Pancreatitis and Pancreas Problems

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This page contains general information and real life cases of Pancreatitis in Dogs that have been treated by Dr. Mike Richards, DVM.

General Information
Diagnosis of Pancreatitis in Dogs
Treatment of Pancreatitis in Dogs
Preventing Future Occurrences of Pancreatitis
Pancreatitis Questions:
Causes of Pancreatitis
Pancreatitis and Liver Disease
Pancreatitis CRF
How the Pancreas Works
Elevated Lipase and Amylase Levels
Can You Feed People Food to Dogs with Pancreatitis?

General Information

Pancreatitis is inflammation of the pancreas caused by leakage of active digestive enzymes into the pancreatic tissue. This causes various clinical signs but most pets affected by acute pancreatitis have abdominal pain, depression and decreased appetite or lack of appetite. Vomiting and diarrhea occur in many dogs with pancreatitis. In severe cases of pancreatitis there may be signs of shock or total collapse. Chronic pancreatitis in dogs may occur, with similar but less severe symptoms. The signs of acute pancreatitis similar to those seen in dogs are not as common in cats and probably account for less than 25% of the cases of pancreatitis among felines. Cats are more likely to have chronic pancreatitis, characterized by a decrease in appetite, lethargy, loss of weight, chronic vomiting and low body temperatures. Cats sometimes have diarrhea or difficulty breathing. The pancreas has several jobs that it performs for the body. The pancreas produces digestive enzymes that break down food into molecules that can be absorbed from the intestine. Special clusters of cells in the pancreas, the islets of Langerhans, produce insulin. Diabetes occurs when these cells do not function properly or when they no longer function at all.

It is unusual for acute pancreatitis to cause acute diabetes mellitus and unusual for chronic pancreatitis to lead to diabetes mellitus, but there are cases in which these things happen. These complications are much more common in dogs than in cats. It is particularly important to be aware of the possibility of diabetes occurring with severe acute pancreatitis and just as important to remember that this is usually a temporary situation. It is critical to monitor insulin needs very closely if an attempt is made to correct high blood sugar using insulin in a dog with acute pancreatitis, in order to avoid the risk of shock due to an over dosage of insulin when the islet cell function returns and the pancreas begins to make insulin normally. Digestive enzymes produced by the pancreas are capable of digesting the dog or cat's body just as well as they digest food. For this reason there have to be very good self-protective mechanisms in the body to keep the digestive enzymes from leaking and to deactivate them when they are leaked. Both of these mechanisms have to work well in order to prevent pancreatitis. There are a large number of things that can interfere with the protective mechanisms of the pancreas.

Pancreatitis is more common in overweight pets. When pancreatitis occurs in an overweight pet it is more likely to cause serious illness, as well. This is one of the many good reasons to keep your pet at or close to its ideal weight. High fat diets, especially in combination with low protein intake, appear to contribute to the development of pancreatitis. A single high fat meal may cause pancreatitis in a pet whose normal diet is moderate or low in fat. We see an increase in cases of pancreatitis around Thanksgiving, Christmas and Easter almost every year, presumably due to the ingestion of high fat leftovers from the big meals associated with these holidays. There are a number of drugs that have been linked to pancreatitis. The most well known of these, prednisone (or other corticosteroids) apparently doesn't actually lead to pancreatitis, at least according to recent information in humans (J.M. Steiner, 2005).

