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Pancreatitis In Your Dog

 

Ron Hines DVM PhD

If your pet is a Cat go here.

What Is Pancreatitis ?

Your dog’s pancreas has the same functions that yours has. It is a pale pink organ with two functions and two different areas of inter-dispersed tissue types. One of the tissue types (the pancreatic acini), produce enzymes that are released into your pet’s intestine to help it digest and absorb the food it eats. The other tissue areas (the islets of Langerhans), produces the hormones that regulate how your dog processes those nutrients once they are absorbed (insulin, glucagons and somatostatin). Both are critical to your pet’s wellbeing. The signs of acute or sudden pancreatitis relates to problems occurring in the acini portion. But it is not unusual for both portions to be affected when your dog has pancreatic issues. You can enlarge the second photograph at the top of this page to see more of the anatomy of the problem your dog is experiencing.

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

Inflammation of the pancreas is called pancreatitis. That inflammation can be mild, it can be substantial or it can be severe. All degrees of pancreatitis occur in dogs. The inflammation can be acute (sudden) or it can be continuous (chronic pancreatitis). It can be progressive or it can remain a minor manageable issue your pet deals with throughout its life. Pancreatitis can occur only once, or it can reoccur again and again. The signs can be mild and barely noticeable to pet 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, once freed from the aceni, digest any of the 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 can enter your pet’s blood stream causing body-wide alterations and damage.

Repeated bouts of inflammation can eventually scar your pet’s pancreas so badly that it cannot perform its other 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 often change. And having lost the insulin needed 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 since 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 develop pancreatitis as well. (ref)

Why Did This Happen In My Dog ?

In the majority of cases, veterinarians never discover 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. That can be due to a diet too rich in fat, obesity, a lifestyle of inactivity, or specific diseases and genetic defects that elevate the lipid/fat content of your pet’s blood. (ref) It can also be due to a pooch eating the fatty remains of a fast food meals obtained from a tipped over trash can or an indulgent owner.

In some miniature schnauzers, a genetic defect, (mutation of the PSTI gene) seems to be responsible for the high blood 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. No one knows why.

I see cases of pancreatitis more frequently in neutered/spayed dogs than in intact dogs - probably because neutered/spayed dogs tend to become more obese and because of the negative effects it has on their metabolism. (ref)

Anything that inflames, damages or blocks the duct (ref) or passage that conveys pancreatic enzymes from your dog's pancreas to its intestine can cause a backup of digestive enzymes into the pancreas. That can lead to 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), certain antibiotics, diuretics, anti-epileptic (ref) and anti-cancer agents (ref) appear to have contributed to a pancreatitis problem. However, it is rarely clear if it was the medication that caused the pancreatitis or if it was the disease that the medication was being given for that did.

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 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 if 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.

As I mentioned earlier, 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. 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 also occur when a pet’s liver no longer produces sufficient bile)

Because these pets are nutrient-deprived, they tend to gradually loose weight no matter how much they eat. They often develop a dry, brittle hair coat that lacks luster.

What Signs Might I See When 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 going on. None of the signs I describe occur only in pancreatitis. There are a great number of other diseases, some mild, some serious, that can cause these 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 pets become depressed and weak. Some dogs pant and most appear worried. These dogs often vomit and they may develop diarrhea (often bloody). Their tummies are very tender and tight when they are poked or prodded. Because of this, they may resist lying on their side. Many run a fever and about half become dehydrated. If your veterinarian's standard diagnostic laboratory has trouble sorting out the meaning of test results, there is a lab that specializes in these issues. (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.

You can read the story about a less-severe, case that arrived at the small animal clinic of the University of Saskatchewan here.

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 your dog's body temperature, steroids to counteract shock, antibiotics to counter infection and oxygen to help your pet breath are all part of standard therapy for shock. 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 judgment as to what additional medications it might need (there is not full agreement as to the best treatment). (ref)

Is My Dog’s Life In Danger ?

In severe cases, it can be.

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

As I mentioned earlier, once a pet’s pancreas is damaged, a cascade of events can occur. 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 as well. So things can deteriorate rapidly. However, with intensive veterinary care, the majority of pets 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 yet that can neutralize those enzymes. We can only give your pet's circulatory and regulatory systems (homeostasis) as much supportive treatment 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, the nature and severity of its problem is often unclear at first. 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 your dog.

When these test results return, it is common to find an elevate white blood cell count, decreased numbers of clotting cells (thrombocytes) and evidence of dehydration (high PCV, Hct). That, in itself, it not sufficient to diagnose pancreatitis. But those results and the result of the vets physical examination may put pancreatitis high on the list of possibilities. Other labwork results are key - as I will go on to explain.

Lab Work

Laboratory blood tests on your pet not only help your veterinarian diagnose an acute pancreatitis attack, they give your veterinarian 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 labwork results for your pet.

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

If your veterinarian is fortunate, your pet’s blood lipase level may be sufficiently elevated to suggest pancreatitis. Lipase is one of the enzymes normally produced by your dog's pancreas. In healthy animals, only traces should be present in their blood. However, traditional serum lipase tests are not a very sensitive indication of pancreatitis. They are sometimes normal when pancreatitis is occurring, and sometimes abnormal even 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 offered by Idexx Laboratories. This 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. All emergency animal hospitals and many day clinics have the equipment and tests on hand to provide this or equally sensitive test results (SNAP cPL, Spec cPL, VetScan cPL Rapid Test, Precision PSL, etc.).

