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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.

Skin Allergy (Canine) By The Petside Team

Canine skin allergy is a common condition that causes inflamed and itchy skin. Secondary skin and ear infections frequently occur. Testing is available for skin allergies, and effective treatments, including allergy injections, may be prescribed.

Common names: Canine skin allergy, Allergic inhalant dermatitis, Airborne allergy.
Scientific names: Canine atopy, Atopic dermatitis.

Diagnosis

Signalment
Atopy usually develops in dogs between the ages of 6 months and 7 years, with 70 percent of affected dogs between 1 and 3 years of age. In certain breeds, signs may begin as early as 2 months of age. Predisposed breeds include terriers, boxers, lhasa apsos, shih-tzus, pugs, golden retrievers, Labrador retrievers, Dalmatians, cocker spaniels, setters, Chihuahuas, miniature schnauzers, Belgian tervurens, shiba inus, and beaucerons. Canine atopy may be more common in females than males, although some studies show no sex predilection.
Incidence/prevalence: Atopy is a common pruritic (itchy) dermatosis that affects 10 to 15 percent of the canine population.

Geographic distribution
While no geographic distribution is appreciated, clinical signs may initially be seasonal or nonseasonal, depending on the offending substances (allergens) involved. Roughly 80 percent of all atopic dogs will eventually have nonseasonal clinical signs. About 80 percent will manifest clinical signs from spring to fall, and about 20 percent begin in winter.

Clinical signs (primary, most to least frequent, scientific term, synonyms)
Pruritus (itch) manifested by licking, chewing, scratching and rubbing, often affecting the feet, flanks, groin, armpits, face and/or ears, Localized or diffuse skin erythema (redness).

Clinical signs (secondary, most to least frequent, scientific term, synonyms)
Salivary staining of fur (from licking), Alopecia (hair loss), Excoriations (linear scabs), scales, crusts (scabs), hyperpigmentation (dark skin) and lichenification (thickened, elephant-like skin) from self-trauma, Secondary pyoderma (skin infection due to bacteria), Malassezia dermatitis (skin infection due to yeast) and otitis externa (ear infection), Conjunctivitis, Facial swelling, Sneezing.

Causes (scientific, common term)
Type I hypersensitivity reaction (allergy) to inhaled or cutaneously absorbed environmental allergens, Genetic predisposition.

Organ systems affected (most to least affected)
Integument (skin), Eye (conjunctivitis), Respiratory (bronchitis or rhinitis, rare).

Diagnostic tests
Skin cytology (impression smear, acetate tape preparations), Ear cytology (if indicated), Deep and superficial skin scraping, Flea combing, Fungal culture (if indicated), Intradermal skin or blood allergy testing.

Differential Diagnosis
Other hypersensitivities (food, flea bite, contact allergy) Ectoparasites, Folliculitis (inflammation of the hair follicle) due to bacterial infection, dermatophyte/fungal infection, Demodex), Malassezia dermatitis.

Overview

Canine skin allergy, also known as atopy or atopic dermatitis, is caused by an allergic reaction to inhaled or cutaneously (through the skin) absorbed environmental allergens in genetically predisposed dogs. Nearly any breed may be affected, and clinical signs are most common in young dogs between the ages of 1 and 3 years. Signs of a skin allergy include pruritus (itch) manifested by licking, chewing, scratching and rubbing of the feet, flanks, groin, armpits, face and ears.

Localized or generalized skin erythema (redness) may be evident. Brown salivary staining of fur from licking, hair loss, scales, crusts (scabs), and dark and thickened skin may also occur. Secondary skin and ear infections, often due to bacteria and yeast, are very common and contribute to itch. Conjunctivitis (inflammation of the lining of the eye) and sneezing are less commonly observed. Signs may be seasonal in nature or year-round. Atopic dermatitis is most commonly caused by an allergy to house dust mites, but grasses, weeds, trees, molds, insects and dander are also very important allergens.

