Pancreatitis in Cats - A mysterious disease that remains tricky to diagnose

Pancreatitis (inflammation of the pancreas) is a common gastrointestinal disorder in dogs and cats.  In the past, the incidence of pancreatitis in cats was thought to be low, but recent studies suggest the contrary. The true incidence of the disease is unknown, however, as many dogs and cats have mild disease and are not presented to a veterinarian.  Unfortunately, many cases of pancreatitis in cats go undiagnosed due to the nonspecific, vague clinical signs, and the lack of a highly sensitive and specific diagnostic test.  However, a new test has become available that may improve our ability to achieve a diagnosis of this elusive disease in cats.

The pancreas serves a dual role in animals.  It is an “endocrine” organ – it  produces hormones that regulate body functions, the most well-known of these hormones being insulin, which helps regulate blood sugar levels.  It is also an “exocrine” organ – it produces enzymes which are involved in digestion of food.   Many things can go wrong with the pancreas.  The endocrine portion can malfunction in terms of hormone production.  The most common example would be diabetes, in which the pancreas produces insufficient quantities of insulin.  Disorders involving the exocrine portion of the pancreas are also common.  The pancreas can fail to produce sufficient digestive enzymes, causing a condition called exocrine pancreatic insufficiency.  The pancreas can also become inflamed, resulting in the digestive enzymes being released into the pancreas itself rather than into the intestinal tract, a condition we generally term “pancreatitis”. No one is sure what causes pancreatitis in cats.  Trauma, infection, parasitism, and idiosyncratic reactions to certain drugs are potential causes of pancreatitis, however, the vast majority of cases (> 90%) cannot be linked to any one specific cause.  Siamese cats seem to be at greater risk than other cats, which suggest a possible genetic component to the disorder.

Clinical signs of feline pancreatitis are quite variable, and usually differ from signs seen in dogs.  Dogs often vomit and have signs of abdominal pain.  Cats, however, may present with poor or absent appetite, lethargy, weight loss, dehydration, and diarrhea.  Vomiting and abdominal pain are not common clinical findings in cats affected with pancreatitis; only about 1/3 of cats with pancreatitis will vomit, and only ¼ show abdominal pain. Unfortunately for cats, pancreatitis is usually not a one-time occurrence.  Instead, it tends to be a chronic, intermittent problem.  Dogs, by comparison, are more likely to experience acute pancreatitis, a short-term inflammatory condition that may be completely reversible after the inciting cause has been eliminated. In some instances of feline pancreatitis, things can really get out of control, and the pancreatitis can trigger damage to other areas of the body, leading to respiratory failure, steatitis (painful inflammation of fatty tissue), and other damage, often with devastating consequences.

For years, veterinarians have grappled with diagnostic tests for pancreatitis.  The disorder cannot be diagnosed based on historical or clinical signs alone, because the clinical signs (lethargy, inappetance, weight loss, vomiting, diarrhea) mimic many other diseases in cats and are not specific for pancreatitis. Further complicating matters, pancreatitis in cats often develops concurrently with other diseases, such as hepatic lipidosis (fatty liver disease), cholangtiohepatitis (inflammation of the liver and bile ducts), and inflammatory bowel disease.  (In fact, the concurrent occurrence of these three disorders in a cat has been termed “feline triad disease” or “triaditis”). 

 

As for diagnostic testing, it has been suggested that two enzymes found in serum, amylase and lipase, were good indicators of pancreatic inflammation if they were elevated, but recent comparisons have shown that almost 50% of dogs with elevated serum amylase or lipase levels did not have pancreatitis.  In cats, the situation is even worse.  Serum amylase and lipase levels have no clinical usefulness at all for the diagnosis of feline pancreatitis.  This is mostly because other organs in the body produce these enzymes, such as the stomach and small intestine.  Also, these enzymes are excreted by the kidney, and the presence of concurrent kidney disease (which is fairly common in cats) can falsely elevate the serum amylase and lipase levels. Occasionally, an elevated white blood cell count and elevated liver enzymes may be present, but these findings are also not specific for pancreatic disease per se, and in fact may mislead clinicians into thinking that the primary problem is the liver, rather than the pancreas.  

