Pancreatitis In Your Dog

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Why did my dog develop this problem while other dogs didn't ?

Ron Hines DVM PhD ..........................If your pet is a cat, go here

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What Is Pancreatitis?

Your dog’s pancreas has the same function that yours has. It is a pale pink organ with two functions and two different tissue-type areas inter-dispersed. One of the tissue types (the pancreatic acini), produce enzymes that are released into your pet’s intestine to help digest its food; the other tissue areas (the islets of Langerhans), produce the hormones that regulate your dog’s blood sugar level and digestion (insulin, glucagons and somatostatin). Both are critical to your pet’s well being.

I try to keep my web articles as readable as I can for pet owners. If you want a more detailed medical explanation of acute pancreatitis or other perspectives, go here. For a more detailed explanation of chronic pancreatitis, go here

When your dog’s pancreas is inflamed, the problem is called pancreatitis. Since inflammation can be mild, substantial or severe, all degrees of pancreatitis occur in dogs. Inflammation can be acute (sudden) or it can be continuous and progressive (chronic pancreatitis). Pancreatitis can occur only once, or it can reoccur again and again. The signs can be mild and barely noticeable to owners; or they can be severe and life threatening. Perhaps 2 out of 135 dogs will develop pancreatic problems sometime in their life.

An inflamed pancreas leaks digestive enzymes. Because the digestive enzymes digest any of your pet’s own tissues that they encounter, they can cause severe inflammation and pain within the abdomen of your pet. If the leakage is severe, toxic remnants of destroyed tissue enter the pet’s blood stream causing body-wide damage.

Repeated bouts of inflammation eventually scar your pet’s pancreas so badly that it cannot perform its functions. When that happens, your pet may loose weight since it is no longer able to digest and obtain enough nutrients from the food it eats (maldigestion-malabsorption syndrome). The color and consistence of its stool may change. Having lost the ability to regulate its blood glucose, it may become diabetic.

The majority of dogs that develop pancreatitis are middle aged or elderly. (although the problem may have been brewing earlier in their lives) It is not unusual for a single pet to have multiple digestive tract problems in addition to pancreatitis (ref). Pets that are already suffering from diabetes, Cushing's disease or hypothyroidism are more prone to pancreatitis. (ref)

Why Did This Happen In My Dog ?

In the vast majority of cases, veterinarians never learn why your particular dog developed pancreatitis. It does appear that the pancreas of many pet’s malfunction when it is exposed to too much circulating lipids (fats=triglycerides) in the blood. This can be due to a diet too rich in fat, obesity, a lifestyle of inactivity, or specific diseases that tend to elevate the lipid content of your pet’s blood.

In some miniature schnauzers, a genetic defect, (mutation of the PSTI gene) seems to be responsible for this high lipid problem and subsequent attacks of pancreatitis (familial hyperlipidemia) (ref)

Dachshunds, Yorkshire terriers, Silky terriers and Skye terriers seem to get more than their fair share of pancreatitis.

I see it more frequently in neutered pets, probably because they tend to be more obese.

Anything that inflames, damages or blocks the duct passage that conveys pancreatic enzymes to the intestine can cause a backup of digestive enzymes in the pancreas and subsequent pancreatitis.

Corticosteroid administration and hypothyroidism have also been implicated in pancreatitis, possibly because they are known to also increase blood lipids.

In some cases, abnormally high (or low) blood calcium levels (ref 1,ref 2), certain antibiotics, diuretics, anti-epileptic (ref ) and anti-cancer agents (ref) seem to have contributed to the problem. However, it is never clear if it was the medication that caused the pancreatitis or the disease that the medication was being given for.

The Acute Form Of Pancreatitis

Although there are two stages of pancreatitis, it is the acute attacks that are the most frightening, the most dangerous and the most likely to be remembered. Acute pancreatitis attacks are very painful to your pet. They come on suddenly and without warning. They occur because of the severe abdominal inflammation caused by the leaking pancreatic enzymes.

The Chronic Form Of Pancreatitis

Repeated bouts of acute pancreatic attacks eventually destroy the organs ability to produce digestive enzymes. Much of the acinar tissue you see in the diagram linked at the top of this page (microscopic photo A) are replaced by scar tissue and inflammatory cells (microscopic photo B). (The term for this is exocrine pancreatic insufficiency or EPI)

You might observe recurrent bouts of cramping, abdominal pain and tenderness, arched back, reluctance to move, little or no appetite and transient depression over an extended period as your pet journeys into the chronic form of pancreatitis.

