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Latest health and behavior news and advice from the veterinarians at Tufts University.

Features December 2014 Issue

When the Diagnosis is Pancreatitis

What to do depends on the severity of the condition.

Your dog has lost his appetite and perhaps has started to have unremitting episodes of vomiting, and maybe diarrhea, too, not to mention fever. And when you go to touch or hold him around his abdomen, it’s clear that the pressure is causing him pain. Get him to the vet’s office. He may have pancreatitis, and it needs to be treated. It’s not going to go away on its own.

Pancreatitis can really lay a dog low.

The pancreas, an organ located in the abdominal cavity near the stomach, has two functions. One is to help regulate blood sugar; cells in the pancreas called islet cells secrete the hormone insulin, which allows sugar to be removed from the bloodstream and be taken up by all the cells in the body, where it fuels the various cellular functions. The pancreas’s other role is to secrete enzymes that aid in digestion by breaking down food in the small intestine so it can be absorbed into the bloodstream and used to nourish all the dog’s tissues. But when pancreatitis develops, those digestive enzymes misfire.

Normally, explains Tufts veterinarian Linda Ross, DVM, an expert in all things gastrointesintal tract, the pancreatic enzymes that aid in digestion go through the pancreatic duct right to the small intestine where they break nutrients like carbohydrates and fats into smaller components so they can be directly taken up by the blood. But sometimes, instead of going through the duct, these enzymes “escape the cells” where they’re manufactured and “actually start digesting the cells of the pancreas” itself, Dr. Ross explains. That causes inflammation of that organ; hence, the term “pancreatitis” - the suffix “itis” means inflammation.

Once the escaped enzymes start digesting the pancreas itself, that leads to more inflammation, and it “gets into a vicious cycle,” says Dr. Ross.

Cases increase at holiday time

“We see a lot of pancreatitis in dogs after Thanksgiving, Christmas, and Easter,” Dr. Ross notes. Why?

The most common cause of pancreatitis in a dog is the ingestion of a lot of fat. “People feed a lot of high-fat treats in the wake of these holidays, or the dog gets hold of them inadvertently,” the veterinarian notes. The fat then increases the production of the digestive enzymes in the pancreas, which is what gets the process going.

There are also a number of other things that can predispose a dog to developing pancreatitis.

  • Breed. “There are some breeds,” says Dr. Ross, “particularly schnauzers, that can have a genetic defect that causes their blood lipids, or fats, to remain elevated, thereby raising the risk that too many digestive enzymes will be secreted by the pancreas and start eating away at it. Terriers also are predisposed, she says, although “we don’t know why. It just is.”
  • Disease. Certain diseases cause more fat in the blood. These include diabetes and Cushing’s disease.
  • Drugs. Cortisone, a commonly used medicine prescribed for dogs to treat everything from allergies to certain cancers to diseases that affect the immune system, can set the stage for the development of pancreatitis. Others drugs can, too, but they are not used nearly as frequently.
  • Trauma. If a dog gets hit by a car, the impact can damage the pancreas to the point that it overshoots the mark in enzyme secretion. The pancreas can also become traumatized inadvertently during an abdominal surgery taking place on a nearby organ or tissue. The pancreatic trauma causes leakage of enzymes from the enzyme-producing cells, and they go and attack other parts of the pancreas.
  • Obesity. “So much of pancreatitis is related to fat,” Dr. Ross comments. Obesity is no exception and can make a dog more likely to develop the disease.

Making a diagnosis

Neither you nor the veterinarian will be able to make a definitive diagnosis based on the way the dog acts or feels. Signs and symptoms occur along a continuum — it’s not a fixed set of specifics. For instance, sometimes a case of pancreatitis is mild enough that you won’t even think to take your dog to the doctor. He may just not seem himself for a day or two, vomit once or twice, and then recover. It’s as benign as if he ate too much grass.

On the other hand, some dogs can suffer severe, recurrent vomiting episodes, diarrhea, and fever (from the inflammation, which sometimes spreads even to tissues in the abdomen near the pancreas). They’ll get dehydrated. They might also be in a lot of pain — picking them up by the belly can prove excruciating for them. In the illness’s most severe form — acute necrotizing pancreatitis — cells of the pancreas are actually dying, which can prove fatal for the dog.

In the middle of the curve, though, are loss of appetite, vomiting, pain, maybe some distention of the abdomen. Then, if it gets worse, there can be dehydration, kidney problems, perhaps even heart arrhythmias. Jaundice can occur, too. “The pancreas is right next to the liver,” Dr. Ross points out, “so sometimes the inflammation spreads there.” In addition, she notes, “the pancreatic duct and the bile duct connecting to the liver are right together, so the bile duct can also become compressed by inflammation. That’s what actually causes the dog to become jaundiced, or yellow.” (Because dogs’ skin is almost completely covered by hair, jaundice is often easiest to appreciate in the gums or the whites of the eyes.)

If your dog’s signs are very mild, “often times we don’t even run tests,” Dr. Ross says. The doctor doesn’t need to because treatment is the same whether it’s a mild stomach upset or mild pancreatitis: withhold food and sometimes water for 36 to 48 hours, then reintroduce food gradually via a bland diet.

But if symptoms are more severe, tests are called for. The arsenal of diagnostic testing for pancreatitis includes the following:

  • Complete Blood Count. “That would help us look for inflammation,” Dr. Ross says. If there’s inflammation, “the dog’s white blood cell count will be increased.”
  • Chemistry profile. Also performed with a blood draw, a chemistry profile will look at evidence for increased fat in the blood, particularly in the form of triglycerides.
  • Pancreatic enzymes.There’s a test to see whether the levels of two pancreatic enzymes have increased. These are amylase (which helps digest carbohydrates) and lipase (which helps digest fat). This is a more specific test for pancreatitis than a complete blood count or a chemistry profile. But, says Dr. Ross, “there can be false positives and false negatives,” so you can’t view the results with 100 percent confidence.

