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| Ron Hines DVM PhD 11/4/07
What Is Pancreatitis: Pancreatitis is an inflammation of the pancreas, a gland within the abdomen. The pancreas is composed of two portions. One portion produces enzymes that are secreted into the intestine to aid in digestion while the other portion (the islets) produces insulin, a hormone necessary in the regulation of sugar in the blood and its ability to be utilized by the cells that make up the body. In acute pancreatitis, the signs we see are due to the enzyme-producing portion of the gland being inflamed. Pancreatitis is a perplexing disease in dogs and cats for two reasons, no two cases are alike and we really do not know what causes the condition. Both the severity and the outcome of pancreatitis is quite variable. Some dogs and cats show only minimal discomfort and an elevation in pancreatic enzymes while in others pancreatitis is a life-threatening disease. When pancreatitis is severe, many organs of the body are affected and the prognosis (chance of recovery) is poor. Cause: The cause of pancreatitis in dogs and cats and humans remains unclear. However, there are certain things that we know that are associated with the disease. The first is diet. In humans dogs and cats it appears that diets too rich in fat increases the risk of this disease as does obesity and a sluggish life style. There is also an apparent hereditary predisposition to pancreatitis in the miniature schnauzer due to high levels of lipoproteins in their blood stream. Dachshunds, yorkies, silkies, and possibly a few other miniature breeds are also quite susceptible. The disease occurs usually in middle aged to older dogs, and overweight dogs are at a higher risk. It seems to affect females and males equally. It can affect cats of any age. It is seen more commonly in Siamese cats. There is no sex predilection. Signs of pancreatitis in cats include sluggishness, refusal to eat , weight loss, vomiting, diarrhea, jaundice and dehydration. Amylase and lipase tests are of no value in cats. We know that certain drugs and chemicals can cause pancreatitis in pets and humans. One group of these drugs are certain insecticides (organophosphates). Others that we suspect may have caused cases of pancreatitis include diuretics (furosemide), hormones (estrogen), certain antibiotics (metronidazole, tetracycline, nitrofurantoin and sulfonamides) long acting antacids (cimetidine, ranitidine), Tylenol (acetaminophen). In human beings, cases of pancreatitis have occurred after having one’s abdomen hurt in traffic and other accidents. Excessively high levels of blood calcium have also been known to cause the disease. Signs: Dogs and cats with acute pancreatitis often run a fever. Their tummy aches. The most consistent signs are vomiting and refusal to eat (anorexia). These pets are depressed yet restless due to the pain, and they are often dehydrated from vomiting, diarrhea and a lack of drinking. Cats may not vomit but just act depressed. In severe cases, the liver may become involved and the pet may become jaundices (ictric,yellow) by their third or fourth day of the disease. Breed And Age Predisposition: Among dogs, miniature schnauzers are notorious for this condition. It is most common in middle-aged and older pets. Dogs with this condition are often plump and more females develop the disease than males. Diagnostic Tests: When your veterinarian examines your dog or cat, he may suspect pancreatitis when the pet is showing abdominal pain that is centered high and forward near the rib cage. Dehydration, a rapid heart rate, rapid breathing and redness of the gums might also suggest pancreatitis. Pets with pancreatitis may have elevated serum lipase and amylase. These two enzymes are produced by the pancreas and secreted into the intestine to digest nutrients. But in the disease they leak into the blood in excessive amounts. Measuring serum amylase only detects about 60% of pancreatitis cases while lipase detects about 70%. The administration of corticosteroids (cortisone-like drugs) can elevate serum lipase and depress serum amylase – results that might be mistaken for pancreatitis. Work published in 2006 has found that the amylase-lypase tests are not as accurate in predicting the disease as we used to think. A rather substantial number of pets with pancreatitis do not have elevated enzymes and a similar portion with elevated enzymes do not have pancreatitis. A better test, the Spec cPL® amylase test is now offered