Pancreatitis; Canine    

     The pancreas is attached to the upper small intestine and one of its major functions is to secrete digestive enzymes and other substances required for digestion. Pancreatitis refers to inflammation of the pancreas, and is associated with activated digestive enzymes that result in injury to the pancreas and sometimes adjacent organs within the abdomen.

The cause is unknown but it is seen more frequently in middle-aged to older dogs that are obese and female. Ingestion of a fatty meal has always been suspected as a trigger of this disorder. Medication with cortisone is sometimes implicated.

How is pancreatitis diagnosed?
The signs of pancreatitis include vomiting, abdominal pain, fever, and diarrhea. If the attack is severe; shock, acute kidney failure, respiratory failure, haemorrhagic diarrhoea and death may occur. Mild cases may display depression, anorexia with vague abdominal pain.

If your cat has pancreatitis, what might you observe at home?
In the dog (and human) this condition is associated with a lot of nausea and abdominal pain. According to one recent study in cats, though, only 35% of cats with pancreatitis showed vomiting and only 25% appeared to have abdominal pain. Fever is a possible sign but often the temperature will drop instead. Lethargy and appetite loss are consistent signs.
Blood tests are taken that may indicate the diagnosis of pancreatitis, and urine samples may be analysed. X-rays may indicate a problem in the vicinity of the pancreas, although ultrasound is a more reliable way of diagnosing pancreatitis. Unfortunately, some dogs/cats with pancreatitis will elude detection with any of these tests and consequently the diagnosis may be tentative in some cases.

How is pancreatitis treated?
Most cases are treated by withholding oral food and water, accompanied by intravenous fluids to maintain normal fluid and electrolyte balance. Antibiotics, anti-inflammatories, antiemetics (to reduce vomiting) and painkillers may be required. If shock is present other treatments may be indicated. Unfortunately, dogs and cats that present with shock may die despite aggressive treatment.

When there is no more vomiting, the pet is offered small amounts of fluids and if this is not vomited, small amounts of a low fat, low protein diet. Some pets require hospitalization for days before they are ready to be sent home.

Will there be any long-term problems?
Some dogs/cats continue to have recurrent bouts of the disease, known as chronic, relapsing pancreatitis. These pets often require a medical diet to reduce the rate of recurrence.
If a significant number of pancreatic cells are destroyed, insufficient digestive enzymes may be produced leading to digestion problems. These dogs/cats require medication with every meal to avoid diarrhoea and weight loss.
The pancreas is also the site of insulin production. If enough of these cells are destroyed, the patient may develop diabetes and require insulin injections. However, most recover with no long-term effects.

The pancreas is a pale pink glandular organ nestled just under the stomach. It has two main functions: the production of metabolic hormones (insulin and glucagon which regulate blood sugar) and the production of digestive enzymes, which are secreted through a special duct into the intestine to digest our food. In the cat, the pancreatic duct frequently joins with the common bile duct from the liver. In this way both bile (a fluid used to excrete toxins as well as to prepare fat for absorption into our bodies) and pancreatic fluid, which is rich in digestive enzymes, enter the intestine from the same location. There are other hormonal products from the pancreas that assist in the regulation of digestion and movement of our food but the above description should present a basic picture of what the pancreas is there to do.

Pancreatitis is potentially a metabolic disaster.

The normal pancreas has a number of safeguards in place to keep its stored digestive enyzmes safely. If these enzymes escape, they will digest the body! This is exactly what happens when the pancreas gets inflamed: the enzymes escape and begin digesting the pancreas itself. The living tissue becomes further inflamed and the tissue damage quickly involves the adjacent liver. Toxins released from this orgy of tissue destruction is released into the circulation and can cause a body-wide inflammatory response. If the pancreas is affected so as to disrupt its ability to produce insulin, diabetes mellitus can result; this can be either temporary or permanent.

Special disasters include the disruption of surfactants in the lung tissue that normally keep the tiny air-filled alveoli from collapsing after each exhaled breath. Without surfactants, the alveoli close up and respiratory failure results.

Also, there is a special syndrome called Weber-Christian syndrome where fats throughout the body are destroyed.

Pancreatitis is one of the chief risk factors for the development of what is called disseminated intravascular coagulation, or DIC, which is basically a massive uncoupling of normal blood clotting and clot dissolving mechanisms. This leads to abnormal simultaneous bleeding and clotting of blood throughout the body.