The medications most suspected of causing pancreatitis include azathioprine (Imuran Rx), potassium bromide (used for seizure control), l-asparaginase ( a chemotherapeutic agent) and zinc used as a dietary supplement. There are a number of other medications that are sometimes mentioned as possible causes of pancreatitis but the relationship with it is less clear for most of those medications. Pets living in areas in which scorpions occur may develop pancreatitis after scorpion stings. Naturally occurring hypercalcemia ( too much calcium in the blood stream) can lead to pancreatitis and it is likely that over supplementation with calcium or calcitriol could also lead to pancreatitis. It is unclear whether there is a genetic predisposition to pancreatitis in dogs. Pancreatitis is much more common in miniature Schnauzers than in most other breeds but this could be due to a genetic predisposition to hyperlipidemia (high fat content in the blood stream) rather than a direct genetic link to pancreatitis. The most severe form of pancreatitis is referred to as necrotizing pancreatitis, which basically means pancreatitis in which the damage is so severe that portions of the pancreas are being killed. Some authors refer to this as hemorrhagic pancreatitis. This form of pancreatitis can be fatal and requires early intervention and aggressive treatment when it is present. Dogs with necrotizing pancreatitis usually look severely ill and are usually in obvious pain or extreme discomfort. Cats are extremely depressed and won't eat but may not show much else even though the pancreatitis is very severe. also see pancreatitis in cats

Get more information on our overview of Pancreatitis in Dogs

Diagnosis of Pancreatitis in Dogs

Pancreatitis in dogs causes a number of changes in routine blood counts and blood chemistries. Taken in concert these changes can be highly suggestive of pancreatitis but do not definitely confirm its presence and can not be used to completely rule it out. Mild to moderate increases in white blood cell counts generally occur with pancreatitis. Serum amylase and lipase enzyme levels are often three times normal in dogs with pancreatitis, although these enzyme levels can rise for other reasons and do not uniformly rise in dogs with pancreatitis. Rises in liver associated enzymes, particularly alkaline phosphatase and alanine transferase (ALT) may occur in conjunction with pancreatitis. Mild rises in blood sugar and mild to moderate decreases in serum calcium levels sometimes occur. Some dogs will have moderate to severe rises in blood potassium levels. When several of these changes occur at the same time pancreatitis is very likely.

The most accurate blood test for canine pancreatitis at the present time is the canine pancreatic lipase immunoreactivity (cPLI) test. This is a specialized blood test that is only run at the current time at the Gastroenterology Laboratory at Texas A&M University. Some commercial labs offer this test but they just provide a convenient way for veterinarians to get the blood to Texas A&M. Radiographs (X-rays) are not highly specific for detection of pancreatitis. There are some subtle changes that can occur when pancreatitis is present but X-rays are at best a supportive test for making the diagnosis of pancreatitis. Ultrasound examination, when performed by a good ultrasonagrapher, is a good way to diagnose pancreatitis but even the best ultrasonagraphers can only detect pancreatitis about 70% of the time and false positive findings may be common with less experienced sonagraphers. Pancreatic biopsy is considered to be the definitive or "gold standard" test for pancreatitis. In general most vets want to avoid exploratory surgery to obtain pancreatic tissue for biopsy but if surgery is necessary pancreatic biopsy is possible. 

Learn more about Pancreatitis Diagnosis in Dogs

Treatment of Pancreatitis in Dogs

For dogs there are two cornerstones to treatment for pancreatitis, control pain and control fluid and electrolyte disturbances. If these two things can be accomplished the prognosis for living through the pancreatitis improves a great deal. There are a number of pain control medications which can be used in dogs with pancreatitis. The most commonly used pain relievers are probably meperidine (Demerol Rx), fentanyl patches (Duragesic Rx) and morphine but there are several other medications that can be used. The most important thing is to use some kind of pain relief medication. For severely ill dogs the use of continuous IV pain relievers or injection of local anesthetic (lidocaine) into the abdominal cavity along with sufficient fluids to make sure that it spreads everywhere can be very beneficial. This type of therapy is most common at critical care centers and veterinary schools and there is some advantage to asking for referral to a critical care center when a dog has severe pancreatitis.