Once these changes occur, the pancreas cannot regain its healthy state. In those pet, veterinarians will attempt to lessen your pet’s need for the missing enzymes (through special diets) and supplement the missing enzymes with similar enzymes available in powder or tablet form.

Sometimes, it is not only the enzyme-producing tissue within the pancreas that is lost. The portion producing insulin can also be lost, leading to diabetes.

I have noticed that stool color and consistency often change as pets pass into the chronic stage of pancreatitis. It tends to be a lighter yellowish or clay color, smell worse, and have a greasy appearance.

This is because of a lack of pancreatic enzyme (pancreatic lipase) necessary to digest, emulsify and absorb fatty substances in your pet's diet. (similar stool changes occur when a pet’s liver no longer produces sufficient bile)

Because these pets are starved for nutrients, they tend to gradually loose weight no matter how much they eat.

What Are The Signs I Might See If My Dog Has Pancreatitis?

If you have read this far, you already know that the signs you will see in your pet depend on how severe its pancreatitis is and how long the attack(s) have been occurring. None of the signs I describe occur only in pancreatitis; in fact there are many, many other diseases, some mild, some serious, that can cause the same signs in your pet.

Acute attacks come on suddenly. Your pet will probably loose interest in food. It's activity level will decrease. Many are depressed and weak. Some dogs pant and all appear worried. These dogs often vomit and they may develop diarrhea (often bloody). Their tummies are very tender when they are poked or prodded and, because of this, they may resist lying on their side. Many run a fever and about half become dehydrated. (ref)

If the attack is serious, the pet’s pulse is usually rapid and weak.

If the attack is very severe, the dog may go into shock (vascular collapse) or even develop a life-threatening condition called DIC. Disseminated Intravascular coagulation (DIC) is a paradoxical situation where the pet’s blood is simultaneous bleeding and clotting throughout its body. Needless to say, it is an emergency. You need to get your pet to a veterinary emergency center immediately.

Here is a typical , less severe, case that arrived at the small animal clinic of the University of Saskatchewan.

What Are Some Complications That Can Occur?

Dogs with severe pancreatic attacks are in shock. They need intensive care and support. The most important thing the veterinary staff will do is to keep your pet’s blood pressure and kidney function adequate by administering intravenous fluids through an IV tube. The veterinarians will not be certain what is actually wrong with your pet until tests are done – but the treatment of shock is standard no mater what the cause. Warmth to maintain its body temperature, steroids to counteract shock, antibiotics to counter infection and oxygen to help the pet breath are all part of standard therapy for shock of any kind. Your pet will probably receive medications to relieve its pain. If tests show that your pet's blood is not clotting normally due to DIC, your veterinarian will use his/her judgement as to what additional medications it might need (there is a lot of disagreement). (ref)

Is My Dog’s Life In Danger?

Sudden pancreatitis is always an emergency. It is impossible to know in advance how ill your pet will become. Some cases, abruptly dissipate; while others will continue to spiral downward despite an enormous effort by your veterinarian and their technicians.

Once a pet’s pancreas is damaged, a cascade of events occurs. Pancreatic enzymes, once liberated and loose within the body, are very corrosive (auto-digestion) to the undamaged portions of your pet’s pancreas and its other body organs so things can deteriorate rapidly. However, with intensive veterinary care, the majority of pets do stabilize before irreversible damage is done.

In the star-crossed pets that cannot be saved, massive amounts of pancreatic enzymes enter the circulation. Veterinarians have no medications that can neutralize these enzymes. We can only give your pets circulatory and homeostatic system as much support as possible. It is common for dogs with severe pancreatitis to have dangerous heart beat irregularities as well. Your pet’s first 48 hours will be its most critical.

What Tests Will My Veterinarian Run ?

When a pet is rushed to a veterinary hospital, it is often unclear at first as to the nature of the problem. Besides a thorough physical examination, veterinarians begin by running a series of standard blood tests called a CBC/WBC and blood chemistry, while they attempt to stabilize the animal.

When these test results return, it is common to find an elevate white blood cell count, decreased clotting cells (thrombocytes) and evidence of dehydration (high PCV, Hct). That, in itself, it not sufficient to diagnose pancreatitis. But it may make your veterinarian add it to the list of possibilities.

