Pancreatitis

by PETS Referral Center on November 17, 2011

Thanksgiving day is just around the corner and for many families this means the tradition of spending the day preparing a delicious turkey dinner with all of the trimmings. Us humans are not the only ones who look forward to this meal, and I see many pets in the ER after they have decided to help themselves to a serving. While our pets may find this to be an initially satisfying (albeit naughty) indulgence, it can set them up for the development of pancreatitis, a potentially life-threatening disease.

What is the job of the pancreas?

The pancreas is an organ that sits cozily just under the stomach and along the first part of the small intestine. The pancreas is all about secretion and it has two main jobs: the first is the secretion of digestive enzymes to help break down food, and the second is the secretion of insulin and glucagon (to regulate sugar metabolism). The digestive enzymes are the part of the story that concerns us in pancreatitis.

Just what is “pancreatitis?”

Put simply, pancreatitis is inflammation of the pancreas, and it is the inflammation that disrupts its normal integrity. Digestive enzymes that are normally safely stored are released prematurely, beginning to digest the body itself, and the result can be a metabolic catastrophe. As the tissue becomes further inflamed, the damage begins to involve its next-door neighbor, the liver. Toxins released from this progressive party of tissue destruction are released into the circulation causing a body-wide inflammatory response. If the pancreas is severely affected, its ability to produce insulin can be affected and diabetes can result. The good news is that most commonly the inflammation is confined to the area of the liver and pancreas, and most pets make a full recovery with support.

What Causes Pancreatitis?

In most cases we never find out what causes it but we do know some events that trigger it. These can include:

• Dietary “indiscretion” and ingestion of highly fatty foods (such as eating all the meat, skin, and fat trimmings from the turkey!).
  


• Obstruction or “back flow” of the pancreatic duct.


• Hormonal imbalances including diabetes, hypothyroidism, and high calcium levels.


• Use of certain drugs, chemotherapy, and the anti-seizure medication potassium bromide. Exposure to organophosphate insecticides has also been implicated. Steroids have traditionally been thought to be involved but this appears not to be true.


• Trauma to the pancreas (such as a car accident or even surgical manipulation).


• A tumor or abscess.


• Miniature Schnauzers are predisposed to pancreatitis as they commonly have altered fat metabolism.

Signs of Pancreatitis

The classical signs are appetite loss, vomiting, diarrhea, painful belly, depressed attitude, and fever.

Making the Diagnosis

A reliable blood test has been lacking until recently and a new test called the SPEC cPL (specific canine pancreatic lipase) test has come to be the lab test of choice. This is a newer generation test (for dogs only) that can be run overnight by a reference lab and is able to detect 83% of pancreatitis cases and excludes other possible diseases in 98% of cases.   This test should not be confused with the “in-house” pancreatic test which resembles a “pregnancy test” and gives you an answer of “abnormal” or “normal.” I am personally not a huge fan of this test because other disease processes (such as liver or gastrointestinal disease) can cause an “abnormal” result, so I don’t see as much value in this.

Ultrasound detects 68% of cases and provides the opportunity to look at other organs. Since pancreatitis can be accompanied by a tumor near the pancreas, ultrasound is important to catch such complicating factors. I discuss and recommend this diagnostic for all of my patients that I suspect have pancreatitis.

Treatment:

The passage of food through the intestine is a strong stimulus to the pancreas, which is what we want to avoid; essentially, we want the pancreas to “rest.” This generally means no food or water for 2 to 3 days (in our very ill patients) using IV fluid support to prevent dehydration. Fluid support generally requires electrolyte supplementation and a critical patient will need 24 hour care with blood test monitoring several times a day. A plasma transfusion represents a specific type of fluid therapy and may be of great help in severe cases.

Pancreatitis can be a very painful condition and pain management is of utmost importance in recovery and is a cornerstone of treatment. Untreated pain affects the immune system and has been shown to increase death rate. Medications to control nausea are also used. Antibiotics are used because even though pancreatitis is not a bacterial disease, bacterial invasion from the diseased intestine is a common occurrence.

Once the patient has started to eat again, a low fat diet is important to minimize pancreatic stimulation. Since there is potential for the pancreas to always have a smoldering bit of inflammation, long-term use of a low fat diet is likely to be recommended.

As you can see, pancreatitis can be a very severe disease to experience and treat.  In addition to an educational topic, I hope this helps raise awareness of a potential source of calamity: please remember to keep the counter tops pet-safe, take out the garbage promptly, and be extra vigilant of the fact that even the most well-behaved pets can be tempted with all of the food festivities.   Here’s to a SAFE, happy, and wonderful Thanksgiving!