Most dogs with pancreatitis benefit from fluid therapy designed to keep their electrolytes within normal ranges. Low potassium levels are a common problem in dogs with pancreatitis but high potassium levels can also occur and are more dangerous for the dog. Keeping a dog well hydrated makes him or her more comfortable and aids in the recovery from pancreatitis, as well. Severely ill dogs may also benefit from administration of plasma to ward off the disseminated intravascular coagulation (DIC), a severe form of shock that sometimes occurs with necrotizing pancreatitis. It is necessary to monitor electrolytes and acid/base balance to choose the best possible replacement fluids so dogs who have pancreatitis may need repeated blood work over the first few days of treatment. Dogs do not usually require antibiotic therapy when they have pancreatitis but there are exceptions to this rule. If the white blood cell count gets very low or very high, body temperature very high or if other signs that a secondary infection may be present occur it is acceptable to use antibiotics. If vomiting is severe the use of medications to control vomiting may be necessary. In general it is probably better to wait to see if vomiting self corrects, as this is a good prognostic sign and also is an indication that it is acceptable to give fluids and food orally.

For almost my entire career in veterinary medicine the standard feeding advice for dogs with pancreatitis was simply to avoid feeding them while there were clinical signs of acute pancreatitis present, even if they didn't eat for a week or more. This philosophy is changing, mostly due to the results of some studies in humans that show an improvement in survival rates and recovery times among patients who are fed early in the recovery from pancreatitis. At the present time it is reasonable to give oral fluids and to feed dogs once the vomiting stops. Small amounts of a low fat food are best. For dogs who will not eat on their own there is evidence that implanting a feeding tube directly into the small intestine (jejunostomy) seems to be beneficial but is usually something that is done more commonly at critical care centers than general veterinary practices. There may be some benefit to supplementing pancreatic enzymes orally using products such as Viokase (tm). This has not been proven in dogs but human studies show some benefit in pain relief from supplementing enzymes. This is probably due to a feedback mechanism in which the presence of digestive enzymes in the intestines shuts down the release of digestive enzymes from the pancreas, limiting the damage to the pancreas. Some dogs who have chronic pancreatitis will have fairly frequent attacks of mild abdominal pain. It is often possible to wait these symptoms out and not to provide treatment, as long as the dog doesn't seem to be in too much pain or to be too ill. I prefer to go ahead and dispense pain relief medications for these dogs and to start them early but there is no way to know if this is the ideal practice at this time.

Find out more about Treating Canine Pancreatitis

Preventing Future Occurrences of Pancreatitis

In dogs there is a general consensus that a low fat, moderate fiber diet is helpful in preventing future occurrences of pancreatitis. In addition to diet, weight control is a very important factor in controlling the incidence and severity of future attacks of pancreatitis. Overweight dogs seem to have more severe bouts of pancreatitis when it occurs and to have recurrences more frequently. Dog breeds, or individual dogs, prone to hyperlipidemia, especially miniature schnauzers, may also benefit from the use of statin medications, such as Lipitor (Rx) to control the lipid levels in their bloodstream. This has not been proven at this time but reports from vets trying these medications on an experimental basis seem positive -- just remember that anecdotal evidence is always suspect and that this is an experimental therapy.

Get help Preventing Pancreatitis in Dogs through Proper Diet

Pancreatitis Questions:

Question:

Why do some dogs come down with pancreatitis? How serious is this malady? Is there a cure? Does diet have anything to do with the onset of pancreatitis? If so, what are some of the foods and cooking metholodogy that need to be avoided?

Answer:

When pancreatic cells are damaged enough to leak digestive enzymes, pancreatitis occurs. There are some recognized predisposing causes but many dogs develop pancreatitis without having one of the predisposing causes and I do not know what triggers the pancreatitis in these dogs. The known predisposing causes are obesity, high fat diets, ingestion of large amounts of fats as a novel event (like a dog getting into a bag of chocolate candy), hyperlipidemia (common problem in schnauzers), long term use of corticosteroids, Cushing's disease, drug reactions (azathioprine sometimes triggers pancreatitis), blood clotting disorders and trauma. Liver disease sometimes seems to trigger pancreatitis but it may be that there is a common inciting agent in these cases. We see cases of pancreatitis after almost every holiday in which big family meals are cooked. Ingesting a lot of ham seems to be a common history. I am not sure if other vets think that high salt treats can cause pancreatitis but we think there is some correlation with high salt ingestion, too. Avoiding feeding the dog table scraps at family gatherings would cut down on the cases of pancreatitis we see. I think that when there are a lot of people present, the dog just gets more treats because there are more people to provide them. Moderate fiber, low fat diets may help to prevent pancreatitis. 

