Information about Pancreatitis

Information about Pancreatitis
By Emily Hoppmann, DVM

In dogs and cats, as in humans, the pancreas is an organ in the abdomen that produces substances that are critical for digestion and for the body’s normal metabolism. Microscopically, the pancreatic tissue is composed of two parts: exocrine and endocrine. Exocrine pancreatic tissue is responsible for producing and releasing digestive juices that help to break down and digest food in the intestine, especially fatty foods. Appropriate digestion permits nutrients to be absorbed and used by the body, and in this way, the pancreas is essential for transforming food into energy and building blocks that the body can use. The endocrine pancreatic tissue is not involved in digestion, but it is just as indispensable to life: it produces hormones that circulate in the bloodstream and are necessary for vital processes like blood sugar control (which plays a huge part in diabetes).

Acute pancreatitis is a sudden onset of inflammation within the pancreas. The exact trigger is often difficult to pinpoint in most dogs and cats, but the cause is often due to eating something the pet is not used to (a sudden diet change or new bag of food, new treats, and especially feeding table food or getting into the garbage). In humans, pancreatitis is often genetic or brought on by stress or alcoholism, but we don’t run across too many pets with a drinking problem  With acute pancreatitis, the enzymes that are normally produced and released to digest food begin to damage the pancreas itself and can go on to damage the rest of the organs in the abdomen. A variety of symptoms may result from pancreatitis and many of them are symptoms that could be seen with any number of diseases, so blood work, a good physical exam, and accurate history is critical. These signs can range from mild signs of indigestion such as vomiting, loss of appetite, and painful abdomen to severe, life-threatening symptoms such as respiratory difficulty, kidney failure, and even collapse and life threatening shock. Diabetes can also occur as a result of pancreatitis and this can become a life-long disease.

Acute pancreatitis can develop in any dog; however, most affected dogs are overweight and middle-aged or older. It is thought that a high-fat diet, or ingestion of a high-fat treat or table food, plays an important role in allowing pancreatitis to occur. There is a higher occurrence of this disease in miniature schnauzers, suggesting that this breed may be genetically predisposed to pancreatitis. As with most things, cats hide this disease as well they do others and the symptoms are therefore more subtle in cats. As a result, acute pancreatitis is less commonly recognized in this species. However, the effects can be just as severe in cats as in dogs. Some infectious diseases can cause acute pancreatitis in cats, but in many cases, other disorders such as inflammatory bowel disease and chronic liver disease are present concurrently and may be contributing to symptoms more than pancreatitis. An ultrasound of the digestive tract of a cat can be very helpful in sorting out other diseases such as inflammatory bowel disease or changes in the liver.

Many disorders can mimic the symptoms of acute pancreatitis so diagnostic testing is very important. Several tests may be required to eliminate some of these other possibilities in order to determine that pancreatitis is responsible for symptoms. As stated before, getting a complete medical history of your pet, having us perform a complete physical examination, and running blood work is the normal starting point. These all can help to determine the degree of inflammation and dehydration in the body, and to look for other causes of the same symptoms as pancreatitis since kidney problems, liver problems, and many other diseases can mimic pancreatitis. Additional testing includes abdominal x-rays to help rule out some problems with the intestinal tract and tumors in the abdomen that could produce similar symptoms. Also, an ultrasound exam of the abdomen is extremely valuable for helping to identify specific changes in the appearance of the structure of the pancreas expected with pancreatitis, and for identifying contributing or concurrent disorders. Luckily we have both a digital x-rays (radiograph) machine and top-of-the line ultrasound here at Elgin Veterinary Hospital so we can run these tests very quickly.

Unfortunately, no medication exists that cures pancreatitis, but most dogs or cats with pancreatitis improve with medications and nursing care. Treatment is centered on medical care that is supportive: medications and treatments that help the pancreas to heal itself, reduce the likelihood of further pancreatitis being triggered, treat any complications that the pancreatitis can cause, and support vital functions such as nutrition. The extent of supportive care can vary widely from minimal at-home care to intensive, in hospital, round-the-clock medical care, depending on the severity of the pancreatitis.

If medication is necessary, you should give it exactly as directed. Even when is has improved or resolved completely, pancreatitis may possibly be triggered again in the future by inappropriate food. Therefore, it is important to feed only diets that are of an appropriate composition and nutrient profile for patients with a history of pancreatitis. We can work together to determine which is the best type of food, if weight loss is recommended, and ensure that your dog or cat has a tailored diet and exercise regimen to try to prevent pancreatitis from occurring again.
It is important to note that when cats eat less than normal or stop eating all together, including having pancreatitis, they are at risk for developing a serious liver disease called hepatic lipidosis (this is where all the fat stored in the liver is mobilized due to the cat not eating and leads to severe damage of the liver itself). This can be a fatal disease that occurs very quickly so monitor your cat’s food intake closely, and notify us if your cat has not eaten for 24 hours, even if symptoms of illness are not apparent yet.

If the cause of pancreatitis can be identified, it is treated in an attempt to eliminate it. Intravenous fluids are given to treat dehydration. I withhold food for 24 hours if vomiting is a problem so that the pancreas and entire gastrointestinal tract can rest and heal. I also start medication to control abdominal pain and anti-nausea medications.
After resting the gut and being sure that the patient has not vomited for a specified length of time (usually 24 hours), a very small amount of water and a low-fat, easily digestible food is offered. If the dog or cat eats and vomiting does not recur, the amount is gradually increased during the next several days. If vomiting returns at any time, food and water often are once again withheld. Since many disorders can cause symptoms that look like pancreatitis, ongoing vomiting or worsening of symptoms often warrants additional testing. Similarly, during the course of the treatment, several diagnostic tests may be repeated to help assess the effectiveness of treatment.
If diabetes develops, which can occur as a complication of pancreatitis, insulin will need to be given. The development of diabetes negatively affects the overall prognosis and with diabetes brought on by pancreatitis, diabetes may be temporary or permanent.

• Inform us if your cat or dog has ever been diagnosed with a medical condition and is taking medication, because existing medications may alter the treatment plan
• If pancreatitis is present, give medication exactly as directed, and if you are concerned about possible negative effects, discuss them with us immediately rather than discontinuing the treatment
• Understand the importance of short-term withholding of solid food during pancreatitis. Since digestion of food triggers the pancreas to excrete its digestive juices, this makes pancreatitis worse. Therefore, during treatment of pancreatitis, food is almost always withheld for 24 hours or more, until vomiting has stopped and the pancreas has begun to regenerate

• Do not postpone coming in for an appointment if you observe any symptoms of acute pancreatitis in your dog or cat. Prompt treatment can prevent more severe side effects.
• Do not give medication that you have at home that has been prescribed for human use; some of these may interfere with treatment, cause even more severe problems, and can be fatal
• Do not feed large amounts of food during the days following recovery from pancreatitis. The pancreas needs to heal, and this is helped by feeding small frequent meals that add up to the same daily amount of food, but distributed over several feedings

When to Call Elgin Veterinary Hospital:
• If you are unable to give medication as directed
• If your pet is not improving after treatment begins, and especially if you pet will not eat

Clinical signs to watch for as possible indicators of worsening rather than improving include not feeling well, such as an onset of “low spirits” or a pet isolating himself from the family, weakness, loss of appetite, vomiting, or diarrhea. An immediate recheck is warranted if these symptoms are seen. Follow-up appointments are typically scheduled to monitor progress, to determine if treatment should be adjusted, and to pursue any abnormalities on previous blood tests. The first recheck is usually in 10 to 12 days after the diagnosis.