The diagnosis of atopy is based on history and on clinical signs combined with allergy testing, which may involve intradermal skin (considered the gold standard) or blood allergy testing. Tests are also performed on the skin to rule out and treat other causes of itchy skin disease, including skin parasites and infection. Allergy injections are frequently prescribed based on the results of allergy testing and, in most cases, reduce the need for other therapies.

Treatment

Home Care
Treatments of the home environment to reduce exposure to offending allergens (pollens, molds and dust) are available. High-efficiency particulate (HEPA) air and charcoal filters may be beneficial.

Professional Care
A veterinarian may prescribe medications to treat a skin or ear infection, as well as to target the itch associated with skin allergy. This may include medications by mouth, as well as frequent bathing and ear cleaning. If a skin or blood allergy test is performed to determine what is causing the allergy, immunotherapy (allergy shots or vaccine) may be prescribed that will require injections under the skin.

Pet owners may learn to administer the injections, which are usually given for life. With allergy shots, 50 to 75 percent of atopic dogs have a good (some medical therapy still needed) to excellent (no other therapy needed) response. Clinical improvement may require several months after initiating immunotherapy and may require up to a year in some dogs.

Action
Compliance and follow-up care for the patient with allergic skin disease is very important. An increase in itch or the presence of skin lesions is often due to a secondary infection that requires an examination by a veterinarian for appropriate treatment. Often, if an allergy vaccine is administered, the schedule of injections has to be modified over time, so frequent communication with a veterinarian is necessary.

Outcome
The prognosis is good for canine atopy, although lifelong therapy for control is needed in most dogs. Relapses with secondary infections are common, and individualized treatment programs are important.

References/Additional Readings
Scott, DW, Miller WH, Griffin CE. Parasitic Skin Diseases. In: Kersey, R, DiBeradino, C, eds. Muller and Kirk's Small Animal Dermatology. Philadelphia: W.B. Saunders, 2001; 490-500.
Medleau, L, Hnilica KA. Small Animal Dermatology: A Color Atlas and Therapeutic Guide. Philadelphia: W.B. Saunders, 2001; 106-109.
Hillier, A, Griffin CE. The ACVD task force on canine atopic dermatitis (I): incidence and prevalence. Veterinary Immunology and Immunopathology; 2001; 81:147-151.

Ear Infection (Canine) By The Petside Team

Otitis externa, commonly referred to as an ear infection, is inflammation of the external (outer) ear canal. While infection plays a role in the process, it is usually not the primary cause. Instead, a combination of predisposing factors such as long, floppy ears; primary factors such as allergies; and perpetuating factors such as bacterial and yeast infections lead to this condition in dogs. Treatment of otitis externa involves identifying and controlling the primary factors and treating the perpetuating factors.

Common name: Ear infection
Scientific name: Otitis externa

Diagnosis

Signalment
Certain breeds have predisposing factors that increase their chances of developing otitis externa. These breeds include Labrador retrievers, cocker spaniels, springer spaniels, chow chows, poodles, basset hounds, English bulldogs and shar-peis. This condition can occur in all breeds, ages and genders of dogs.

Incidence/prevalence
The incidence of ear infections in dogs is 4 to 20 percent.

Geographic distribution
Warm and humid environments can contribute to this condition.

Clinical signs (primary, most to least frequent, scientific term, synonyms)
Erythematous (red) ear canals, Swollen or thickened ear canals, Painful and/or pruritic (itchy) ears, Discharge from ears (often with a foul odor), Head shaking.

Clinical signs (secondary, most to least frequent, scientific term, synonyms)
Aural hematoma (blood filled swelling of the pinna or ear flap), Head tilt, Aggression secondary to painful ears.

Causes (scientific, common term)
Predisposing factors, Long, floppy ears, Narrow ear canals, Increased hair and glandular secretions in the ear canals, Frequent bathing and swimming, Incorrect cleaning methods, Primary factors, Allergies, Parasites, Foreign material, Abnormal immune systems, Systemic diseases, Growths in the ear canal , Perpetuating factors, Bacterial infections, Yeast infections, Chronic inflammation, Treatment errors.

