The pancreas is an organ located near the stomach and alongside the small intestine. It is responsible for producing most digestive enzymes as well as hormones (such as insulin) that regulate blood glucose. Pancreatitis in dogs is the condition we see when the pancreas becomes inflamed, leading to vomiting and abdominal pain. This disease can be life-threatening and have long-term effects. In this article we will discuss the causes, symptoms, diagnosis, treatment and prevention of pancreatitis.
Pancreatitis presents in two forms, namely acute pancreatitis and chronic pancreatitis. Acute pancreatitis has a rapid onset with severe symptoms that may be life-threatening. Chronic pancreatitis results from long-standing, low-grade inflammation in the pancreas. This can lead to irreversible changes such as fibrosis (normal tissue being replaced with scar tissue). This condition can be either subclinical (symptoms are not seen), low-grade recurrent (regular bouts of non-specific symptoms such as fussy eating) or occur as flare-ups of acute pancreatitis symptoms.
What causes pancreatitis?
The development of pancreatitis is considered idiopathic, which means that we do not always know exactly what causes it. However, certain risk factors have been identified.
Certain breeds are predisposed to pancreatitis. Miniature Schnauzers, Yorkshire and other terriers have been shown to be at increased risk for developing acute pancreatitis, while chronic pancreatitis is more common in Cavalier King Charles spaniels, English cocker spaniels, boxers and collies.
Hypertriglyceridaemia (high blood fat levels) and obesity have both been shown to be common in patients presenting with pancreatitis. Dietary indiscretion is the term used to describe dogs eating things they shouldn’t be eating, such as table scraps, large amounts of treats, or digging in the dustbin for discarded foods. This is also very common in patients with pancreatitis. Other possible risk factors include infectious diseases such as biliary, certain drugs, trauma to the abdomen (such as surgery or blunt force trauma) and various endocrine diseases such as hyperadrenocorticism, diabetes mellitus and hypothyroidism.
How does pancreatitis develop?
During acute pancreatitis, the pancreas becomes inflamed when digestive enzymes are activated inside the pancreas instead of in the intestine, there is an accumulation of cellular waste products, and a decrease in blood flow. If this inflammation is very severe it can lead to multiple organ failure and death.
Chronic pancreatitis occurs as a long-standing inflammation of the pancreas that may not be detected. It can also develop after a bout of acute pancreatitis. This ongoing inflammation damages the cells of the pancreas, which can lead to them not performing their functions properly. Dogs can develop diabetes mellitus if the cells aren’t producing enough insulin or they can develop exocrine pancreatic insufficiency (EPI) if they aren’t producing adequate digestive enzymes. These diseases are discussed in more detail in other articles.
What are the symptoms of pancreatitis?
The most common symptoms of acute pancreatitis are:
- vomiting
- abdominal pain
- listlessness
- weakness
- dehydration
- diarrhoea
- fever
Chronic pancreatitis is more difficult to identify as the symptoms will often be mild and non-specific, such as dogs being fussy with their food, occasionally vomiting or just having an ‘off’ day. Owners may not even really notice that their dog is not well. Chronic pancreatitis can have severe consequences if left untreated, so dogs with chronic mild symptoms of illness should have a full panel of blood and urine tests done. Identifying and managing chronic pancreatitis early on may prevent the development of diabetes mellitus and EPI.
How is pancreatitis diagnosed?
Patients that present with acute pancreatitis will need various tests as no single test can accurately identify pancreatitis. X-rays of the abdomen will help the veterinarian to rule out a foreign object in the GI tract, which also commonly presents as abdominal pain and vomiting. Abdominal ultrasound can help to identify markers of pancreatitis as well as exclude other causes of the symptoms. A specific blood test called canine pancreatic lipase immunoreactivity (cPLi) is a good indicator of the presence or absence of pancreatic disease. A full blood panel can also help to identify any other organ dysfunction possibly associated with pancreatitis. The presence of other organ dysfunction indicates more severe disease with a poorer prognosis.
Chronic pancreatitis is more challenging to identify. The findings on an abdominal ultrasound are oftentimes more subtle than in cases of acute pancreatitis. The cPLi test can also be ambiguous as the levels are often not as high as with acute pancreatitis cases. Repeat blood samples may be needed to correctly identify the problem. Full blood and urine panels are also recommended to exclude other conditions that may mimic chronic pancreatitis.
How is pancreatitis treated?
Aggressive treatment of acute pancreatitis is necessary to prevent full organ failure, which is fatal. The dog will need to be put on a drip, which means they will have to stay in hospital until they have recovered. Depending on the severity of the disease, the dog can be in hospital for three to 10 days or even longer. They will be treated for nausea and pain. Feeding these patients is key to their recovery, but since they are usually unwilling to eat, they may need to be fed with a syringe or have a feeding tube inserted. An ultra-low-fat diet is recommended. Pancreatitis is seldom associated with bacterial infections, so antibiotics are not used unless specifically indicated.
Chronic pancreatitis is often not as severe and may be treated on an outpatient basis. These patients will be given a painkiller if they are experiencing abdominal pain, and an anti-nausea treatment if they are vomiting or not eating.
How is pancreatitis managed in the long term?
Risk factors such as the use of certain drugs or existing endocrine diseases need to be identified and addressed. All dogs that have pancreatitis need to be permanently put on a low-fat diet. Various prescription diets are available that have been specifically formulated for this reason. It is very important that these diets be strictly adhered to because eating fatty foods can trigger pancreatitis. These patients may only receive low-fat treats such as vegetables and fruits and most certainly no human food! If your dog has had pancreatitis, ask the vet to recommend the best low-fat treats for your dog.
Conclusion
Pancreatitis in both its acute and chronic form is a common disease. It is vital to identify and treat it early on to prevent severe consequences. If your dog has pancreatitis, the veterinarian will recommend the treatment they believe is best. It is better to treat the problem aggressively than to treat conservatively and ‘see what happens’. It is important that dog owners strictly adhere to the vet’s instructions to treat and manage their pet’s pancreatitis, and to minimise the risk of severe complications or even shortening their dog’s life.