Pancreatitis

What is the pancreas and what does it do?

The pancreas is an L shaped organ in the front part of the abdomen. It lies in close association with the liver, gall bladder, stomach and small intestine. The pancreas produces enzymes for the digestion of dietary fats and insulin for glucose regulation. Pancreatic enzymes pass down the pancreatic duct into the upper small intestine, very close to the bile duct. Due to the close proximity of the pancreatic and bile ducts, any inflammation around the pancreas can also upset the liver.

What is pancreatitis and how is it caused?

Pancreatitis is an inflammation of the pancreas that occurs when digestive enzymes are activated INSIDE the pancreas, rather than the small intestine. The enzymes start to digest the organ, creating significant pain and the clinical signs seen in your pet.  The resulting inflammation causes body-wide changes, some of which can be life threatening.

In most cases, we cannot identify an inciting cause. Some pets are already at increased risk due to breed (Schnauzers, terriers, some retrievers) or concurrent hormonal disease that affects fat metabolism (hypothyroidism, diabetes or Cushing’s disease). A very fatty meal can sometimes push a pet with long standing low grade (chronic) pancreatitis into an episode of acute pancreatitis.

Injury, surgery and some illnesses can cause problems with blood supply or local inflammation can lead to pancreatitis. E.g. abdominal abscess or tumour, car accident, abdominal surgery, gastroenteritis, immune mediated haemolytic anaemia & thromboembolic disease. 

Very rarely; drug reactions, infectious disease (Toxoplasma) & hypercalcaemia can trigger pancreatitis.

What signs are seen with pancreatitis?

Acute

Signs associated with acute (sudden) pancreatitis can range from mild to severe. In mild pancreatitis, your pet may have decreased appetite, mild vomiting (1-2 episodes), mild mucoid diarrhoea, or a small amount of bloody diarrhoea. We can attempt outpatient management at home with medications in some of these cases – your veterinarian will let you know if this is possible. 

Severe pancreatitis can be life threatening. Clinical signs include anorexia, lethargy, vomiting, bloody diarrhoea, abdominal pain and dehydration. Jaundice may develop if the liver is affected. These patients may have problems with clotting their blood, and can develop peritonitis. These patients require 1-5 days in hospital, with intense supportive care. 

Cats - signs often subtle & challenging to diagnose. Cats will often show only very mild signs even in the presence of acute necrotising pancreatitis. They are at high risk of secondary hepatic disease. Cats may also have have triaditis (a combination of pancreatitis and cholangiohepatitis +/- IBD), so proactive investigation and management is recommended.

Chronic

Chronic pancreatitis is the most common form in cats and a common finding in dogs. The signs in cats are very vague and nonspecific, usually reflecting concurrent disease which can include cholangiohepatitis, IBD and renal disease.

Dogs, chronic intermittent low-grade GI signs are seen, including inappetence, postprandial abdominal pain & mild diarrhoea and/or vomiting.

Chronic pancreatitis has the potential to convert to acute-on-chronic illness, so should be strictly managed with diet.

How are these conditions diagnosed?

Acute pancreatitis

Dogs - Clinical signs and physical examination findings may direct your clinician to either pursue further workup or recommend trialling outpatient care. Other conditions that can cause severe abdominal pain (such as foreign body ingestion) must be ruled out. This will include blood testing and CRP (C- reactive protein), a sensitive marker of inflammation as screening tools. An abdominal ultrasound is almost always recommended, as pancreatitis can be secondary to other problems.

Cats - Clinical signs are vague and nonspecific, so we are more reliant on laboratory testing. Blood screening is used to assess electrolyte and hydration status and to look for concurrent organ dysfunction. Ultrasound is used to assess all the abdominal organs but is still less reliable then it has shown to be in dogs. 

What is the treatment?

Outpatient management

If outpatient treatment is chosen by your veterinarian a bland low fat diet will be the basis of management. Other medications to help with nausea, pain and concurrent infection may be required.

Patients receiving outpatient care must be monitored closely for signs that their condition is declining – your veterinarian may require daily revisits until we are confident that your pet will not become dehydrated at home.

Inpatient management

If your pet is dehydrated, or suffering from severe pancreatitis, admission for care is recommended. In hospital, your pet will receive pain relief, IV fluids, nausea management, nursing care and IV antibiotics if required. 

Projected costs highly variable, ranging from several hundred to several thousand dollars depending on the care required.

What is the expected outcome?

For acute pancreatitis, the projected mortality rate ranges from 0 to 100% depending on the severity of organ damage and number of organs affected. Pets with concurrent hormonal disease have a higher risk of fatality. In order to minimise the risk of death, pets who appear very unwell with potential pancreatitis are hospitalised for intensive management and investigation.

Your pet will be hospitalised until they are comfortable and eating voluntarily without nausea. This can take one to ten days, depending on the severity of their illness. 

For dogs and cats that have clinically recovered from acute pancreatitis, the organ changes (scarring, fibrosis & inflammation) will persist for at least six months. Many dogs exhibit chronic, low grade pancreatitis. Therefore, we recommend long term dietary management and monitoring for relapse into acute pancreatitis.

What long term management is required?

Pets who have suffered an episode of pancreatitis should be maintained on a restricted fat diet for life. This can be a little challenging as many foods will have a minimum fat content written on their packaging, but not a maximum fat content. Look for foods with guaranteed dietary analysis and the lowest fat content you can find (less than 10% is ideal). We will usually discharge our patients with ‘Hills i/d low fat’, a prescription diet. Feeding chicken and rice exclusively long term is not recommended as it is very difficult to give your pet sufficient calories and this is not a balanced diet. 

Please do not give any commercial treats or human foods in future as these can frequently cause a relapse. We very often see patients that have not had pancreatitis for years re-present to us after eating a triggering item (such as sausages). Instead you can use vegetables (eg carrot sticks) or cubes of fresh steamed/ boiled/ grilled chicken.

If the pancreatitis was secondary to another disorder (eg a bile duct obstruction), then please follow your veterinarian’s directions for feeding and aftercare.

Recurrent acute pancreatitis or longstanding chronic pancreatitis can lead to long term medical problems. The resultant scarring to the pancreas can prevent normal production of hormones and digestive enzymes; causing pancreatic insufficiency (EPI) and/or diabetes. Your vet will recommend screening your pet for these conditions if your pet is believed to be at increased risk.