Causes of Pancreatitis

Question:

I know a little something about pancreatitis. What I need to know is to what extent diet could be held as the culprit for the onset of pancreatitis. I understand that cooking food in some kind of fat (butter or oil) can be a cause of pancreatitis occuring. Could this be true? I'm just wondering what other causes there are and if there are other preventative measures that can/should be taken to minimize the possible onset of pancreatitis. And what are the remedies?

Answer:

The only recognized dietary cause of pancreatitis that I am aware of is feeding high fat foods or treats to dogs. In our practice we think there may also be some correlation with high salt content but that is just an observation and may not be true. In one study of the effect of high fat diets (Hall, 1989) on pancreatitis, the diet used was also low protein and I am not sure if that is also necessary in order to increase the risk of pancreatitis or if the high fat alone is enough. High fat diets apparently cause release of pancreatic lipase in the microscopic circulation of the pancreas which digests fats in the blood causing release of damaging fatty acids, which cause inflammation and release of more lipase, which eventually starts to digest the pancreatic tissue, leading to the severe inflammation that causes the signs of pancreatitis. Non dietary predisposing factor for pancreatitis include being a miniature schnauzer, a Himalayan cat or a Shetland sheepdog, chronic corticosteroid use, having high triglyceride and/or cholesterol levels in the blood stream, having hyperadrenocorticism or hyperparathyroidism (due to high calcium levels) or being obese. This is one reason to control obesity in pets whenever possible, since it is the most preventable of the inciting causes. Avoiding high fat meals and treats is also a good idea. Keeping corticosteroid use to the lowest necessary levels is always best. Other than these things, I don't know of any useful preventative measures for pancreatitis. Mike Richards, DVM 9/18/2001

Pancreatitis and Liver Disease

Question:

Over the past half year you have given great counsel on my Pomeranian Woofy's pancreatitis and liver disease. Although very expensive and time consuming, we think his quality of life has been great (as far as we know)and that has been worth it for us. This is the second month of Woofy's blood work showing a loss of protein and now there seem to be other changes that are not looking so good either. We just have gone through another bout of vomiting and food refusal and now I alternate hand feeding him turkey diced and dusted with Prozyme, then squirt Beef flavored Vivonex down him ( the turkey serves as reward for being a good sport about the Vivonex). Other than Tagamet and Urisidiol,we have discontinued antibiotics Baytril and Amoxicillen (he has also been on Metrodiazonole, Clavamox, and Denosyl at one time or another) as this only seems to upset his stomach more. I told Dr Paulsen I am tired of pilling and dosing a shaking dog. We had an ultrasound done around thanksgiving that showed his pancreas is continuing to calcify and that there is thickening and changes in the bowels. At that time we changed his food to Purina's EN as Dr Remillard's homemade diet was no longer being processed even with Enzymes. Enzymes! When he gets sick he refuses them on anything and that goes for Prozyme and particularly Viocase. Now my pharmacist tells me that he has had success compounding Viocase with fish oil and making a paste that the dogs lick off their paws. He also swears that Woof won't get ill from the antibiotics if he compounds them. We know that was not the case when they compounded the Metrodiazanole. I have been told that nothing is going to really help him in the long term. If he survives at the very least he will be a diabetic. But no-one has told Woofy all this.

