Pancreatitis

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One of the functions of the pancreas is production of digestive enzymes.These are the enzymes that break down ingested foods into molecules thebody can digest. These enzymes are carefully handled by the pancreas inorder 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 ina 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 contributeto 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 hada 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 canbe 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 inpatients with pancreatitis. Rapid heart rate and rapid breathing are sometimes seen with pancreatitis. Poor circulation in capillaries may lead to rednessof 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 casesof 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 areoften taken to make sure other conditions are not causing the pain, suchas 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 orit can become chronic and keep returning over and over again. It can bea 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 pancreatitisis often associated with feline infectious peritonitis or toxoplasmosis and it may be beneficial to try to rule out these conditions if pancreatitisis suspected.

It is important to take pancreatitis attacks seriously, especially the first one. Pain management seems to help a great deal in preventing escalationpancreatic 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 releasedigestive 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 wardoff secondary infections but this may not be necessary in milder casesas bacterial infections do not commonly accompany pancreatitis. Corticosteroidsare not thought to be helpful in treatment of pancreatitis. It may be necessaryto use intensive medical therapy for serious side effects of the diseaseor even surgical intervention in really severe cases of pancreatitis. Inminiature 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 novomiting 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. Blanddiets may be beneficial in some patients but we usually recommend returningto the patient's normal diet as long as it wasn't likely to be the causeof the problem due to fat content. Diets moderately high in fiber may bebeneficial in lessening the number or severity of attacks in chronic pancreatitis.Weight loss and increasing exercise are also very likely to help preventfuture 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'teat, 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 coupleof 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.


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