The article below is provided for our education by our Rescue Veterinarian
John Flaagan, DVM
of Feist Animal Hospital

What is Pancreatitis?

by John Flaagan, DVM
of Feist Animal Hospital, St.Paul MN
 

In dogs, pancreatitis at first glance seems only a disease of the gastrointestinal tract leading to vomiting, diarrhea, refusal of food and lethargy. A mild case of pancreatitis may be mistaken for an upset stomach. This supposition on an owner’s behalf is often furthered by the common historical finding of dietary indiscretion. That is, the dog had eaten fatty or rich foods preceding the episode. Veterinarians often see many such cases over the holidays

What exactly is pancreatitis? Pancreatitis is defined literally as an inflammatory event of the pancreas. Most people are aware of hormonal functions the pancreas serves (such as insulin secretion), but few are aware that over 90% of the pancreas is devoted to digestion within the first part of the small intestine. This part of the pancreas aids digestion by releasing activated enzymes into the small intestine. It is this function that has gone awry in pancreatitis events. The body makes an attempt to safely store these enzymes in an “inactive” form, but under select circumstances “inactive” enzymes are inappropriately activated within the pancreas. This leads to autodigestion and concurrent inflammation. Autodigestion literally means digestion of the self. The implications of such an event are rarely confined to the pancreas. Of course the GI tract is affected, hence the diarrhea and vomiting, but in severe cases the liver, respiratory, urinary, and cardiovascular systems may be affected. The risks associated with the more serious acute case are obvious, but the chronic intermittent cases are equally serious in the long run. Progressive loss of pancreatic mass over the years due to a smoldering pancreas can lead to insulin insufficiency or diabetes.

Most predisposed animals are often uniquely intolerant of excessive dietary fat and protein. Any dog may be seen for pancreatitis, but miniature schnauzers are most over represented with miniature poodles and cocker spaniels being seen often. Pancreatic trauma may elicit an event and we do see an increased number of animals for pancreatitis that have diabetes, Cushing’s disease, renal failure, and cancer among other diseases. Some therapeutic drugs can also trigger an event in predisposed animals and, finally, obese animals are at risk.

Diagnosis can be difficult especially if the disease is mild. Blood, fecal, and urine tests may initially be recommended to rule in or out pancreatitis. However, normal values on all previous counts do not rule out pancreatitis. Further, abnormal values may heighten suspicion but doesn’t necessarily always lead to a definitive diagnosis. Severe or chronic cases where diagnosis is elusive may require special testing or an ultrasound conducted by specialists. Pancreatic biopsies are gaining ground as the gold standard for diagnosis, but most general practicing veterinarians are still reluctant to do these (rightfully or not).  To date the most sensitive and specific test for pancreatitis in the dog is a blood test referred to as canine pancreatic lipase immunoreactivity (cPLI). It shows promise, being able to detect somewhere around 82% of cases. But, its drawback is that it must be currently run through Texas A&M and turn around time is 5-7 days—not helpful in the acute phase of the disease.

The vast majority of pancreatitis cases seen in general practice are treated conservatively with dietary manipulation and medications to control symptoms. Coincidentally, conservative treatment for uncomplicated vomiting and diarrhea and mild pancreatitis often overlap. Recurrent or worsening cases require more aggressive workup and treatment. As the case complicates treatments complicate. However, the general cornerstone in dogs is supportive while gut rest is assured. This usually involves fluid therapy of some sort often aggressive in severe cases. Medications are used to control signs, symptoms, metabolic complications, and pain. Management can continue for days, but controlled feeding is usually gently reinstituted when the doctor determines it is safe. IV feeding and feeding tubes are occasionally used.  Animals can, in rare circumstances, continue to struggle despite all efforts and veterinarians may be asked to euthanize or they may succumb with every effort made to the contrary. Generally the disease is serious but amenable to treatment. Recurrences may be spontaneous but are most often linked to ongoing dietary indiscretion.