Serum Amylase

Amylase is another enzyme produced by your pet’s pancreas. It may also leak into your dog’s blood stream when pancreatic damaged has occurred. 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 an acute pancreatitis episode (amylase tests are thought to pick out a bit more than half of the pancreatitis cases in dogs ). (ref)

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 indicator that your dog does or does not have pancreatitis. But the test is valuable when considered together with your dog’s symptoms, other bloodwork results and the tests that I discuss next. Some say that a positive cTLI test may not be as reliable an indicator of pancreatitis as a positive cPL test. (ref) But diagnostic laboratories always promote and favor the tests they market. Others found the TLI test to be just as helpful. (ref)

Ultrasound Examination

The ultrasound machine has become as important to the 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 in real time. But it can be quite difficult to interpret the images one sees on these machines. A veterinarian must be highly skilled in interpreting those images 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. Your veterinarian is a generalist, trained, like me, to be reasonably competent in many fields of medicine. It is always wise for critical examinations, like ultrasound for suspected pancreatitis, to be performed and interpreted by a veterinarian who does only that.

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 to it in density and composition. So the pancreas is quite hard to visualize on x-rays. However, when all the organs in your pet’s abdomen are grainy and hazy on the image (a sign of inflammation or pooled fluids) or when they are slightly displaced due to swelling, your veterinarian might take that as a hint of possible pancreatitis. The chief use of x-rays is to rule out other possible causes for vomiting and abdominal pain – things like swallowing foreign objects, intestinal blockages, bloat 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.

A 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 fence rail, time-after-time leaving no one sure as to what the problem is or how to proceed. You may have taken your dog to several veterinary hospitals and received conflicting diagnoses. 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 an ultrasound machine will allow your veterinarian to collect 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 interpretations and pancreatic inflammation can be limited to small, dispersed areas that can be missed when obtaining the samples.)

What Treatment Options Does My Veterinarian Have For My Dog ?

When your pet is suffering from the shock of a sudden case of severe pancreatitis, your veterinarian will concentrate on stabilizing the dog first. Stabilization treatment for shock from all causes is quite similar. So even if your veterinarian is still unsure of the diagnosis, the initial treatment plans will likely be quite similar. That plan will concentrate on keeping your pet’s circulatory system functioning adequately, keeping the constituents of its blood in proper proportion, maintaining your pet’s body temperature and providing its tissues with adequate oxygen. Those severe cases often require intravenous fluids and, perhaps, oxygen and other heroic efforts.

Pets usually 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, many dogs benefit from antacids and vitamin B injections, pancreatic enzyme supplements and a very bland, easily-digested or pre-digested diet.

We want to give your pet’s pancreas a period for rest and renewal. So veterinarians often suggest that nothing, other than specific liquids, go into your pet’s mouth for several days.

Will A Special Diet Help ?

Yes.

Diets designed to be easily digested and low in fat often help. If your dog is overweight, returning it to a trim weight is critical. I know that diet and weight loss is easy to recommend and hard to accomplish. Read some of my suggestions about that here.

There are several easily-digested commercial diets on the market. The most popular are Hills Prescription i/d®, Purina’s EN® and Royal Canin's GASTROINTESTINAL® . You can also prepare an easily-digested diet yourself. You will find some of my recipe suggestions here. Whichever you choose, feed your pet frequently during the day and in smaller amounts.

Try to keep your homebody or sedentary dog's diet low in fat (~5-10%) and only moderately high in protein (~20%). Most of these commercial bland diets are also quite low in fiber. That is because they are also used to treat dogs with inflammatory bowel disease. Unless your dog suffers from IBD , vomiting issues or chronic diarrhea, I suggest you supplement its diet with moderate amounts of high fiber vegetables to supply it with additional fiber.

Both protein and fat require your dog's pancreas to work harder. (ref) As I mentioned early, garbage-scrounging and fast food treats often trigger pancreatitis flareups. Col. Sanders is no friend of your dog. Nor is the Pizza Hut delivery man. (ref)

Does My Dog Need Any Special Supplements ?

Yes.

If your dog has documented chronic pancreatic problems, it will not absorb fats and oils well from its food. Certain vitamins (A,D,E&K) are fat soluble. They enter your dog's body best when they are dissolved in fat or oil. They are poorly absorbed when your pet lacks the pancreatic enzymes needed to absorb those fats or when the fat content of your pet’s diet is low. I used to suggest my clients give their pet a portion of a Centrum-type complete multivitamin (a portion proportional to its body weight) every day. Zoetis still makes Pet-Tabs®, dogs like their taste better. They are just as good and less of a hassle. I always suggest coated vitamin tablets be crushed. I do not know if dogs possess the enzymes necessary to dissolve human pill coatings.

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 if pancreatic issues are chronic. You can 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 onto its food.

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

If these products 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 these pets back on their old diets could be an invitation for future attacks.

What Can I Do To Prevent A Future Attack ?

Some dogs suffer a single pancreatitis attack and never have 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 lifestyles and diet might affect pancreatitis relapses.

But based on what we know about pancreatitis, I can give you some suggestions - most of which I have already mentioned:

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 dog in frequent smaller meals throughout the day.

4) Encourage your dog 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 blood checkup every six months.