Pancreatitis

Liaison: Jan Young

The pancreas has two primary functions: an endocrine function (production of insulin for the regulation of blood sugar) and a digestive function (secretion of digestive enzymes, primarily for the digestion and absorption of fats). Pancreatitis refers to an inflammation of the pancreas. This can be acute or chronic.

Signs and Symptoms

The primary symptoms are loss of appetite, vomiting, diarrhea, fever and abdominal pain. These lead to a hunched posture of the dog to help alleviate the pain, lack of appetite, dehydration, and abdominal swelling. The diarrhea is caused by undigested fats in the stool which cause a greasy yellow appearance to the stool. There may be fever. In more severe cases, there can be heart arrhythmias (irregular heart beat), sepsis (infection spreading through the blood), respiratory distress, and a condition called disseminated intravascular coagulation (DIC) which disrupts the normal clotting mechanism resulting in multiple sites of bleeding in the body. The inflamed pancreas, in very severe cases, may leak digestive enzymes and result in injury to near-by organs through partial digestion of them.

Causes

In most cases the cause is not known (idiopathic)

Risk Factors

There are a number of possible contributing factors to pancreatitis:

Certain medications (potassium bromide, some cancer medications, sulfa-containing antibiotics)
Infection
Certain metabolic disorders: hyperlipidemia (high amount of fat in the blood), hypercalcemia (high amount of calcium in the blood), hypothyroidism, and hyperadrenocorticism.
Pancreatic tumor
Trauma, including abdominal surgery
Obesity and overweight
High fat diet
Middle age
Genetics: Certain breeds (Schnauzers, Yorkshire Terriers). One study found that sled dogs ( Laikis and Malamutes but not Samoyeds were listed specifically) were more prone. (2)

Diagnostic Tests

Diagnosis is suspected because of the clinical findings. Specific tests for pancreatic enzymes (amylase and lipase) show elevated levels. Liver enzyme tests may be elevated as well. Abdominal ultrasound may be useful. A recent grant study sponsored by SCARF found that a new test, pancreatic lipase immunoreactivity (SPEC cPL) may be useful (4, 5) and this is becoming the gold standard test.

Treatment Guidelines

Note: Treatment of animals should only be performed by a licensed veterinarian. Veterinarians should consult the current literature and current pharmacological formularies before initiating any treatment protocol.

Acute Pancreatitis: Acute pancreatitis can be life-threatening. Early recognition and treatment can improve chances of recovery. The initial mainstay of treatment is to correct dehydration and electrolyte imbalances, and to allow the pancreas to rest by not feeding anything by mouth for 24 to 48 hours. Hydration and nutrition are provided intravenously or subcutaneously (under the skin) during this time. Then small, bland, low fat, high fiber feedings are begun. Depending on the severity of the condition and whether or not it becomes chronic, it may be necessary to continue this diet indefinitely. Underlying causes (medications, infections) should be treated accordingly. Rarely, a pancreatic abscess may develop requiring abdominal surgery.

Plasma transfusions may be helpful by providing certain proteins that inhibit pancreatic enzyme activity. These can be added to the intravenous fluids used for hydration.

Prognosis is unpredictable. Mild cases may have full recovery and a low fat diet is all that is needed to prevent recurrence or complications.

Recent studies (3) have found that early enteral (by mouth rather than by vein) nutrition allows for better health of the intestines and thus a more rapid recovery. Pain relievers are used as appropriate.

The Royal Veterinary College in London has completed a study on the Nutritional Management of Acute Pancreatitis in Dogs and Cats. threebonesrating

Chronic pancreatitis: Some animals develop chronic pancreatitis which can lead to diabetes or pancreatic insufficiency. In this latter instance, food is passed undigested. Dogs with this condition have a ravenous appetite, diarrhea, and weight loss even though they are eating. Treatment for pancreatic insufficiency is life long and expensive. Digestive enzymes can be replaced through a product processed from the pancreas of hogs and cattle.

References

(1) Canine Pancreatitis by Wendy C. Brooks, DVM, DipABVP, at www.veterinarypartner.com
(2) Papa K et al 2011. Occurence, clinical features and outcome of canine pancreatitis (80 cases). Acta Vet Hung 59(1) 37-52.
(3) Mansfield et al 2011. A Pilot Study to Assess Tolerability of Early Enteral Nutrition via Esophagostomy Tube Feeding in Dogs with Severe Acute Pancreatitis. J Vet Int Med 25(3) 419-425

SCARF-sponsored research:

(4) Report to Grant Sponsor (SCARF) from Investigator: Specificity and Sensitivity of the Pancreatic Lipase Immunoreactivity (SPEC cPL) Test for the Diagnosis of canine Pancreatitis:

Published Paper:

(5) Trivedi S, Marks SL et al 2011. Sensitivity and Specificity of Canine Pancreas-Specific Lipase (cPL) and Other Markers for Pancreatitis in 70 Dogs with and without Histopathologic Evidence of Pancreatitis. J Vet Int Med 25(6): 1241-1247.

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SCARF-Sponsored Research

AKCCHF grant #01227-A: Specificity and Sensitivity of the Pancreatic Lipase Immunoreactivity (SPEC cPL) Test for the Diagnosis of Canine Pancreatitis. Stanley L Marks, BVSc, PhD, University of California Davis