He is still very alert, still playing with his friend Shamu and having his way with his toy. He does not walk far, but when he gets his leash on he has every intention of doing so. I just don't want to give up unless it really is hopeless, on the other hand I don't want to be foolish or cruel either. One way or another he will die in his sleep. Is there any point to compounding the antibiotics and trying again? I thought I would at least try the Viocase compound as we don't want him to starve to death, and obviously the current feeding routine is not a high quality of life. I trust Dr.Paulsen implicitly but I think he is thinking of us now even more than Woofy. The attachement is Woofy's latest bloodwork please give us the benefit of your wisdom. I do so hope that one day for your subscriber's you will write a long article on what can happen when owner's indulge their dogs with human food or give high fat and protein "treats " as are so many of the jerkies and chews like sow's ears. Robert and I thought if it came from the pet supply warehouse it had to be o.k.! 

Answer:

One thing that I have forgotten to mention, that came up in a recent email from another subscriber, is that it is possible to supplement digestive enzymes by feeding pancreas tissue. This may be helpful in pets that are sensitive to pork, since Viokase (tm) is derived from pork. Most dogs readily accept pancreas, which may also be called "sweetbreads". I am assuming this is a euphemism left over from a time when people did eat all the parts of the beef and had to convince children certain parts were edible when they didn't seem to be. The only problem is finding a source of the pancreas. Apparently, the pancreas is not considered to be an edible portion of the beef and slaughterhouses may require a medical authorization in order to sell the pancreatic tissue, in the U.S. If you can find a local butcher, this may not be a problem. If that is the case, feeding about 3 ounces or so of the pancreas per day. It has to be fed raw but it does not hurt to freeze it and the enzymes stay viable for several months frozen. It is just an additional option that Woofy might like better than the enzyme powders. I tend to think that most of the side effects of antibiotics still occur when they are compounded, so if the vomiting is a direct side effect of the medication it will probably still occur. I do think a few dogs vomit due to the taste of medications and I can see where compounding would help in that situation. The only thing I saw on the lab work that you didn't seem to be addressing was the high blood sugar. It may become necessary in the near future to consider insulin therapy. It would be good to at least monitor the blood glucose, since it was over 200 mg/dl. I know that there are three Dr. Paulsons in California, but one of them is a classmate of mine (Roger Paulson). I wish that I could offer more help. 

Pancreatitis CRF

Question:

More questions have arisen, re the usual progress of CRF. Over this past weekend, Trudi has experienced a boute of acute pancreatitis, for which she rec'd sub-Q fluids and anti-nausea injections. She's presently on a prophylactic dose of amoxycillin for a week. She's made a dramatic improvement so far. If you remember, Trudi is the Sp. F. boxer who was diagnosed as having congenitally malformed (medulla) kidneys, resulting in CRF. We've been managing her quite well on regularly scheduled cimetidine , Rocal, and a diet consisting of 1/2 canned k/d and half home-cooked renal diet. Now, we're aware that acute, end-stage renal failure causes ketosis, resulting in that awful sweetish breath, and we've also been told that there usually are ulcerations present in the mouth. But what we can't seem to find out is whether this attack of pancreatitis is (closely) interwoven with the kidney disease. Is it a common occurrence in cases of CRF. It is *bound* to have done severe damage to her already-compromised kidneys. At the moment, we are still limiting Trudi to five 1/2-cup servings (spread out over each day) of a home-cooked rice gruel........plain boiled rice, mashed with water and a tad of chicken bouillon flavoring. How long would you recommend staying with this dietary regime......in order to give the pancreas time to recover? (And no, Trudi has not gorged on anythng, nor had a diet the least bit high in fat!)