Pancreatic encephalopathy (brain damage) can occur if the fats protecting the central nervous system become digested.

Fortunately, total disasters such as the above are rare but one should be aware that the potential for such disasters exists should the pancreatic inflammation get out of hand.

Most of the time the disease is confined to the area of the liver and pancreas.

• Pancreatitis can be acute or chronic (acute cases can reverse completely)
   
• Pancreatitis can be mild or severe (acute cases tend to be more severe)

What Causes Pancreatitis in Cats?

Unfortunately, 90% of the time we never find out. We have some idea of possible risk factors, though.

• Trauma (getting hit by a car or falling from a great height)
   
• An active feline distemper infection
   
• Toxoplasma (a special parasite) infection can involve the pancreas (though it almost always involves other tissues as well)
   
• There may be an association with pancreatitis and inflammatory bowel disease. (The theory is that the abnormal intestinal disease leads to an overgrowth of bacteria. These bacteria are able to crawl up the pancreatic duct and cause infection in the pancreas.)
   
• Organophosphate insecticide exposure (organophosphates are not commonly used in flea control any more but they are readily available in hardware and garden stores. They are also present in some flea collars.)
   
• Use of drugs (drugs have certainly caused pancreatitis in humans and dogs but have not been proven to have done so in cats). Still, it is prudent to avoid drugs that have been associated with pancreatic inflammation in a cat with history of pancreatitis. Such drugs included: azathioprine (an immune suppressive agent), thiazide diuretics, furosemide (Lasix), tetracycline (an antibiotic), valproic acid (a seizure control agent), and procainamide (a heart medicine).

Chances are the cause for a given case will never be revealed.

If your cat has pancreatitis, what might you observe at home?

In the dog (and human) this condition is associated with a lot of nausea and abdominal pain. According to one recent study in cats, though, only 35% of cats with pancreatitis showed vomiting and only 25% appeared to have abdominal pain. Fever is a possible sign but often the temperature will drop instead. Lethargy and appetite loss are consistent signs.

Pancreatitis is hard to diagnose. What tests can be run to find out if a cat has pancreatitis?

One of the first steps in evaluating a sick cat is a metabolic database (a blood panel and urinalysis). Often this will not turn up a good indicator of pancreatitis. There are two pancreatic enzymes commonly checked on this panel (amylase and lipase) but, unfortunately, elevations in these enzymes are not consistent even with obvious or severe pancreatitis. Changes in the liver usually are evident (remember, the pancreas is located near the liver and the liver very readily indicates when it has been damaged by releasing its own enzymes (ALT and AST).) Radiographs are often included in this initial testing work up but the pancreas is difficult to visualize and radiographs may not reveal the problem.

If the cat does not respond to support, further evaluation is needed: either ultrasound or other advanced imaging or actual surgical exploration. Ultrasound often reveals an enlarged pancreas surrounded by fluid and confirms the diagnosis. Surgical exploration offers the further advantage of allowing tissue sampling of other adjacent organs to rule out additional problems (such as inflammatory bowel disease). The pancreas can be biopsied but many veterinarians are reluctant to do so for fear that removing a piece of tissue could generate further inflammation. Some also feel that flushing the belly with warmed sterile fluids helps remove some of the inflammatory toxins.

There is another blood test that is very accurate in the diagnosis of pancreatitis and that is the PLI test. PLI stands for Pancreatic Lipase Immunoreactivity. Lipase is one of the pancreatic digestive enzymes and small traces are normally present in the circulation. These levels jump dramatically in pancreatitis and the diagnosis can be confirmed with a less expensive and non-invasive test. The problem is that technology needed to run this test is unique and the test can only been run in certain facilities on certain days. Results are not necessarily available rapidly enough to help a very sick cat.

How are cats treated?

There are three parts to treatment: removing the cause of the pancreatitis (this is usually not possible since the cause is only rarely known), monitoring

Junior Junior Arnopp, pancreatitis survivor

Prognosis

How a cat does in the long run depends on how severely ill he or she is. If the cat survives the episode of acute pancreatitis there is a good chance that he or she will live a normal life thereafter. Chronic cases of pancreatitis may, however, wax and wane for years requiring a permanent diet change and chronic medication administration.