In fact, no one test provides a definitive diagnosis for pancreatitis. “You have to put all the test results together, then add in the dog’s clinical signs, and come up with a probable diagnosis from there,” Dr. Ross says. The only gold standard test for a foolproof diagnosis is a biopsy. “But you don’t want to do that,” she says. “It’s invasive, and it inherently means you’re going to be going in and damaging the pancreas and making things worse.”

Beth Mellow, Tufts Media Services

When the pancreas becomes inflamed, organs near it can be adversely affected as well.

Fortunately, blood work can reveal more than just white blood cell count and the amount of fat in the blood. A low blood calcium level can also be indicative of pancreatitis. Consider that the release of digestive enzymes by the pancreas leads to the saponification of fat, which literally means soap formation. Calcium is involved in that reaction, so the lower the blood calcium, presumably, the more that has been precipitated out of the blood to participate in that chemical process.

Blood work can also show telltale elevations in liver enzymes. Again, because the pancreas is right next to the liver, pancreatitis can affect that organ’s ability to properly regulate its own enzyme release system.

Finally, there’s a test that many vets call a cPLI, which stands for circulating pancreatic-lipase immune reactivity. But this, too, can have false negatives and false positives, “so it’s not a 100 percent indication,” says Dr. Ross. “It’s just another test whose results we look at combined with all the others.”

If the damage to the pancreas is unusually extensive, or there’s a tremendous amount of inflammation, sometimes the islet cells there that release insulin in order to regulate blood sugar stop working properly, and the vet will see too high a concentration of sugar in the bloodstream. “That usually goes away when the pancreatitis gets better,” Dr. Ross says, “but occasionally results in permanent diabetes.”

Along with blood tests, a veterinarian might be able to zero in on pancreatitis with diagnostic imaging, an ultrasound in particular. There are signs on an ultrasound that provide an indication of inflammation of the pancreas. A vet will also use an ultrasound to look for cysts or abscesses that may form within the pancreas during pancreatitis.

Treating the disease

Mild cases of pancreatitis can be treated on an outpatient basis. As we said before, all you have to do is withhold food and water for 36 to 48 hours and then reintroduce food with a bland diet. “One of the key things is to make sure to feed a diet that’s low fat,” says Dr. Ross. “A typical low-fat diet for the short term,” she says, “is rice and skinless chicken breast, microwaved or baked. You can also use lean ground beef,” she adds but notes that “I always find it has more fat than the chicken. Low-fat cottage cheese can be used as well. It depends on what the dog will eat.”

You can also choose a low-fat over-the-counter diet or low-fat prescription diet, checking with your veterinarian, or perhaps a veterinary nutritionist, to see which brands meet the necessary requirements.

How long should the dog remain on a low-fat meal plan? “If the pancreatitis is on the mild side and was caused by your pet’s getting into the Christmas turkey,” Dr. Ross says, “it might not need to be long-term — just until your dog is better.”

More severe cases of pancreatitis are going to require more involved treatment. “If your dog is vomiting a lot and is dehydrated or is running a fever, the vet will likely recommend hospitalization,” says Dr. Ross. “She will give intravenous fluids to correct any dehydration and will keep the dog from eating or drinking for a period of time that might go longer than a day and a half to two days. New studies are questioning whether that’s totally necessary,” she says. “But for now, the standard is to withhold food and water until the dog is no longer vomiting or is no longer nauseated. You can tell a dog is suffering from nausea if he’s licking his lips a lot. If the nausea is severe, he may have a lot of drooling.”

The vet will most likely also give the dog some medication to stop the vomiting. Pain medication often goes into the treatment protocol, too. The pain experienced by a dog with severe pancreatitis can be “almost as bad as appendicitis pain,” Dr. Ross remarks. (What the dog will most likely not get is antibiotics. “In people,” says Dr. Ross, “pancreatitis is often associated with infection. That’s usually not true in dogs.”)

In the most dire of cases, a dog can become critically ill. The pancreatitis can cause inflammation throughout the body, requiring intensive care. “A dog can develop blood clots, kidney failure, fluid in both the abdomen and the chest,” says Dr. Ross. If not properly handled or if the disease rages out of control too fast, death can ensue.

To help a dog heal, he will be kept in the hospital on his cocktail of different treatments until his fever goes away; he’s hydrated again; he has stopped vomiting; and he is experiencing no more abdominal pain. Even then he cannot go home right away. “We’ll start him back on some water to drink. If the dog does okay with that, we’ll go to tiny amounts of a bland diet — and make sure he can deal with it before moving forward. Then we’ll gradually wean him off the IV fluids, finally sending him home on a low-fat diet. How long he stays on it depends on how severe the disease is. Sometimes we recommend it permanently.”

Preventing a recurrence

For most dogs, preventing a recurrence means no fatty meat, no gravy, no sweet potatoes or other vegetables made with loads of oil, no buttery desserts….you get the drift. That’s generally all it takes to make sure pancreatitis doesn’t repeat itself in your dog. But if the dog is on a diet that the vet determines is high-fat, or at least higher in fat than necessary, she may advise you to go with a different formula — again, sometimes for a while, sometimes permanently. It depends on the severity of the bout of pancreatitis the dog just went through. In most cases, it will have been moderate to mild. Keep the trash can tightly sealed, and keep your dog away from your own rich foods.

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