X-ray findings are subjective and may not be apparent.  A few cases show an enlarged liver and presence of fluid in the abdomen, but in most instances, radiographic findings are normal.  Ultrasound is a helpful tool for diagnosing pancreatitis.  In the past, it was suggested that if you could find the pancreas during an abdominal ultrasound, it had to be swollen and therefore abnormal.  This is not true.  A well-trained, skillful ultrasonographer using today’s state-of-the-art equipment should be able to identify the pancreas nearly every time the abdomen is ultrasounded.  Once identified, the ultrasonographer can then determine if the pancreas is of normal size, shape and density, or if it looks abnormal or diseased.  In feline pancreatitis, however, ultrasound detects pancreatitis only 11 – 35% of the time that it is present.

Several years ago, a test was developed to assess how well the pancreas was producing digestive enzymes.  The test, called the serum feline trypsin-like immunoreactivity (fTLI) test, was very accurate for diagnosing exocrine pancreatic insufficiency, the condition in cats described above whereby the pancreas produces inadequate digestive enzymes.  A low level confirmed that the pancreas was under-producing these enzymes.  Not long after the test became available, it was noted that cats with pancreatic inflammation would often have an elevated fTLI test.  Over the last few years, there’s been some controversy regarding how accurate the test is in terms of diagnosis; some clinicians sing its praises, while others remain highly skeptical.  Despite its flaws, the serum fTLI test is still the most sensitive diagnostic tool currently available for pancreatitis in cats.

Recently, a new test for measuring serum pancreatic lipase immunoreactivity (PLI) has become validated for dogs and cats.  Serum canine PLI (cPLI) has been shown to be highly sensitive for detecting canine pancreatitis.  Serum feline pancreatitis (fPLI) is still being evaluated, and preliminary studies look promising.  In some cases of experimental pancreatitis, as well as a few naturally occurring cases, serum fPLI has been elevated.  It is believed that with further refinement, the fPLI test may prove to be even more sensitive than the fTLI test.  At this time, however, there is no single diagnostic test, other than biopsy, that is completely reliable in diagnosing feline pancreatitis.  

Treatment of pancreatitis in cats can be equally as frustrating as the diagnostic process.  Supportive care is the mainstay of therapy.  Efforts should be made to try to identify and eliminate any inciting cause.  Intravenous fluid therapy in crucial, and blood or plasma transfusions may be necessary.  Resting the pancreas by prohibiting feeding for a few days may be warranted.  Medication to control pain and vomiting may be necessary, and antibiotics may be needed if an infectious cause is suspected.   

Sidebar:  Clinical signs in cats with severe pancreatitis 

Sign	% of cats affected
Lethargy	100%
Poor appetite	97%
Dehydration	92%
Rapid breathing rate	74%
Low body temperature	68%
Jaundice	64%
Rapid heart rate	48%
Vomiting	35%
Abdominal pain	25%
Abdominal mass felt on physical exam	23%
Labored breathing	20%
Diarrhea	15%
Incoordination	15%
fever	7%

Liver disease & Pancreatitis « WebCanine.com

Penny Watson [Penny Watson of the Cambridge Veterinary School and a European diplomate in internal medicine] Explores Liver Disease And Canine Pancreatitis, UK
Liver disease is one area where knowledge has advanced at a particularly rapid rate and has overturned many of the old certainties about the diagnosis and management of the condition.
Like all students of her 1980s generation, Dr Watson was told in her undergraduate course that steroids are a frontline treatment in the care of patients with chronic liver disease. But that was based on the assumption that most animals with the disease were just like human patients in suffering from an autoimmune condition. But now the finger of suspicion is pointing towards an infectious agent as the probable cause and in that case giving drugs that will weaken the patient’s immune response is likely to do more harm than good, she says.

Dr Watson will also point out that colleagues will need to buy a new text book if their current volume advises the attending clinician to put any patient with chronic liver problems on a low protein hepatic diet. Patients that are fighting liver disease will often need a higher than normal dietary intake of protein and it is particularly important that it is good quality material, she says. There is also increasing evidence that a diet rich in anti-oxidants can be helpful in managing the condition.

