatening condition called disseminated intravascular coagulation (DIC) which results in multiple hemorrhages. If the inflammation is severe, organs surrounding the pancreas could be 'autodigested' by pancreatic enzymes released from the damaged pancreas and become permanently damaged.

Diagnosis

The diagnosis of pancreatitis is made through information obtained from the history,
the physical exam and laboratory testing. Dogs with pancreatitis generally have an increased 
blood levels of the pancreatic enzymes called amylase and lipase. If the liver also becomes inflamed,
liver enzymes as measured in the blood may be increased. A rather new test, serum trypsin-like immunoreactivity, may prove to be a valuable diagnostic aid. The white blood cell count is generally
increased in acute pancreatitis. Radiography (x-rays) and ultrasound can also help in making 
the diagnosis. biopsy can result in a conclusive diagnosis, but is not commonly performed.

Treatment

The goal of treatment is to rest the pancreas, provide supportive care and control complications.
Treatment always begins with a withholding of food, water, and oral medications for at least 24 hours.
The lack of oral intake stops the stimulation of the pancreas to produce digestive enzymes. 
Depending upon the animal's response food intake can be started again after a few days. 
The pet is generally fed small meals of a bland, easily digestible, low-fat food. Over the course of a 
week or more, the size of meals and quantity of food fed are increased. The dog may need to stay 
on the special diet for life, or it may be possible to gradually reintroduce the former diet.

The second major component of treatment is fluid therapy. Dehydration and electrolyte 
imbalances are common in dogs with acute pancreatitis, and water intake is often restricted so
fluid therapy is usually needed. Fluids are either given subcutaneously or intravenous.

Dogs who are experiencing severe pain can be treated with pain relievers such as meperidine 
or butorphanol. Antibiotics are often administered prophylactically to protect against infection.

If the pancreatitis was caused by a medication, the medication should be stopped. If is was 
caused by a toxin, infection, or other condition, and appropriate therapy for the underlying
condition should be started.

In rare instances where there are intestinal complications or the development of
a pancreatic abscess, surgery may be necessary.

Long term management and prognosis

Pancreatitis can be a very unpredictable disease. In most cases, if the pancreatitis was mild and
the pet only had one episode, chances of recovery are good and avoiding high fat foods may be 
all that is necessary to prevent recurrence or complications. In other cases, what appears to be
a mild case may progress, or may be treated successfully only to have recurrences, sometimes severe.

Dogs with severe pancreatitis can recover, but may also develop fatal complications. The risk of developing fatal pancreatitis is increased in dogs who are overweight, or have diabetes mellitus, hyperadrenocorticism, hypothyroidism, gastrointestinal tract disease, and epilepsy. Pets who have repeated bouts of pancreatitis may need to be fed low-fat diets to prevent recurrence. Even so, some animals develop chronic pancreatitis which can lead to diabetes mellitus and/or pancreatic insufficiency, also called 'maldigestion syndrome'.

In pancreatic insufficiency, the nutrients in food are passed out in the feces undigested. An
animal with this disease often has a ravenous appetite, diarrhea, and weight loss. Even though he 
is eating, he could literally starve to death. Treatment for pancreatic insufficiency is lifelong and
expensive, but is possible. The pet's digestive enzymes are replaced through a product
processed from pancreases of hogs and cattle which contain large quantities of the digestive
enzymes. A change in diet with added nutritional supplements may also be necessary.

Summary

Acute pancreatitis can be a life-threatening condition, and early recognition and treatment can improve chances of recovery. In dogs, fever, lack of appetite, depression and vomiting are the most common signs. Treatment is based upon stopping all oral intake to rest the pancreas, correcting the dehydration and maintaining proper fluid and electrolyte balances, and treating any complications or underlying conditions.
 

References
 

Hess, RS; Kass, PH; Shofer, FS; Van Winkle, TJ; Washabau, RJ. Evaluation of risk factors for fatal acute pancreatitis in dogs. Journal of the American Veterinary Association. 1999;214(1):46-51.

Stewart, AF. Pancreatitis in dogs and cats: Cause, pathogenesis, diagnosis and treatment. The Compendium on Continuing Education for the Practicing Veterinarian. 1994;16(11):1423-1431.

Williams, DA. Exocrine pancreatic disease.In Ettinger, SJ; Feldman EC (eds): Textbook of Veterinary Internal Medicine. WB Saunders Co. Philadelphia, PA; 2000;1347-1355. 
 

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