Is there anyone who’s heard ‘pancreatitis’ and not freaked out a little? And if you didn’t freak out, maybe its because you truly just didn’t know much about it. I will review what pancreatitis is, how its diagnosed, how its treated, the prognosis, how to prevent pancreatitis and our personal pancreatitis journey with not 1 but 2 doxies.
First you might be wondering what your dog’s pancreas has to do with diabetes. The pancreas is an organ that has both endocrine (think insulin production) and exocrine (think digestive enzymes for fat and protein breakdown) functions. So since the pancreas has endocrine functions it is most definitely involved in diabetes. Pancreatitis can be acute or chronic. It can be mild or subclinical, it can also be severe. Pancreatitis can cause diabetes. Its also said that diabetes can cause pancreatitis.
Here’s a little breakdown of how pancreatitis happens: Pancreatic ‘juices’ get secreted ➡️ Other enzymes get activated ➡️ Damage to the exocrine pancreas occurs (Ex. Bleeding, swelling, inflammation, breakdown including fat breakdown, etc) ➡️ The body mounts an inflammatory response ➡️ Enzymes and inflammatory substances spread throughout the body ➡️ General inflammation spreads throughout the body affecting multiple organs. So with all this potentially going on, you can see how even just one episode of pancreatitis could cause permanent changes to your dog’s pancreas.
SYMPTOMS of pancreatitis can be vomiting, anorexia/hyporexia (not eating at all versus decreased appetite), dehydration, fatigue, weakness, pain, depression, diarrhea, fever, high heart rate, breathing difficulties, shock, etc. My non-diabetic dachshund was diagnosed with pancreatitis years ago and her only symptom was that she wasn’t sleeping well. She was constantly up and down, because she was unable to get comfortable due to pain.
You may never know the CAUSE of your dog’s pancreatitis. Many cases are idiopathic, or cause unknown. Here are some potential causes:
Diet and nutrition are important triggers. Generally this is a high fat/low protein diet. There are typically an increase in cases around the holidays when dogs tend to get into table food they shouldn’t. Always ensure your dog can’t get to food or your trash! It can happen with just one ‘meal’ of fatty table scraps. Also certain prescription diets such as those that help dissolve bladder stones.
Hypertriglyceridemia is when there is excess fats circulating in the dog’s blood (typically >500mg/dL).
Surgery – although this is now thought to be caused by decreased perfusion to the pancreas during anesthesia
Any dog can be affected by pancreatitis. It is more common in middle aged to elderly dogs. It is more common in females. Research from necropsies are beginning to show far more dogs are affected than anyone originally thought. Certain breeds are known to be more predisposed to pancreatitis. Those include: Schnauzers, Poodles, Cocker Spaniels, Yorkshire Terriers, Dachshunds, etc.
DIAGNOSING pancreatitis whether acute or chronic can be very tricky! I was shocked to discover Beignet had chronic pancreatitis. How could I have not known she had it??? In humans, lipase and amylase elevations typically give you your diagnosis but do not determine severity of disease. Amylase shows elevations within 5-8 hours of symptom onset and returns to normal by day 3-4 and reaches a maximum 12-72 hours after symptom onset. Some research supports only checking lipase in humans due to it being elevated both in the early and late stage. Lipase elevates within 4-8 hours of symptom onset, peaks at 24 hours and returns to normal within 8-14 hours. In humans, both amylase and lipase can also increase with other disorders. I feel its important to understand a little about human diagnosis to help us understand dog diagnosis. Below I will go through each diagnostic option in dogs:
- CBC & Chemistry Profile: These are extremely important to evaluate the dog for systemic complications, but are NOT useful to diagnose pancreatitis. In a dog with pancreatitis, you may commonly find signs suggestive of nonspecific inflammation, a decrease in platelet count, an increase in neutrophils with a left shift, increased BUN and creatinine, increased liver enzymes, increased bilirubin, etc. Although amylase and lipase are on the Chem profile, they are described below.
- Amylase: Has very poor sensitivity and specificity. Very limited as a measure of pancreatitis diagnosis. Possibly given the human info above, its already potentially normalized by the time the dog presents to their vet.
- Lipase: This is generally on most in-office metabolic panels. Lipases are something released from multiple organs including the pancreas, liver, stomach, endothelium etc). A serum total lipase is NOT specific for pancreatitis. An article online from Texas A&M Vet School said it could miss up to 86.4% of pancreatitis patients. Lipase can be increased by steroids, cancer as well as diseases of the kidney, GI tract, and liver. Also there is an increase in false negatives in pancreatitis patients due to hemolysis, lipemia and icterus (jaundice). Beignet has never had an elevated amylase or lipase.
- Serum Pancreatic Lipase Immunoreactivity (PLI): The Spec cPL®️ specifically tests for pancreatic lipase and has rare false positives. In office rapid cPL tests are available, but generally cPL tests are send out tests for most vets. This test is how we got Beignet’s diagnosis of chronic pancreatitis. http://vetmed.tamu.edu/gilab/service/assays/pli. Be aware that many GI conditions can cause mild pancreatic inflammation. This in turn can increase your cPL test. Sometimes a repeat cPL maybe needed to help determine if the dog has a primary or secondary pancreatitis.
