Pancreatitis refers to inflammation of the pancreas.

Dogs with acute pancreatitis usually present to the veterinarian with depression, anorexia, vomiting and, in a few cases, diarrhea.

The treatment of acute pancreatitis is largely symptomatic and supportive until the pancreatic inflammation resolves.

Pancreatitis is an unpredictable disease of widely varying severity, and it is difficult to give a prognosis even when the diagnosis is established via ultrasound or with surgical biopsy. The clinical condition of patients with pancreatitis can deteriorate rapidly and unexpectedly.

Pertinent Anatomy

• The pancreas is a gland within the abdomen located along the stomach and the first part of the small intestine. It has two major functions: production of insulin (endocrine pancreas); and, secretion of digestive enzymes (exocrine pancreas). Normally, the digestive enzymes are secreted into the intestine to help break down primarily fats and proteins in food, and insulin is secreted into the blood stream to enable sugars and fats to enter the body cells.
             

What is pancreatitis?

• Pancreatitis refers to inflammation of the pancreas. It is believed that inflammation develops when there is activation of the digestive enzymes within the pancreatic gland instead of in the intestine where digestion normally occurs. This results in pancreatic autodigestion (the pancreas begins to digest itself). Acute pancreatitis is defined as inflammation of the pancreas with a sudden onset. Recurrent acute disease refers to repeated bouts of inflammation with little or no permanent pathologic changes. Chronic pancreatitis is a continuing inflammatory disease characterized by irreversible changes that lead to permanent impairment in function of the pancreas. Diabetes mellitus, or less commonly loss of digestive enzyme production, may be a result of chronic pancreatitis. Chronic mild interstitial pancreatitis is characterized by inflammation of the tissue between the cells spreading from the ducts within the pancreas and is most commonly reported in cats. Complications of both types of pancreatitis may include pseudocysts, abscess, or necrosis (death of the tissue).
• The inciting cause of spontaneous pancreatitis is usually unknown. There is evidence that low-protein, high-fat diets may induce pancreatitis, and that pancreatitis is more severe in pets being fed high-fat diets. Hyperlipidemia (high fat in the blood) is often seen in the blood of pets presenting with signs of pancreatitis. Other causes that may lead to pancreatitis are partial or complete obstruction of the pancreatic duct leading into the intestine from biliary calculi (stones in the bile duct), edema (swelling) of the duct or small intestinal wall, cancers, parasites, trauma, and surgery. Overwhelming infection is a major cause of death with severe pancreatitis as a result of bacteria moving out of the intestines into the blood stream. The release of digestive enzymes into the blood stream can cause breakdown (digestion) of the body tissues (heart, lung, liver, etc.) and is another major cause of death associated with severe pancreatitis.

Diagnosis

• Dogs with acute pancreatitis usually present to the veterinarian with depression, anorexia, vomiting and, in a few cases, diarrhea. Severe acute pancreatitis may be associated with shock and collapse. Other cases may have less dramatic signs extending over several weeks. Some dogs demonstrate abdominal pain by assuming a praying position with front legs outstretched, chest on the floor, and hind legs extended. On physical examination a mass may be palpated in the upper abdomen, the abdomen may be painful to the touch, or small amount of fluid may be found in the abdomen (ascites). Most pets are mildly to moderately dehydrated and have a fever (temperature >103-104 F). Although dogs of any age may develop pancreatitis, affected pets are usually middle aged or older, and often obese. The onset of signs may follow the consumption of a large amount of fatty food.
• Clinical signs of pancreatitis in cats may include fever, lethargy, increased heart rate, abdominal pain, decreased to absent appetite, and, occasionally, vomiting. As with dogs, they usually present with mild to moderate dehydration.
• Abdominal radiographs (x-rays) may be helpful in the diagnosis of pancreatitis, but definitive radiographic evidence is usually not present. Abdominal ultrasound may reveal changes consistent with pancreatic inflammation, and will detect any fluid in the abdomen. Ultrasound may also be able to detect abscesses or pseudocysts in the pancreatic region. Gall bladder obstruction may occur secondary to chronic pancreatitis. A normal ultrasound study is not uncommon in pets with pancreatitis because of the difficulty in visualization of this gland, especially in cats.
• Blood work changes seen with pancreatitis are variable and may include evidence of dehydration, secondary kidney or liver failure, concurrent diabetes (increase blood glucose), or infection. High levels of fats within the blood may be present, even if your pet has not eaten for an extended period prior to evaluation.
• There is no widely available test or combination of tests that allows the accurate diagnosis of acute or chronic pancreatitis in either dogs or cats. In the absence of exploratory surgery and direct examination and biopsy of the pancreas, the diagnosis often is only tentative.

Treatment

• The treatment of acute pancreatitis is largely symptomatic and supportive until the pancreatic inflammation resolves. There is no known specific therapy to stop the inflammation of the pancreas. Intravenous fluid therapy with electrolyte supplementation is the mainstay of supportive care for patients with pancreatitis. Food and water is initially withheld, thereby allowing the pancreas to rest and recover from the inflammatory process. Antibiotics may be indicated to help prevent bacterial translocation from the intestines to other parts of the body because of the inflammation. Medication can also be given to help control the vomiting. If abdominal pain is severe, analgesic therapy may be given to provide relief. This can be in the form of a narcotic patch or injection. Blood work will need to be done daily to evaluate your pets electrolyte status and kidney values. Additional tests may be indicated as needed based on your pet’s condition.
• Small amounts of water will be offered after vomiting has stopped. If this is kept down, then food will slowly be reintroduced. The preferred diet initially is a high carbohydrate low fat food. This type of diet is less likely to stimulate pancreatic enzyme secretion.
• In many dogs, after a single episode of pancreatitis occurs all that is necessary to prevent relapse is avoidance of feeding high-fat foods. In other dogs repeated bouts of pancreatitis occur, therefore, severely restricted fat diets may be required permanently. In spite of this, some dogs will continue to experience relapses.
• The cause of pancreatitis in cats is poorly understood. Some cats may experience single episodes of pancreatitis, whereas other cats have continuing relapses. The role of dietary therapy to control pancreatitis in cats is in doubt. Some cats with chronic pancreatitis have chronic concurrent intestinal and liver disease. Corticosteroid or other anti-inflammatory therapy may be required to diminish recurrence of pancreatitis.

Prognosis

• Pancreatitis is an unpredictable disease of widely varying severity, and it is difficult to give a prognosis even when the diagnosis is established via ultrasound or with surgical biopsy. The clinical condition of patients with pancreatitis can deteriorate rapidly and unexpectedly.
• Persistent vomiting and diarrhea, respiratory distress, neurologic problems, cardiac abnormalities, bleeding disorders, and acute kidney failure are all poor prognostic indicators. Many animals with severe pancreatitis do not survive.
• Even with aggressive supportive care, it may take 7-14 days before your pet is eating and able to leave the hospital