Pancreatitis (Canine)

Pancreatitis is a disease involving inflammation of the pancreas. The pancreas is a gland located between the stomach and small intestine. It has two primary functions, including the secretion of insulin, which is the hormone responsible for regulation of blood sugar, and the secretion of digestive enzymes. During inflammation, the pancreas leaks enzymes, resulting in significant tissue damage.

Common name: Pancreatitis
Scientific name: Pancreatitis

Diagnosis

Signalment
Pancreatitis can occur in dogs of all breeds and ages. However, middle-aged dogs, overweight dogs and certain breeds, such as schnauzers, Cocker spaniels, and miniature poodles, are more commonly affected.

Incidence/prevalence
Associated with a consumption of fatty table scraps; may be more common around holidays such as Thanksgiving.

Geographic distribution
No geographic predilection known.

Clinical signs (primary, most to least frequent, scientific term, synonyms)
Vomiting, Diarrhea, Anorexia (loss of appetite), Lethargy, Abdominal pain.

Clinical signs (secondary, most to least frequent, scientific term, synonyms)
Pyrexia (fever), Cardiac arrhythmia (irregular heartbeat), Liver damage, Kidney damage, Sepsis (infection in the blood), Peritonitis (inflammation of the lining of the abdominal cavity).

Causes (scientific, common term)
Consumption of a fatty meal, Trauma, Infection, Certain medications and toxins, Genetic predisposition, Organ systems affected (most to least affected), Pancreas, Gastrointestinal tract (stomach and intestines), Kidney, Liver.

Diagnostic tests
Blood tests (chemistry profile and complete blood count), Ultrasound, cPLI (canine pancreatic lipase immunoreactivity), TAP (trypsinogen activation peptide).

Differential Diagnosis
Gastroenteritis, Peritonitis (inflammation of the lining of the abdominal cavity), Inflammatory bowel disease, Intestinal obstruction (blockage).

Overview

Pancreatitis is a disease involving inflammation of the pancreas. The pancreas is a gland that is located between the stomach and small intestine. It has two primary functions, including the secretion of insulin, which is the hormone responsible for regulation of blood sugar, and the secretion of digestive enzymes. During inflammation, the pancreas leaks enzymes, resulting in significant tissue damage.

Pancreatitis can occur in dogs of all breeds and ages. However, middle-aged dogs, overweight dogs and certain breeds, such as schnauzers, Cocker spaniels, and miniature poodles, are more commonly affected.

Pancreatitis may be caused by the recent consumption of a fatty meal, by trauma or by an infection. Certain underlying conditions, such as Cushing's disease (hyperadrenocorticism) or hyperlipidemia (high fat content of the blood), can also predispose animals to developing pancreatitis. In the majority of cases, however, the exact cause is unknown.

Pancreatitis can range from mild to potentially life threatening. Mild cases of pancreatitis typically result in vomiting, anorexia (loss of appetite), lethargy, diarrhea and abdominal pain. In severe cases, it can also cause fever, weakness, cardiac arrhythmias (irregular heartbeat), kidney and liver damage, peritonitis (inflammation of the lining of the abdominal cavity), sepsis (infection in the blood) and death. The most severe form of pancreatitis is necrotizing pancreatitis, in which a section of pancreas becomes nonviable or essentially dies.

There is no single reliable test for pancreatitis. Presumptive diagnosis can be made based on clinical signs and history. A blood chemistry profile may reveal an increase in the pancreatic enzymes lipase and amylase, but these elevations are not consistently seen in all cases. Ultrasound is useful, as it allows a thorough evaluation of the organ. Radiographs may be helpful for general evaluation of the abdominal organs and may be suggestive of the condition, but they are not a sensitive test for pancreatitis. Specific blood tests such as cPLI (canine pancreatic lipase immunoreactivity) and TAP (trypsinogen activation peptide) are available to aid in diagnosis. Pancreatic biopsy can provide a definite diagnosis but is not commonly done because of the invasive nature of the test.

Treatment

Home Care
Mild cases can be managed by withholding food for 24 hours and then reintroducing small, frequent low-fat meals.

Professional Care
In moderate to severe cases, total restriction of food intake for 24 to 72 hours (sometimes longer) to decrease the stimulation of the pancreas may be needed. Intravenous fluid therapy is necessary. Medications used to treat the pancreatitis may include antiemetics (antinausea medications), antacids, analgesics and potentially antibiotics. Severe cases may require plasma transfusion. Animals that need to be fasted longer than five to six days need nutritional supplementation, such as intravenous nutrition or a tube placed in the small intestine to administer food. Clinically improved animals are started on a prescription diet or a homemade bland diet and fed in small amounts.

Action
Prevention involves avoiding feeding table scraps and weight control. A special diet may be needed for animals predisposed to pancreatitis. Aggressive veterinary care is required.

Outcome
Pancreatitis is an unpredictable disease with widely varying severity. Many patients with an acute, uncomplicated single episode of pancreatitis may recover spontaneously. Dogs with mild to moderate uncomplicated pancreatitis and that receive appropriate medical treatment generally do well. Prognosis for complicated severe pancreatitis and necrotizing pancreatitis is guarded to poor.

References/Additional Readings

Leib M.S., Monroe W.E., Acute pancreatitis in Dogs. In: Practical Small Animal Internal Medicine, Philadelphia, W. B. Saunders Company, 1997; 766 -769.

Nelson R.W, Couto C. G. Acute Pancreatitis. In: Manual of Small Animal Medicine, St. Louis, Mosby, 1999; 343-349.

Simpson, K. W., Pancreatitis. In: Handbook of Small Animal Gastroenterology, 2nd Ed. St. Louis, Saunders, 2003; 353-365.