Answer:

I don' t know of a syndrome involving renal failure and pancreatitis in dogs except for cases of leptospirosis (a bacterial infection), in which both problems are sometimes caused by the infection. That doesn't necessarily mean there isn't one --- there are lots of conditions that occur in just a few dogs that I am not at all familiar with. Pancreatitis does sometimes cause increases in serum calcium levels and if that occurs, extra attention to fluid therapy and possibly the use of furosemide (a diuretic) to protect the kidneys might be worthwhile. We have had several instances of pancreatitis in patients that also had pre-existing renal failure and we haven't seen highly noticeable changes in long term kidney function as a result of these episodes as long as adequate hydration was maintained during the pancreatitis problems. I wish that I had more information that I could give you but I'm hoping that Trudi's experience will match our previous cases and this will be only a short term setback. 

How the Pancreas Works

One of the functions of the pancreas is production of digestive enzymes. These are the enzymes that break down ingested foods into molecules the body can digest. These enzymes are carefully handled by the pancreas in order to prevent them from damaging the pancreas itself or surrounding tissue. When these self-protective mechanisms break down for any reason, the result is leakage of enyzmes which damage the pancreas and any surrounding tissue they reach. This breakdown is called pancreatitis. There are a number of things which can initiate or facilitate enzyme leakage, so pancreatitis can occur for a number or reasons.

Often, it takes a combination of precipitating factors to cause pancreatitis to occur in a dog or cat. High fat diets, obesity and lack of exercise are the most common "life-style" contributors. Miniature schnauzers are predisposed to pancreatitis due to a tendency to have high levels of lipoproteins in their blood streams. Corticosteroids and azathioprine medications may contribute to the tendency to develop pancreatitis. Hyperadrenocorticism, a naturally occurring overproduction of corticosteriods that is fairly common in dogs may also lead to an increased susceptibility to pancreatitis. Anything that interferes with blood supply to the pancreas or release of digestive enzymes by the pancreas may lead to pancreatitis. For some reason, pancreatitis does not occur, or is not recognized, as often in cats as it does in dogs. The "typical" pancreatitis patient is middle-aged or older and overweight. There may be a slightly higher prevalence of this problem in female dogs but it does occur commonly in both sexes. Often, the family has just had a party or a big holiday meal when this disease strikes. This is not a disease that restricts itself to any particular scenario, though. It often occurs in patients that do not fit the typical profile and it has highly variable clinical signs.

Any time a dog appears to be exhibiting signs of unexplained pain, pancreatitis must be considered. Vomiting is common with pancreatitis. Depression can be severe. Affected pets may seem restless or be reluctant to move, they may seem weak, irritable, have diarrhea or simply refuse to eat. Many owners recognize that their pet is very ill but may be baffled by a lack of symptoms to explain their pet's discomfort -- they just know they don't feel well. When your vet examines your dog and suspects pancreatitis, she will look for abdominal pain that seems to be centered in the portion of the abdomen that is partially covered by the ribs. Dehydration is common in patients with pancreatitis. Rapid heartrate and rapid breathing are sometimes seen with pancreatitis. Poor circulation in capillaries may lead to redness of the gums and eye linings. Confirming a diagnosis of pancreatitis can be frustrating. Currently, there is no single reliable diagnostic test for this disease. Often, amylase and lipase levels are elevated in the bloodstream. Unfortunately, this seems to happen slowly in comparison to the progress of the disease so a pet may be pretty ill before the enzyme levels elevate and in some cases of pancreatitis an elevation in these enzyme levels doesn't occur. Often, blood tests that help evaluate liver and kidney function are slightly elevated as well. White blood cell counts are usually high. Ultrasound exam of the pancreas, if your vet can do this, is helpful in diagnosis. X-rays are often taken to make sure other conditions are not causing the pain, such as intestinal obstruction, but usually it is not possible to be sure a dog has pancreatitis based on X-ray changes. Pancreatitis is harder to diagnose in cats because they are less likely to have high enzyme levels and either hide pain better or experience less pain, making the need for testing less obvious.