Chronic liver disease in dogs is a particularly frustrating condition to treat because the cause will often appear idiopathic and there is only a limited amount of published evidence to support the different treatment options. But there is anecdotal evidence that some of those options will help recovery and a proper diagnostic work up, including hepatic biopsies will help identify some patients with eminently treatable causes of liver problems.

In a second presentation, Dr Watson will be updating colleagues on another condition that presents difficult clinical challenges for a first opinion practitioner, canine pancreatitis. Again there is little convincing evidence to support any particular treatment option. She will be advising on ways to identify patients with severe disease at the earliest opportunity as the condition is very painful and with a high mortality and so the owners need to be warned of the poor prognosis.

“Dogs don’t drink alcohol, they don’t have gallstones and they don’t suffer from cystic fibrosis, which are the three main causes of acute pancreatitis in people. So we have got to be looking at some of the more unusual causes of this disease if we want to learn anything from our human medical colleagues,” Dr Watson points out.

But there are some strategies used in NHS hospitals that may help recovery in dogs with acute pancreatitis, such as aggressive use of fluid therapy and early attempts at assisted feeding in dogs who may be emetic and have little appetite for food. As in patients with liver disease, the received wisdom 20 years ago was to discourage feeding of patients with such a severely compromised digestive system – so once again the information told to veterinary surgeons-to-be as recently as the 1980s has again been found to be completely inaccurate, she says.

Notes

1. Session titles: Diagnosing and managing acute pancreatitis in the dog, 9am, Saturday 24 September Treatment of chronic liver disease, 10.30am, Saturday 24 September

2. BVA Congress, in association with BSAVA, will be held in London on 22-24 September 2011 under the theme ‘Vets in a Changing World’.

Source:
British Veterinary Association

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Pancreatitis: The often preventable disease

When I was working in the clinic, I was surprised at how many dogs came in suffering from pancreatitis.  Quite literally, that means “inflammation of the pancreas”.  The techs working would tell me, ‘it’s because people are feeding their dogs crap’. I thought they were almost kidding, yet our animals often suffer from so many things we can prevent, for example diabetes in cats.  Cats, in nature, don’t get fat.  I’ve heard many people suggest we are to blame for their acquisition of Diabetes Mellitus.

The pancreas is an amazing organ with many functions.  One of them, is to secrete digestive enzymes our bodies need to digest our food.  The idea is that the pancreas, due to any number of disruptions, over produces those digestive enzymes and begins to digest itself.  Those digestive enzymes, as they autodigest the pancreas, cause abdominal pain, vomiting, anorexia, fever, and dehydration (to name a few).

While there are some other factors which may cause it such as certain drugs, tumors, and trauma, the largest school of thought is that it’s fatty foods.  Dogs who are obsese, and/or consume high fat diets are at risk.  At the clinic, we saw instances of dogs suffering from pancreatitis following fatty-food holidays.  Fourth of July, Thanksgiving, Christmas..  Our dogs eat dog food and healthy snacks typically, but sometimes we allow them to feast on hot dogs and other fatty items their bodies are not used to.  Thusly, we see an increase amount of cases following our holidays.  We think our dogs are just like us.  In many, many ways.. they are.  But our bodies are used to the crap we put in them, our dogs’ bodies are not.

I have asked many people “how much” fatty junk would it take to cause pancreatitis, and the answer has always been the same: it depends.  I have had vets tell me a couple of hot dogs did it for a particular dog.  Other dogs, maybe much more.  Bottom line is, don’t risk it.  It’s bad enough we eat it, keep your dogs on healthy food.

This condition is treatable, but will most likely require your dog be hospitalized and put on a ‘no food’ diet until their digestive system and pancreas can calm down and return to it’s natural function.
Remember, our dogs love snacks and treats, but they are pretty happy with anything we give them.  Pass them some fruits and veggies, and they will likely be just as happy.  They will be extra happy to skip on hot dogs and avoid getting pancreatitis!

-SM