Lab Work

Laboratory tests on your pet’s blood not only help veterinarians diagnose acute pancreatitis attacks, they allow veterinarians clues as to the severity of the attack and, by following blood levels day by day, they let your vet decide if the treatment plan is working.

Enzyme test results are often below normal when repeated acute attacks have destroyed much of your pet’s pancreatic function (pancreatic enzyme insufficiency) . So they are useful in identifying chronic pancreatitis cases in dogs that can no longer digest their food properly.

You can go to this page to see normal lab work results for your pet.

Serum lipase & cPL (Pancreatic Lipase Immunoreactivity(PLI))

If the veterinarian and your pet are fortunate, your pet’s blood lipase level may be sufficiently elevated to suggest pancreatitis. Lipase is one of the enzymes normally produced by the pancreas. But in healthy animals, only traces should be present in the blood. However, traditional serum lipase tests are not a very accurate indication of pancreatitis. They are sometimes normal when pancreatitis is occurring, and sometimes abnormal when pancreatitis is not the cause of your pet’s current illness. If serum lipase levels in your dog is 2-3 times what it should be, and your pet is showing the physical signs of pancreatitis your veterinarian will probably lean toward a diagnosis of pancreatitis and proceed accordingly.

Texas A & M University’s Gastrointestinal Laboratory has done pioneering research to discover more accurate ways to diagnose pancreatitis in your pet. Their research recently led to the development of a much more sophisticated and accurate test for pancreatic lipase, the cPL test from Idexx Laboratories. This new test will be positive in about 75% of dogs with acute pancreatitis. The A&M GI lab is currently the World center of pancreatic and gastrointestinal knowledge in dogs and cats.

Serum Amylase

Amylase is another enzyme produced by your pet’s pancreas. It may also leak into the animal’s blood stream when the pancreas is damaged. However, the standard blood serum amylase enzyme assay is no more accurate than the standard serum lipase assay in picking out pets that are undergoing acute pancreatitis. (amylase tests are thought to pick out a bit more than half of the pancreatitis cases in dogs )

Serum Trypsin-like Immunoreactivity (cTLI)

Another pancreatic digestive enzyme that shouldn’t be floating free in your dog’s blood stream is trypsin. Like all tests for pancreatitis, a single positive or negative test result is never an absolute indication that your dog has or does not have pancreatitis. But the test is valuable when taken together with your dog’s symptoms, other bloodwork and the tests that I discuss next. A positive cTLI test may not be as reliable an indicator of pancreatitis as a positive cPL test. (ref) But diagnostic laboratories tend to promote and favor the tests they market. Others found the TLI test quite helpful. (ref)

Ultrasound Examination

The ultrasound machine has become as important to your veterinarian in the 21st Century as the stethoscope was in the 20th. It is such an invaluable and priceless way to see what is happening in your pet’s body. It can be hard to interpret the images one sees on the machine – so the veterinarian must be highly skilled in using it if the machine’s full potential is to be met. In the hands of a highly skilled ultrasonographer, ultrasound will detect over half of the cases of acute pancreatitis - depending on the skill of the radiologist.

If there is even the slightest doubt in your veterinarian’s mind as to what the images mean, have them sent, electronically, to a board-certified veterinary radiologist. (no matter what the certainty, positive ultrasound findings need to be confirmed with laboratory blood tests.)

X-rays (radiographs)

X-rays require that the tissues they pass through be of varying densities or composition to appear on the film or screen. Unfortunately, the pancreas is nestled among tissues that are quite similar in density and composition. So the pancreas is quite hard to visualize on x-rays. However, when the organs in your pet’s abdomen are grainy and hazy on the film (a sign of inflammation or pooled fluids) or when they are slightly displaced due to swelling, your veterinarian might take it as a hint of possible pancreatitis. The chief use of x-rays is to rule out other possible causes of vomiting and abdominal pain – things like swallowing foreign objects, intestinal blockages or tumors. Some large veterinary centers own CAT scan [Computed tomography (CT)] or MRI apparatus. They can be helpful in frustrating cases when all other standard tests fail to give a definitive answer as to why your pet is in pain.

Pancreatic Biopsy

Occasionally, your veterinarian will still remain perplexed as to the cause of your pet’s abdominal health issue. Tests results may come back, sitting on the rail, time-after-time and no one is sure what the problem is or how to proceed. You may have taken your dog to several veterinary hospitals and received conflicting diagnosis. In those cases, peering into your pet with an instrument called a laparoscope, surgically exploring the pet’s abdomen or guiding a small biopsy needle to specific areas with the ultrasound machine will yield your veterinarian tissue samples that are sometimes the only way to get to a definite diagnosis. (Even pancreatic biopsies are not fool proof. Pathologists can differ on their interpretation and pancreatic inflammation can be limited to small, dispersed areas that can be missed.)