Pancreatitis can be acute and only occur once in a dog's lifetime or it can become chronic and keep returning over and over again. It can be a rapidly fatal illness or a mild attack of pain that resolves in a few hours or a day or so. It can cause tremendous side effects, including shock, blood clotting disorders, heart arrythmias, liver or kidney damage and death. I think that chronic disease with varying levels of pain and secondary side effects is the most common form of pancreatitis. Fortunately, most of the time dogs with chronic pancreatitis problems do not die from the attacks. It is possible to lessen the severity and frequency of attacks in many of these dogs by managing their diet and exercise. Less commonly, pancreatitis strikes with a sudden severe fury that creates severe secondary problems, particularly with blood clotting and shock. In these cases, it can be fatal. It is not clear whether these are entirely separate disorders or different manifestations of the same problem. In cats, chronic pancreatitis is often associated with feline infectious peritonitis or toxoplasmosis and it may be beneficial to try to rule out these conditions if pancreatitis is suspected. It is important to take pancreatitis attacks seriously, especially the first one.

Pain management seems to help a great deal in preventing escalation pancreatic attacks, based on our clinical experience. Totally restricting food intake (no food) for 24 to 72 hours seems to help a great deal as well. This may be due to a decrease in stimulation of the pancreas to release digestive enzymes. Fluid therapy to prevent dehydration and help maintain circulatory function is usually necessary. Medications to control vomiting are often used. Many veterinarians use antibiotics in an effort to ward off secondary infections but this may not be necessary in milder cases as bacterial infections do not commonly accompany pancreatitis. Corticosteroids are not thought to be helpful in treatment of pancreatitis. It may be necessary to use intensive medical therapy for serious side effects of the disease or even surgical intervention in really severe cases of pancreatitis. In miniature schnauzers, medical control of the lipid levels may be beneficial and is sometimes possible using medications. Once the patient seems to feel better, oral fluids are given. If no vomiting occurs in 12 to 24 hours, food can be offered in small quantities. Most pets can go home once they are willing to eat and drink again. Bland diets may be beneficial in some patients but we usually recommend returning to the patient's normal diet as long as it wasn't likely to be the cause of the problem due to fat content. Diets moderately high in fiber may be beneficial in lessening the number or severity of attacks in chronic pancreatitis. Weight loss and increasing exercise are also very likely to help prevent future attacks. Keeping your pet away from the table during traditional holiday meals can be very helpful, too. It is very important to remember NOT to feed your dog when it is showing signs of abdominal discomfort or unexplained pain. It is almost painful to think of the number of times dog owners have said to me "she wouldn't eat, so I gave put a couple of tablespoons of bacon fat on her food...... or gave her a bowl of ice cream...... or a bowl of milk....... or a couple of pieces of ham....... " This is the worst thing you can do if your dog has pancreatitis. Learn to let them help themselves heal by not eating when their body is telling them it isn't a good idea! This can be the difference between a 24 hour attack of mild abdominal pain and 5 days in our hospital treating severe pancreatitis. 

Elevated Lipase and Amylase Levels

Question:

Kenya, my ten-year-old spayed female chihuahua/dachshund/terrier mix, has had some digestive problems. I would like your help with diagnosis and treatment if possible: Off and on over the last year, I have noticed a bit of mucus in her stool. Someone had told me that an occasional appearance of mucus was normal, so I didn't pursue it. But about six weeks ago, I noticed a large quantity of mucus in the stool. And I realized that she had been acting mildly uncomfortable with increased frequency lately: Waking up at night, occasional grimacing and tail down, etc. I thought it was due to pain in her spine area, which has a history of disc problems and a discolysis three years ago---until I noticed the increased mucus. I had a blood test done and it detected a lipase level raised to about 593. All other levels apparently were normal. I took her off her usual feed: Eagle brand dry with 1/4 cup of doggie stew (cooked veggies, Lipiderm, garlic, brewers yeast, brown rice, tofu)and put her on white rice, ground turkey and flax seed. The ultimate goal was to decrease fat and simplify the diet. It took over two weeks before her stool was free of mucus and had returned to a firm consistency--it had gotten loose and yellow upon eating the rice and turkey. After 3 weeks her lipase went down to 519. The vet and I are considering the possibility of: pancreatitis, colitis, and/or inflammatory bowel disease. She has NOT been vomiting to my knowledge. She was not having diarrhea, to my knowledge, prior to the diet change. Now it isn't quite diarrhea, but it is very loose and quite yellow. The vet has mentioned an endoscopy or colonoscopy might be useful in diagnosing IBD. What about an ultrasound to look at the pancreas? If you have any ideas, insights, suggestions, I would be most appreciative.

