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PANCREATITIS

This information is provided by Provet for educational purposes only.

You should seek the advice of your veterinarian if your pet is ill as only he or she can correctly advise on the diagnosis and recommend the treatment that is most appropriate for your pet.

Note for Pet Owners:
If you have an animal diagnosed as having pancreatitis there are some important guidelines that you should follow:

  • Always give the medications that your veterinarian has prescribed at the correct dose and at the correct times.
  • Contact your veterinary practice if you are concerned that your animal is having a relapse, or if it appears to react abnormally following treatment.
  • Keep your animal on the strict diet that your veterinarian recommends and AVOID feeding high fat foods because fat intake can make the condition much worse. If your pet is a bin scrounger or likely to steal food - stop him/her . Many "snacks" are relatively high in fat - so cut them out !!

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Description
Pancreatitis literally means inflammation of the pancreas. If the condition is sudden in onset it is called acute pancreatitis, whereas chronic pancreatitis is a continuing inflammatory process with sub-acute recurrence's of the disease. Both forms of the disease can lead to permanent damage and reduced functionality of the pancreas with serious consequences for the animal. When the pancreas is inflamed local release of enzymes occurs including trypsin , kallikrein, elastase, lipase, phospholipase A, amylase and lysosymes. These cause local problems in adjacent tissues and affect the range of clinical signs that develop including causing peritonitis.

Cause
In many cases of pancreatitis the initiating cause is unknown. However, several specific associations have been reported:

  • Nutritional changes - Extremely high fat content diets (60% fat) can cause acute pancreatitis in some dogs , if they are kept on it for 14-38 weeks. High fat, high protein diets cause increased pancreatic enzyme synthesis and storage and lead to acute pancreatitis, whereas a protein-deficient diet can cause pancreatic atrophy.
  • Drugs - several drugs have been implicated in the development of pancreatitis - one of the most common being corticosteroids. Others include diuretics (thiazides and frusemide), antibiotics (sulphonamides and tetracycline) azothiaprin, L-asparaginase and exposure to cholinesterase inhibitors in insecticides and cholinergic agonists.
  • Injury to the brain or spinal cord. Trauma to the central nervous system has been associated with the onset of actue pancreatitis in humans and in dogs. In dogs the significance of the trauma itself is often difficult to determine because many patients (e.g. following acute intervertebral disc protrusion) are treated routinely with corticosteroids which have also been implicated in causing pancreatitis.
  • Hypercalcaemia - increased blood calcium concentrations in parathyroid disease (hyperparathyroidism), and after the administration of excess calcium.
  • Other - proposed (but unproven) causes might include - Infectious agents -bacteria and viruses, Immune diseases, obstruction of the pancreatic duct, reflux of intestinal contents up the pancreatic duct, uraemia, impaired blood supply to the pancreas (ischaemia), and hereditary factors.

For a list of risk factors CLICK HERE

Breed Occurrence
 There is no reported breed prevalence for primary pancreatitis although some breeds do have a predisposition to develop other conditions which may then lead to pancreatitis for example:

  •  Miniature Schnauzers develop hyperlipidaemia which can result in secondary pancreatitis.
  • Briards
  • Shelties
  • Himalayan cats

Signs

Complications

Include : jaundice, dyspnoea or increased respiratory rate (tachypnoea), bleeding disorders and heart arrhythmias.

Diagnosis
 Apart from the clinical signs, diagnosis depends upon the following laboratory tests:

  • Plasma amylase - in dogs plasma amylase concentrations greatly increase (to over 5000U/L), but it's an unreliable in affected dogs because amylase concentrations can increase due to other causes. In cats with pancreatitis plasma amylase concentrations DECREASE.
  • Plasma lipase - is the best test for evaluation of pancreatic disease in dogs. Plasma concentrations of lipase D increases greatly in dogs with pancreatitis to over 500U/L - with a sensitivity of over 98%, so most cases will be detected. A few positive cases will have other causes (liver disease, kidney disease or cancer).In cats there is no direct correlation between lipase concentrations and pancreatitis and normal results do not rule out the diagnosis.

    Other tests -the following tests may prove helpful in some cases:

  • Blood glucose - increased in some dogs and cats
  • High blood cholesterol or triglyceride concentrations - seen in cats and may be causative factor in dogs.
  • High enzymes (Alanine aminotransferase (ALT) and alkaline phosphatase (ALP) - if liver disease present, and high bilirubin if the bile duct is obstructed.
  • Protein in the urine. Prerenal increase in blood urea concentrations.
  • Low blood calcium.
  • Xray - Increased radiodensity and sometimes calcification in the right cranial abdomen adjacent to the duodenum which, because of gut stasis might, be filled with air and also the position of the duodenum remains static on sequential Xray films. Xray examination can be normal in some cases.
  • Examination during exploratory surgery and Biopsy
  • Examination of the pancreas during exploratory surgery - reveals various abnormal appearances from inflammation and loss of pancreatic tissue, to localised fat necrosis in surrounding tissue. Sometimes adhesions form. Fine needle biopsy can be performed quite easily, although excessive handling of the pancreas should be avoided.

Treatment
 One objective of treatment is to minimise the stimuli that cause secretion of pancreatic enzymes.

Diet - Some authors advise no food by mouth for 2-5 days. During this period parenteral nutrition should be given if the facilities are available. Small volumes of glucose solution can then be given by mouth, followed by the gradual introduction of a bland starch-based diet e.g. boiled rice. Carbohydrate sources are chosen because they cause the least stimulation of pancreatic enzyme secretion. Other authors recommend the oral feeding of small amounts of a special diet that has the following characteristics :

  • Low fat
  • Highly digestible

CLICK HERE for a reference in cats

Corticosteroids - the use of corticosteroids is controversial because of their known association with causing pancreatitis. However, they may have an important beneficial role in controlling shock when it is present.

Blood transfusion - should be performed in very severe cases because recent evidence suggests that plasma protease inhibitors are used up in pancreatitis leading to saturation of a -macroglobulins which can result in life-threatening intravascular coagulation. Transfusion replaces the macroglobulins.

The other objective is to reverse any complications :

  • Replace fluid and electrolyte losses.
  • Antibiotics - bacteria have been found circulating in the blood of dogs with pancreatitis even though the bacteria were not involved as a cause of the disease.
  • Insulin is required if diabetes mellitus is a complication due to loss of Islets of Langerhans.

Prognosis
 Good in most cases except in severe cases with widespread intravascular coagulation, or severe cardiac complications.

Long term problems
 If significant tissue damage has occurred exocrine pancreatic insufficiency and/or diabetes mellitus may result.

 

 
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