Pancreatitis in Dogs & Cats

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Background

As part of the endocrine and digestive system, the pancreas is necessary for digestion of foods, producing enzymes that digest food, and producing insulin. Pancreatitis, inflammation of the pancreas, disrupts the flow of these enzymes into the digestive tract and leaking them into the abdomen. Rapid enzymatic digestion of the exposed tissues occurs, along with serious clinical consequences.

Because the kidneys and liver are located close to the pancreas, they are often affected, and the abdomen can become inflamed. If bleeding occurs within the pancreas, shock, and even death can result.

Pancreatitis can be acute and rapid in dogs and cats. If treated promptly, permanent organ damage can usually be averted. However, if pancreatitis goes on chronically without treatment, severe organ damage can occur.

Pancreatitis affects both dogs and cats, although it is more common in cats.

Symptoms

A variety of symptoms can be observed, including:
• Fever
• Vomiting
• Diarrhea
• Loss of appetite (anorexia)
• Weight loss (more common in cats)
• Dehydration
• Fatigue and sluggishness
• Mild to severe abdominal pain (may become more sever after eating)
• Depression
• Increased heart rate
• Difficulty breathing

Causes

Possible causes include: nutritional factors, such as high blood levels of fat (lipemia) and calcium (hypercalcemia), trauma to the pancreas, and certain drugs or toxins. Obesity linked to a high fat and low carbohydrate diet is also a risk factor.

Pancreatic inflammation can occur after eating a large amount of fatty foods. This typically happens around holidays periods, when dogs and cats are given table scraps they are unaccustomed to eating.

Although unusual, the sting of a scorpion release venom can cause pancreatitis.

While pancreatitis can occur in any dog or cat breed, it occurs more frequently in cats, especially Siamese. In dogs, the most commonly affected breeds are the miniature schnauzer, miniature poodle, and American cocker spaniel. Inflammation of the pancreas is also more common in females than in males, and more common in elderly cats and dogs.

Diagnosis

Upon presentation to a veterinarian, a complete physical examination and a series of lab tests will be performed to check for pancreatitis, diabetes, acid reflux, and even gall stones. X-rays and/or abdominal ultrasound imaging will likely be used to look for evidence of any injury to the pancreas. Inflammation can cause the pancreatic insulin-producing cells to be damaged, which could lead to diabetes.

Specific Laboratory Tests for Pancreatitis **
Pancreatic Lipase Immunoreactitivity (PLI) and Pancreatic Trypsin-Like Immunoreactivity (TLI)

Although pancreatitis is commonly seen in human beings, an estimated 90% of clinical or subclinical cases remain undiagnosed. Similarly, pancreatitis is a common gastrointestinal (GI) disorder in both dogs and cats that can be assumed to remain undiagnosed in the majority of cases. This is partly due to the nonspecific clinical presentation of these canine and feline patients, but also because highly sensitive and specific clinical diagnostic tests for this disease was not available until the early 2000s.

Sensitivities and specificities of different diagnostic tests for canine pancreatitis were recently compared. Serum amylase activity showed a specificity of 57% and sensitivity of 62%, while serum lipase activity showed specificity of only 55% and a sensitivity of 73%. While these results would be marginally acceptable, almost 50% of dogs with an elevated serum amylase or lipase activity did not have pancreatitis.

The situation is even worse in cats, where serum amylase and lipase activities have been shown to have no clinical usefulness for diagnosis of feline pancreatitis. Serum feline trypsin-like immunoreactivity (fTLI) concentration, while highly specific for feline pancreatitis only has a sensitivity of 30 to 60%. The serum TLI, however, is still the most sensitive diagnostic tool currently available for pancreatitis in cats.

Recently, new assays for measurement of serum pancreatic lipase immunoreactivity (PLI) have been developed and validated for both dogs and cats. Serum canine PLI (cPLI) has been shown to be highly specific for exocrine pancreatic function, and was highly sensitive for canine pancreatitis at the cut-off value of 200 µg/L. When compared to this test, sensitivities of serum cTLI concentration and serum lipase activity were much lower. Dogs with renal failure had normal cPLI, so this test can still be used to diagnose pancreatitis in these patients. To date, clinical experience with the cPLI test has been excellent. The cPLI test is highly sensitive for canine pancreatitis.

Serum fPLI has been evaluated in cats with experimental pancreatitis. In these cats, serum fPLI returned to normal concentrations many days after the fTLI, indicating that this test is likely to be more sensitive than is serum TLI concentration. Initial results in feline clinical cases indicate that a serum fPLI concentration above 10 µg/L is highly suggestive of feline pancreatitis. However, as chronic small intestinal disease possibly compensated by chronic pancreatitis is more common than primary pancreatitis in cats, feline cases with chronic GI disease should also be assessed with measurements of serum cobalamin and folate concentrations. For both dogs and cats, serum TLI concentration remains the test of choice for exocrine pancreatic insufficiency (EPI).

In summary, serum PLI measurements have been validated for dogs and cats, and assays have been commercially available for about 15 years. Serum cPLI concentration has been shown to be both highly specific for EPI and highly sensitive for canine pancreatitis. Serum fPLI concentration can be elevated in the experimental and spontaneous pancreatitis of cats.

[Adapted from Dr. David Williams, Head, Veterinary Clinical Medicine, University of IL, and consultant to GI Lab at Texas A & M University.] **

Treatment

If mild, pancreatic inflammation can often be treated in a veterinarian’s office and will likely include fluid therapy with a colloid solution, electrolyte and potassium supplements. Any implicated medications will be stopped.

It is important to restrict the pet’s activity level following treatment to allow for organ and tissue healing. Food and fluids will usually be stopped for a few days to give the pancreas time to rest, and to slow the production of digestive enzymes. Fluid therapy may be needed during this time to prevent dehydration.

Drugs will be used if vomiting occurs and persists. Severe cases of pancreatitis often can be saved with intraperitoneal lavage of canine or feline fresh-frozen plasma, as this blood product contains the alpha-1-antitrypsin protein that neutralizes the trypsin enzyme leaking out from the inflamed or damaged pancreas. Pain relief may be needed as well. Antibiotics are used to help prevent infection, and surgery may be necessary to relieve any blockages and remove severely damaged tissues.

When food can safely be resumed, a bland, low fat, high carbohydrate, and easily digestible diet is recommended. If the pancreatitis was severe, or is chronic (recurring), a special bland low fat diet may need to be given permanently.

Living and Management

Diets that are high in fats should be limited for the long-term, and protein levels should be moderate and highly digestible. The recovering pet should drink plenty of fresh water, and periodic checkups should be made with a veterinarian.

Prevention

Preventative measures that can help prevent re-occurrences include:
• Weight control, if the pet is overweight
• Avoiding high-fat diets
• Maintaining an ideal weight
• Avoiding drugs known to increase inflammation

* Summarized from Pet MD, on line, 2015, and Antech News, May 2004.

W. Jean Dodds, DVM
Hemopet / NutriScan
11561 Salinaz Avenue
Garden Grove, CA 92843

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