byIDEXX Laboratories. Abdominal ultrasound : Abdominal ultrasound is often an effective way to confirm pancreatitis. I has been able to detect 68% of canine cases when done by an experienced practitioner. It may be even more accurate in cats. Biopsy Tissue Examination: This is the most complicated but most accurate way to diagnose the disease. It requires exploratory surgery or the use of fiber-optical viewing devices (laparascopes) to retrieve a small snippet of the pancreas Treatment: The most important treatment for acute (sudden) pancreatitis is the administration of large amounts of intravenous fluid solutions. Most dogs with pancreatitis are dehydrated due to persistent vomiting and many of them have lost additional body fluid due to diarrhea. Dehydration leads to shock and intravenous administration of dilute salt solutions help to cure shock. I can estimate the degree of dehydration by monitoring the plasticity of the skin as well as the concentrations of potassium, sodium and chlorine in the blood. A more precise measure of dehydration involves chemical analysis of blood salts. The blood may also becomes either too acidic or too basic (alkaline) so we usually also give these pets a buffering agent (intravenous sodium bicarbonate). Many veterinarians also administer antibiotics to limit the spread of bacteria liberated from the intestines. Feeding intravenously allows the pancreas to rest. Pancreatitis is a painful condition. Often the abdomen (tummy) is as tight as a drum. These pets need pain killers such as butorphanol (Torbugesic) meperidine (Demerol), hydrocodone or oxycodone. They are all best given by injection. Most patients begin feeling better in a day or two. However, some go into shock and develop problems with their blood clotting mechanism. So it is very important to monitor ill pets closely. Dogs and cats that are vomiting need relief from nausea. I usually administer metoclopramide (Reglan) to calm their stomachs. If the pet is hospitalized I give this medicine by subcutaneous injection. If the patient is at home I dispense pediatric suppositories. A more potent anti-emetic injection and tablet for dogs was recently released by Pfizer (Cerenia™ ,maropitant citrate). Because dogs with pancreatitis tend to nausea and vomission, I withhold any type of oral nutrition (food) until the pet has begun to recover. Once the pet is no longer retching, I can begin by giving it frequent, small amounts of water and gradually add nutrients to the liquid. At this stage I only allow low-fat products such as soups made of rice, cereals and potatoes as well as cooked egg whites which I give in frequent small feedings. A good commercially available product is Hills Prescription diet i/d or CNM-Purina's EN . If the dog or cat has not improved enough to begin taking oral nutrients in 3-4 days one needs to give nutrients intravenously. I treat mild pancreatitis with low fat diets. Some recipes for low fat diets are given on this web site. After repeated bouts of mild pancreatitis the pancreas may become scarred and unable to produce digestive enzymes. If this occurs I supplement their diets with pancreatic enzymes (Viocase, Pancreozime). Dogs in severe pancreatic shock often have heart irregularities. They may have difficulty breathing, an inability to produce urine and other major organ failure. Each of these problems needs to be treated in order for the pet to survive. A common complication of severe pancreatitis is life-threatening disseminated intravascular coagulation (DIC) – a condition in which the blood both clumps and leaks from within the circulatory system. I treat this with oxygen, intravenous fluids, a blood-thinning agent called heparin, an osmotic agent (dextran) antibiotics and B-vitamins. As a last resort I give whole blood transfusions or blood plasma. Some veterinarians also give dopamine and selenium. I also give intravenous steroids to pets that are drifting away in shock when I fear I am going to loose them. Although long term use of corticosteroids may be one of many factors leading to pancreatitis, corticosteroids may be quite helpful to pets in shock. Prevention: Most veterinarians recommend a low fat (5-10%) diet for pets that have experienced pancreatic. Weight reduction in obese pets is probably also wise. Pancreatitis may be a one-time problem. But in some pets it reoccurs at intervals. Try not to feed these pets table scraps or rich fatty diets and keep them trim and active. |
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