Answer: 

Usually, it is best to evaluate the lipase and amylase levels in conjunction with each other. If both amylase and lipase are elevated more than 2 to 3 times the normal value, pancreatitis is very likely. Kidney disease and pancreatitis are the two most common causes of elevations in amylase and lipase. Pancreatitis will usually elevate the values more than kidney disease will. There is a possibility of mild increases in lipase and amylase due to intestinal disease or liver disease. It is important to compare the normal values for the laboratory running the samples to the sample values in making determinations about rises in enzyme levels, because lipase and amylase tests vary somewhat between labs. A general average value for lipase would be 0 to 160 U/L , so the reported values in the high 500s are above 3X the normal range, probably. An ultrasound exam might be very useful in making a diagnosis. There was a recent report that ultrasonography was as good at identifying whether inflammatory bowel disease was present as endoscopy. It would be a better way of looking for pancreatitis. However, the advantage of endoscopy is that it identifies the presence of IBD and also can allow a diagnosis of the cause through biopsy of the intestinal lining in many cases. Low fat diets are generally beneficial when there is intestinal irritation so that was a good thought. The best diagnostic technique for ruling in or ruling out chronic pancreatitis is a pancreatic biopsy. Unfortunately, it is necessary to do exploratory surgery to get pancreatic samples, so it generally makes more sense to consider ultrasound exam and to check the lab work once a week for two or three weeks prior to considering this, unless the patient seems to be getting worse or if there is significant pain. Some vets are quicker to go to surgery and there is some justification for this, since it takes a few days to get biopsy results in most cases and they do help in planning treatment options. One other thing you might consider, if the lipase continues to be the only elevated value, is asking your vet to recheck the lab work through another lab. Once in a while there are problems with a specific lab test at a lab and it can take some time for the problem to be identified and corrected. I'd especially consider this if Kenya continues to seem to be OK, except for soft stools. 

Can You Feed People Food to Dogs with Pancreatitis?

Question:

I previously wrote to you about my dog and his hip dysplasia and pancreitis. I was wondering, since the vet told me NO MORE TABLE SCRAPS OR FATTY FOOD(S), is there anything I can add to their food to make it a little more palatable for them? Broth? Rice? The gloucosimine tablets are supposed to be flavored, but I have to wrap it in Fat Free cheese. Is that ok? I know they will live w/out people food, but man are they spoiled........(yeah, I know ..I did it!)

Answer:

I would not worry about a client using cheese or a small amount of peanut butter or similar things to help with administration of medications even after a bout of pancreatitis. I may not be the best source of information on this topic, though. I don't even worry about clients giving dogs table scraps after the first bout of pancreatitis. I just tell them to avoid very high fat and high salt treats because they seem to cause problems, even though I can't find any real evidence to support the high salt advice. It probably is better to feed pet foods consistently after a second or third bout of pancreatitis (or maybe even the first bout) but I think that having a little pleasure in life is worth a small amount of risk. It will be easier for you on future office visits if you follow your vet's advice though. Rice as a food additive is usually a safe choice. Broth is OK if it isn't high in salt, so you shouldn't use bouillon cubes to make the broth unless you use low salt ones. Just adding warm water to food makes it more palatable for some dogs. Mixing a low fat canned food in with dry food is often helpful in enticing reluctant dogs to eat, too. Good luck with this. Hopefully this will be an isolated incident. 


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Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...

 

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