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Background
The pancreas is a small organ located
in the abdomen. In addition to being part of the endocrine system and producing the
hormones insulin and glucagon, it produces digestive enzymes that are necessary for the
proper digestion of food. This aspect of the pancreatic function is called the exocrine
pancreas. The digestive enzymes produced by the pancreas are normally inactive until they
are secreted into the small intestine. Once in the intestine, the enzymes become active
and aid in the digestion of food.
Pancreatitis means the pancreas is inflamed. The inflammation can become severe, and the
digestive enzymes that are normally inactive can become active and the enzymes cause
damage to the pancreas. This causes a cycle of increasing inflammation.
Pancreatitis can be acute - meaning the inflammation occurs suddenly, or chronic - where
the inflammation is slow and gradually occurs over a long period of time. Acute
pancreatitis causes little or no permanent damage to the pancreas. Acute
pancreatitis is rare in cats. Chronic pancreatitis can result in scar tissue forming in
the pancreas, which in turn decreases the ability of the pancreas to function properly.
There are many differences in the causes and treatment of pancreatitis in dogs and cats
Causes
The exact cause of pancreatitis is unknown but may be due to:
- high fat, low protein diet
- trauma (car accidents, a fall from tall building)
- other diseases (Cushing's syndrome, diabetes)
- tumors
- some drugs and toxins (some diuretics, antibiotics,
insecticides)
- in cats - toxoplasmosis, FIP, feline herpesvirus, or
inflammation of the bile ducts
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
Signs of acute
pancreatitis
- lethargy or depression
- anorexia or inappetance
- vomiting (common in dogs, less common in cats)
- abdominal pain (dogs may show an unusual posture, cats tend
to "hide" pain more)
- diarrhea (more common in dogs)
- dehydration
- jaundice (more common in dogs)
Diagnosis
Diagnosing pancreatitis is very
difficult because the available tests are not 100% reliable.
- Lipase and amylase are two
digestive enzymes produced by the pancreas that can be measured in the blood. Elevations
in these enzymes can suggest pancreatitis, but are not definitive tests. This is because
both lipase and amylase are produced by other body tissues, and because elevated levels
may be due to other diseases such as kidney dysfunction. The lipase test may be more
reliable than the amylase test, but it is not always available and it must be requested as
a special blood test. Many dogs and cats (15-20%) with pancreatitis do not have elevations
in lipase and amylase, so when these blood values are normal, it does not rule out
pancreatitis.
- Trypsin-like immunoreactivity (TLI)
test. The TLI test may help diagnosing acute pancreatitis in both 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. Unfortunately, only a few labs perform this test and it may take
about two weeks to get the test results back.
- Abdominal x-rays may be taken.
- Ultrasound may be useful in
diagnosing pancreatitis, but it is difficult to perform and may not show any
abnormalities.
- Needle-aspiration biopsy may be
performed.
Treatment
There is no specific medication or
treatment for pancreatitis. Surgery is rare and only used if there is a mass on the
pancreas that is causing the pancreatitis. Treatment is different for dogs and cats, but
the overall goals are the same:
- rest the pancreas
- reduce inflammation
- prevent complications (dehydration and infection)
- minimize pain
Dogs
For acute pancreatitis, dogs are hospitalized and are not allowed to drink or eat
any food for 3 to 5 days. This is called NPO, which stands for "nothing per os".
By preventing food from entering the digestive system, the pancreas is allowed to rest and
is not stimulated to produce digestive enzymes. This rest allows the inflammation to
decrease. When blood lipase and amylase levels are near normal, water and frequent, small
feedings of a very low fat diet is started. To prevent dehydration, fluids are given
(usually intravenously), but sometimes subcutaneously. Broad-spectrum antibiotics are
often given to prevent bacterial infections. If vomiting is severe, anti-emetics may also
be given. Acute pancreatitis is painful, so pain medications are often given. The acute
pancreatitis usually clears up in a few days.
Cats
Cats are also hospitalized, but are usually not maintained NPO for more than a
short time (12-24 hours). This is due to the risk of hepatic lipidosis (fatty liver). Cats
are usually fed a highly digestible, low fat diet. When it is necessary to withhold food
for longer periods, intravenous feeding may be necessary. If the pancreatitis causes a cat
not to eat, it may be necessary to use parenteral feeding techniques. This is where a
feeding tube is surgically implanted into the intestine.
Long-term
management
Weight loss in obese pets is
important. When a single attack of acute pancreatitis occurs, avoiding a high fat
diet may be all that is needed to prevent another attack from occurring. Holiday
feasts, table scraps, and garbage can raids should be prevented. If the pancreatitis
recurs, a fat-restricted diet becomes the diet for the rest of the pet's life. There
are pancreatic enzymes that can be added to the pet's diet, and although there is no harm
in giving them, they may not help.
Complications of acute
pancreatitis
- diabetes mellitus The inflammation of the pancreas may cause the endocrine portion of the pancreas
(the insulin producing part) to become dysfunctional. This may resolve once the
pancreatitis is cleared up.
- chronic pancreatitis may occur after an acute pancreatitis episode.
Considerations
for Diabetics
The pancreas has two separate functions:
the endocrine function of blood glucose regulation, and the exocrine function of
digestion. When either of these functions are abnormal, it may cause the other one to
be disrupted. Diabetes can cause pancreatitis, and pancreatitis can cause diabetes.
When a diabetic animal has a bout of pancreatitis, any vomiting, lethargy, or necessary
dietary adjustments will likely require an adjustment to the insulin dose. Diabetic
animals that have a bout of pancreatitis may show some insulin resistance. This can
become a complicated situation that requires extra care and observation by both the vet
and the owner.
Personal Experiences
Read Whisker's memorial
page - how she dealt with pancreatitis and diabetes, and how her owner
learned that fatty "treats" are not in a pet's best interest.
Note
Exocrine Pancreatic Insufficiency (EPI) is not the same as pancreatitis. EPI occurs
when the cells of pancreas that produce digestive enzymes die off and the pancreas is
unable to produce sufficient quantities of digestive enzymes. This disease can be treated
by adding supplemental digestive enzymes to the pet's diet. A
"maintenance" diet is often used, as opposed to the restricted fat diet used to
manage pancreatitis.
Resources
References
 
Updated August 2001
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Pancreatitis and
Diabetes