Tucker came in to us - all 7.5 pounds of him!! - having had vomiting and diarrhea for the past 4 days or so and being anorexic and very lethargic. He was also VERY painful when his belly was palpated. He was seen ripping up a bed a few days prior and his mom thought he may have eaten some of the fibers from it! Normally a bright eyed happy tail-waggy kinda guy.....we knew he HAD to be feeling pretty miserable to present this way. Blood work, xrays and a barium series later - he had two problems diagnosed! Pancreatitis and an obstruction!! Thankfully the obstruction (in his intestines) was pushed along - and out - with the barium. He HAD eaten some of the stuffing from the bedding! Luckily - THIS time - he did not need surgery! Did this cause the pancreatitis?? Perhaps. He was admitted to treat the pancreatitis and ..........after 3 days of intravenous fluids and medications.... thankfully went home a happy dog!
The Pancreas and Pancreatitis
The pancreas is an organ that nestles under the stomach and alongside the duodenum. It has two main functions. The first is to secrete enzymes for the digestion of food and the second is to secrete the hormones insulin and glucagon, both of which are involved in the regulation of sugar metabolism. The digestive enzymes are what concern us in the condition known as Pancreatitis.
Pancreatitis is Inflammation of the Pancreas.
In pancreatitis, inflammation disrupts the normal integrity of the pancreas. Digestive enzymes that are normally safely stored in granules are released prematurely where they digest the body itself, instead of safely digesting the food like they should! The result can be a metabolic catastrophe. The living tissue becomes further inflamed and the tissue damage quickly involves the adjacent liver. Toxins released from this orgy of tissue destruction are released into the circulation and can cause a body-wide inflammatory response. If the pancreas is affected so as to disrupt its ability to produce insulin, diabetes mellitus can result; this can be either temporary or permanent.
Specific Pancreatitis Disasters
Specific disasters include the disruption of surfactants in the lung tissue that normally keep the tiny air-filled alveoli from collapsing after each exhaled breath. Without surfactants, the alveoli close up and respiratory failure results. So pets with pancreatitis can present or come down with breathing problems.
Also, there is a syndrome called Weber-Christian syndrome where fats throughout the body are destroyed, which has painful and disastrous results. So a dog with pancreatitis may present with severe abdominal pain.
Pancreatitis is one of the chief risk factors for the development of what is called disseminated intravascular coagulation, or DIC, which is basically a massive uncoupling of normal blood clotting and clot dissolving mechanisms. This uncoupling leads to abnormal simultaneous bleeding and clotting of blood throughout the body.
Pancreatic encephalopathy (brain damage) can occur if the fats protecting the central nervous system become digested.
The good news is that most commonly the inflammation is confined to the area of the liver and pancreas,
but even with this limitation pancreatitis can be painful and life-threatening.
Causes of Pancreatitis
Most times we never find out what causes the occurrence of pancreatitis. There are however some known irritants that can pre-dispose an individual to this disease.
- duodenal reflux into the pancreatic duct. The pancreatic enzymes are safely stored as their inactive versions as a safety mechanism to prevent self digestion. In order to start digesting food, they have to be activated by activating enzymes released by the duodenal cells. If these enzymes backwash into the pancreas via the pancreatic duct - they activate the pancreatic enzymes prematurely and result in pancreatitis. This is the most common reason for this disease in humans though thought to be not as common in veterinary patients.
- concurrent hormonal imbalances such as Diabetes and hypercalcemia predispose an animal to pancreatitis. This is because the first causes the fat metabolism in the body to be altered and the second condition elevated blood calcium levels which activates stored enzymes.
- Trauma to the pancreas - whether it be external from an accident or internal - as from surgery - can cause pancreatitis.
- a tumor in the pancreas can incite pancreatitisl
- HIGH FAT food or diet is the most important cause of pancreatitis in the dog.
Signs of Pancreatitis
- In the dog: There is an increased incidence in the middle-aged dog. Clinical signs often follow recent history of a recent high fat meal or scavenger activity - ie. got into the garbage, ate something in the yard, got into something toxic etc...
- Anorexia, depression, hunched stance due to abdominal pain, dehydration, vomiting and diarrhea are most common complaints that are seen.
- The signs are very non-specific so diagnostics will be needed to diagnose this disease
- In the cat: Most patients may show only subtle signs
- Lethargy, anorexia, dehydration, and hypothermia are the most common complaints.
- Vomiting and abdominal pain are less common than in the dog.
Blood tests are done to assess the hydration status and status of other organs such as the liver and kidneys as well as the pancreas. Xrays may be needed to see if there is anything else wrong with the pet. We cannot assume that JUST because we suspect the pet has Pancreatitis - all else will be normal. Occasionally xrays may show that the pet has other problems in addition, which also need to be addressed in order for the pancreatitis to resolve. Sometimes, ultrasound may be the only way to definitively diagnose that the pet has pancreatitis. Which tests are needed depends on how sick the pet is, the presenting complaint and the results of individual tests.
The treatment of pancreatitis is aimed at giving the pancreas a rest so the inflammation goes down and the injured tissue heals. In order to do this, food and water are withheld and the pet is unable to be fed for 2 to 3 days. So supportive therapy is crucial in getting the dog or cat through, till they are able to tolerate being fed again. Hence, the pet is hospitalized for 3 or 4 days. Intravenous fluids, dextrose and pain management are critical in achieving stability and comfort for a pancreatitis patient. Antibiotics may be used to prevent additional problems with infections from the injured intestines, even though pancreatitis is not a bacterial disease in and of itself. Medication to decrease nausea and vomiting, as well as to decrease acidity and esophageal problems due to this are also called for and used.
Once the pet has stopped with all the symptoms and is able to tolerate feedings without pain, vomiting or loss of energy, it can be sent home on a low fat diet and medications for a week or two.
It is most important to maintain these patients on a low fat diet since as we described earlier - high fat is an important instigator of pancreatitis.