What Treatments Does My Veterinarian Have For My Pet?

When your pet is suffering from the shock of a sudden case of severe pancreatitis, your veterinarian will concentrate on stabilizing it first. Treatment for shock from any cause is quite similar. So even if your veterinarian is still unsure of the diagnosis, the initial treatment plan will be quite similar. That plan will concentrate on keeping your pet’s circulatory system functioning adequately, maintaining your pet’s body temperature and providing its tissues with adequate oxygen. This will require intravenous fluids and, perhaps, oxygen and other heroic efforts.

Pets will also receive medications to combat pain and nausea and often antibiotics as well. In addition, some pets will receive treatment for DIC, bicarbonate, potassium, corticosteroids, and even transfusions.

Longer term, some benefit from antacids and vitamin B injections, pancreatic enzyme supplements and a very bland diet.

We want to give your pet’s pancreas a period for rest and renewal. So we generally do not want anything going into your pet’s mouth for several days.

Will A Special Diet Help?

Yes. So will returning your pet to a trim weight – if obesity is a problem.

There are several easily-digested commercial diets on the market. The most popular are Hills Prescription id and Purina’s EN. You can also prepare an easily-digested diet yourself. You will find recipes here. Whichever you choose, feed your pet frequently during the day in smaller amounts.

Try to keep your sedentary pets diet low in fat (5%) and only moderately high in protein (18-20%). Both protein and fat require the pancreas to work harder. (ref 1)

Does My Dog Need Any Special Supplements?

Yes. If your dog has documented pancreatic problems, it will not absorb fats and oils from its food well. Certain vitamins (A,D,E&K) are fat soluble. They are poorly absorbed when your pet lacks the pancreatic enzymes needed to absorb fat or when fat in your pet’s diet is reduced. So I suggest you give your pet a portion of a Centrum-type complete multivitamin (a portion proportional to its body weight) every day.

There are also two essential fatty acids that your pet might become deficient in (Linoleic and linolenic acid). Supplement your pet’s diet with these as well. Do this by giving your pet a mixed omega-3/omega-6 supplement from a health food store (in a portion proportional to its body weight). You can drip the capsule contents on its food.

There are commercial enzyme preparations meant to replace the pancreatic enzymes your pet can no longer produce in cases of chronic pancreatitis. If your pet’s stool returns to normal texture and consistency after a bout of acute pancreatitis, they are not required. But if your pet cannot maintain a healthy body weight, or if its stools remain abnormally greasy, these digestive enzyme tablets can be of benefit. Two are Viocase and Pancrezyme. If you use a tablet form, crush and disperse it in the pet's food.

If they help your pet, I still would not return it to its prior, high-fat (high-lipid) diet. That is because so many cases of pancreatitis are associated with high blood lipids (triglycerides). My feeling is that putting the pet back on its old diet is an invitation for future attacks.

What Can I Do To Prevent A Future Attack ?

Some dogs suffer a single pancreatitis attack and never another. Veterinarians have no way of predicting how your pet’s pancreas will behave in the future and there are no studies that show how future pet lifestyle might affect pancreatic relapses.

But based on what I know about pancreatitis, I can give you some suggestions:

1) If your dog is plump, slowly but surely return it to a healthy body weight. Show your love with touch and attention rather than treats and fatty scraps.

2) Feed a monotonous, bland, low fat, easily digested diet.

3) Feed your pet in frequent small meals throughout the day.

4) Encourage your pet to exercise. Dogs in good physical shape have better functioning digestive systems. Your pet’s pancreas is part of that system.

5) If your pet has a history of high blood triglycerides levels, include a triglycerides level checkup every six months.

When I write these articles , I try to draw on a variety of sources to present a balance picture of what is occurring in your pet and your options. I can not do that when telling you about diagnostic tests for pancreatitis because one Company, Idexx Laboratories, controls the message and your diagnostic options. I have great admiration for Idexx Laboratories. Many of my links are to their promotional brochures or research they have an investment in. But when you read them, please remember that all for-profit companies over-state how common a health problem is, overstate the accuracy of their tests, and understate alternative options to the use of their products.

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