I’m going to discuss a case today that ties in with the upcoming Thanksgiving holiday. Names have been changed to protect the “guilty parties.â€
Barley presented to the Internal Medicine service at Michigan State for a very short history of decreased appetite and diarrhea. It was the day after Thanksgiving. (Yup, we were right back to full service at the hospital at that time. No Black Friday campouts in front of Best Buy!)
When the student interviewed the owners to get a history, she was given the following information:
Barley is a 4 year old Yellow Labrador retriever, spayed. She is current on all vaccinations and her most recent heartworm test was negative. Her most recent fecal check was negative as well. She is on monthly heartworm prevention with no doses missed in the last year. Her normal diet is Fit’N’Trim, of which she gets 2 cups in the morning and 2 cups in the evening. She also gets a treat whenever she comes in from being outside, which is 6-8 times a day. She has been otherwise healthy with no medical problems in her history.
On examination, the student had these findings:
Barley weighs 88# – significantly overweight (body condition of 4/5). Her temperature is 103.4F (normal is 99.5-102.5 F). She seems depressed and dull in the exam room, and doesn’t rise to greet the student. She does wag her tail. She has a small amount of tartar and gingivitis. Eyes and ears are clean and normal. Her heart rate is 110 beats per minute (normal is about 70-90 for a big dog that’s relaxed and quiet). The heart sounds normal when listened to. Her breathing rate is also elevated at 30 breaths a minute (normal is 12-20). Her lungs are normal when listened to. All of her lymph nodes are normal. Skin and haircoat are normal. When Barley’s abdomen is palpated (examined by touch), she is very painful in the upper right part of the abdomen. She groans when this area is touched and licks her lips. Otherwise, her internal organs feel normal.
The student then asks the following questions:
Did Barley have exposure to anything like household cleaners, antifreeze, oil, or other toxins? The owner says she did not.
Does Barley ever chew up toys or swallow big hunks of rawhide, or eat clothing or anything like that? No, she’s not a chewer and doesn’t have bones.
Did Barley eat anything unusual in the last few days? The owner says that on Thanksgiving, Barley jumped up on the counter and ate half of a cheesecake. She also took a bite out of a pecan pie. The family’s grandmother was so grossed out by Barley grabbing a bite of the pie that she gave the rest to Barley because it wasn’t fit to serve the family.
Barley was sent to have bloodwork run and to have radiographs taken of her abdomen. The findings included: high liver values, high pancreas values, a high white blood cell count, and high lipids. Her radiographs showed a large area in the upper right part of her abdomen that was abnormal. The duodenum, which is the first part of the intestine after the stomach, was dilated with gas. Her colon was also distended with gas. A stool check showed no specific reason for diarrhea, though there was a little bit of blood in the stool as well.
Barley was admitted to the hospital to get IV fluids, antibiotics, and anti-nausea medication. Her blood sugar and white cell counts were monitored very carefully. She spent 4 days in the hospital before she started eating again (an easily digestible, low-fat diet) and felt good enough to go home. Barley did extremely well after her hospital stay and had no further complications. (Lucky!)
So, what did Barley have? Pancreatitis! (Pancreas and ‘itis.’ ‘itis’ means inflammation, so we have inflammation of the pancreas.)
The pancreas is an organ with 2 major functions: making digestive enzymes and producing insulin. Insulin is the hormone that regulates blood sugar levels in the body. In Barley’s case, that wasn’t the function that was disrupted. The digestive enzyme part was, however. The pancreas lives near the stomach and duodenum, as noted in the picture below. It has 2 ‘arms’ and a small duct that opens into the upper part of the duodenum so the digestive enzymes can be put into the food. It shares this duct with the gall bladder, which puts bile into the intestinal tract to aid in digestion. The colon also passes by the very tip of the right arm of the pancreas.
When a dog gets a meal that is unusually high in fat, the pancreas can get VERY upset. In other cases, any unusual food, or even the act of vomiting for another reason can aggravate the pancreas. Some dogs are very prone to having the pancreas get inflamed, as well. Schnauzers, female dogs, and obese dogs are all at higher risk of developing inflammation in the pancreas. Barley’s offending foods were the two pies she ate in one sitting. WAY more than her system could handle.
Once the pancreas is inflamed, those digestive enzymes start to leak into the tissue itself instead of going through the duct into the intestinal tract. This causes even more inflammation. Pancreatitis is very painful, which is why Barley groaned when the student palpated her abdomen. The high white cell count means that there is inflammation or infection in the body somewhere. The fever can lend support to infection in and around the pancreas, too. The reason Barley had diarrhea was two-fold: the inflammation of the pancreas also irritated the colon, causing bloody diarrhea. In addition, a suddenly high-fat or unusual food ingestion can cause diarrhea.
Pancreatitis can be lethal if untreated. In some cases, that pancreas can become a huge abscess. Those dogs do not do well, and most die. If a patient is lucky, the pancreatitis resolves without complications. In the future, low-fat foods are recommended. In some patients, the pancreas is so damaged that it can’t produce insulin anymore, which makes that pet a diabetic. It’s a serious, serious secondary effect of the pancreatitis that requires lifelong treatment with insulin injections twice a day.
So, what can be done to prevent pancreatitis? DO NOT feed your dog a pie and a half, for starters! 
I strongly urge you not to share the table food with your pet this holiday season. If you want to share a healthy treat with your pet to celebrate the holiday, plain potatoes (boiled or baked), or defatted ground turkey/hamburger/chicken are usually safe for pets. Small bites of plain breads should be OK as well, but uncooked bread dough can be toxic, so be careful there. Stay away from spices, dairy foods, pies/cakes/cookies. No raisins or grapes, either, as they can be toxic to the kidneys.
I can understand wanting to share the happiness that comes from a wonderful holiday meal or family gathering with your pet. We love to pamper and treat, and that mutual affection for food is a feel-good moment to share with our pets. That bond also means protecting our pets from harm, which unfortunately can come from feeding the wrong thing or even too much of the right things. Some one on one attention, playing with a favorite toy, going for a walk, or even just sharing the usual treats (in moderation) can be just as rewarding and enjoyable for our pets as a special occasion food. I’d much rather not have to see my patients for illness at holiday time, as that’s a time for family and fun at home.
没有评论:
发表评论