Organ systems affected (most to least affected)
Ears, Skin.

Diagnostic tests
Otoscopic exam: ear exam with a cone, light source and magnification, Otic (ear) cytology: microscopic examination of the discharge to look for parasites, yeast, bacteria and cells, Bacterial culture, Blood test for systemic diseases, Allergy test, Complicated cases may require additional tests.

Differential Diagnosis
Otitis media (inflammation of the middle ear), Otitis interna (inflammation of the inner ear), Trauma.

Overview

Otitis externa, commonly referred to as an ear infection, is inflammation of the external (outer) ear canal. While infection plays a role in the process, it is usually not the primary cause. Instead, a combination of predisposing factors, primary factors, and perpetuating factors lead to this condition in dogs.

Predisposing factors are breed characteristics and lifestyles that make dogs more likely to develop this condition. Long, floppy ears; narrow ear canals; and increased hair and glandular secretions in the ear canals predispose certain breeds. Some examples are Labrador retrievers, cocker spaniels, springer spaniels, chow chows, poodles, basset hounds, English bulldogs, and shar-peis.

In addition, frequent bathing and swimming and incorrect cleaning methods can contribute to the development of this condition. Primary factors are the underlying causes of the inflammation. The most common cause in dogs is allergies.

Environmental allergens, food and topical medications can be the triggers. Parasites such as ear mites and ticks, foreign material in the ear canal, systemic diseases, and growths can also be primary factors. Perpetuating factors prolong and increase the severity of otitis externa. These include bacterial and yeast infections, chronic inflammatory changes in the ears, and treatment errors. Bacteria and yeast are normally found in the ears; however, the predisposing and primary factors allow for an environment in which they can overgrow, leading to infection.

Signs of otitis externa may include red, swollen (or thickened) painful and itchy ears. There is often a foul smelling discharge from the ear canals. Pain and itching may cause excessive scratching and head shaking, decreased interaction, and, possibly, increased aggression.

Treatment

Home care
Veterinary care is necessary to determine the cause and appropriate treatments. It is important to follow home cleaning and medicating instructions. Monitor for reactions to medications.

Professional care
Diagnosis and management of otitis externa begins with a thorough physical and otic (ear) examination. The veterinarian may examine the discharge from the ears under a microscope to look for parasites, yeast, bacteria and cells. In recurrent cases or cases of severe bacterial overgrowth, the vet may culture the discharge to determine the type of bacteria and the best choice of antibiotic treatment. Blood and allergy tests may be performed to identify possible primary factors.

Once identified, primary factors can be treated or controlled to reduce or prevent the recurrence of signs. Topical and possibly oral medications containing antibiotics, antifungals and steroids may be prescribed along with ear cleaners to treat the perpetuating factors. In severe cases, surgery may be necessary.

Action
It is important to see the veterinarian if your dog has signs of otitis externa. You may want to request a demonstration of proper cleaning and medicating techniques. This condition can become more severe if left untreated and may lead to chronic pain and hearing loss. Identifying and treating the primary cause is essential, and, in some cases, consulting a veterinary dermatologist is helpful in the management of otitis externa.

Outcome
The outcome of otitis externa is favorable with treatment. Some dogs require long-term therapy.

References/Additional Readings

Logas, D, Bellah, J. Diseases of the External Ear and Pinna. In: Morgan, RV, Bright, RM, Swartout, SM, Handbook of Small Animal Practice, 4th Ed. Philadelphia: Elsevier Science, 2003; 1049-1054.

Medleau, L, Hnilica, KA. Otitis Externa. In: Medleau, L, Knilica, KA, Small Animal Dermatology, A Color Atlas and Therapeutic Guide. Philadelphia: W.B. Saunders Company, 2001; 276-283.

Radlinsky, MG, Mason, DE. Diseases of the Ear. In: Ettinger, SJ, Feldman, EC, Textbook of Veterinary Internal Medicine, 6th Ed. St. Louis: Elsevier Saunders, 2005; 1171-1180.