- Trypsin-like Immunoreactivity (TLI): This is the diagnostic test of choice for EPI as it tests exocrine pancreas function. It is not very sensitive for pancreatitis though.
- Abdominal X-ray: This is more important to help excluse other diagnoses in your vet’s differential diagnosis (the diagnoses your vet is ruling in or out including pancreatitis). Findings in pancreatitis will be nonspecific.
- Abdominal CT or MRI: Very insensitive in cats and never truly evaluated in dogs. Probably not worth what this would cost you.
- Abdominal Ultrasound: Highly specific for pancreatitis, but just seeing an enlarged pancreas with fluid accumulation around it is not enough to give you the diagnosis. With newer high resolution ultrasounds, occasionally pancreatic nodular hyperplasia could be misinterpreted as pancreatitis. When it comes to an ultrasound, consider the expertise of the ultrasonographer (who maybe your vet), quality of the machine, and the level of suspicion of your ultrasonographer. When Beignet was sick, my vet told me his ultrasound machine was older and if we wanted to do one locally, he would send us to do one on a better machine. We were going to a vet school, and chose to wait to do one there done by their radiologist. I was able to see chronic changes quite easily on the entire left side of Bennie’s pancreas on her ultrasound😢. Contrast enhanced ultrasounds have improved diagnostic evaluations but aren’t routinely done.
- Pancreatic Cytology or Histopathology: This can give you a definitive diagnosis. FNA (fine needle aspiration) of the pancreas has been reported to be safe. But sometimes the disease is very localized, so a normal FNA does not exclude pancreatitis. Biopsy on the other hand can increase a dog’s risk of pancreatitis as compared to FNA. If pancreatitis is severe, a dog’s anesthesia risk is much greater. An exploratory lap or FNA may be too risky in severe pancreatitis.
If your dog has joined us in the pancreatitis club, you maybe curious about TREATMENT options:
- Aggressive fluid treatments with electrolyte replacements if needed.
- Remove any potential causes.
- +/- Gut rest. Recommendations on this vary. Definitely will be done if the dog is vomiting despite anti-nausea medications. Beignet required it.
- Nausea medications: Cerenia and ondansetron are potential options
- Pain medications
- +/- Antibiotics: these have questionable value so are not routinely recommended.
- Reglan (metoclopramide) for improving gastric motility. It can help with nausea but should not be used as the dog’s anti-nausea medication in pancreatitis. I read that it could decrease blood flow to the pancreas potentially. Bennie was put on this for gastric emptying and it was increased from twice to three times a day when she was hospitalized at a vet school.
- Reflux medications. Many dogs are put on them but I haven’t seen them listed as parts of treatment. Bennie was put on omeprazole but advised to stop after a week due to potential issues with long term PPI use. However she may have been put on this more for her suspected IBD than her pancreatitis.
- Food: May require a permanent food change. Generally <10% dry matter fat, but Ultra Low Fat diets are what we will see being recommended in the future. Stay tuned for an upcoming post with all my dry matter fat calculations. Do not use the fat percent on your dog food label (unless Hill’s, who often has the actual dry matter fat values on their labels) but instead put the information into a calculator like this one http://fnae.org/dmb.html. Know that these values are minimums and typically the food contains ~3% more fat than what you calculate. You can always contact the company to ask for the actual value. Early nutritional support is a key component of successful treatment in humans with pancreatitis.
- Plasma transfusions maybe needed in severe cases of pancreatitis.
- If a dog isn’t responding, prednisone, prednisilone, or cyclosporine maybe given. Cyclosporine for a dog with diabetes is preferred as it has less of an impact on insulin resistance. There is not a lot of data on its use in chronic cases.
- Entyce – a newer appetite stimulant maybe needed to get your dog to eat. Since I forgot to originally add this, I will post about Entyce in an upcoming blog.
To PREVENT pancreatitis, keep your dog at their recommended, ideal weight. Avoid feeding foods high in fat. Work on a weight loss plan for your dog if they are overweight. Discuss any medications your dog is on with your vet to determine if they potentially increase your pet’s risk.
Your dog’s PROGNOSIS depends on the severity of disease. Risk factors for poor outcomes include: hypothermia, acidosis, low calcium and failure of 1 or more organs. Chronic pancreatitis typically has better outcomes, but may eventually cause diabetes (like in Bennie) and/or other diseases that affect the dog’s quality of life. There are many dog’s like Beignet that have an upset tummy here and there, but aren’t very ill. So even with a visit to the vet, no one is aware that the dog is actually having a mild pancreatitis flare. Chronic pancreatitis maybe associated with intestinal or liver inflammation.
This went a little longer than I initially intended. My information is more to give a better understanding of pancreatitis and should not replace the care and advice of your vet team. My information comes from my own personal medical knowledge and reading various articles over the past months. Texas A&M vet school has many great articles on pancreatitis. The Merck Manual online also has some great reading on dog and cat pancreatitis. Hopefully if you experience an acute flare your dog does well! I will tell Bennie’s story in a future post.
-Devoted Doxie Mom