Pancreatitis is defined as inflammation of the pancreas and can be caused by a number of inciting

factors. The pancreas is responsible for tasks such as glucose regulation and aids in the digestion
of food. Accordingly, two separate parts are responsible for these functions: the endocrine
portion, which produces insulin for glucose regulation and the exocrine portion, which produces
enzymes for food digestion. While the origin of most cases remains unknown, several
predisposing factors have been identified. Inciting factors for dogs and cats include high fat
meals, such as table scraps and other people food, physical trauma to the organ, and concurrent
systemic disease (diabetes, Cushings disease, high triglycerides) or local disease involving the
liver or gastrointestinal tract.

History, Signs, and Physical Examination

Dogs and cats with pancreatitis can have a wide variety of signs, which include, but are not
limited to the following:

Vomiting
Diarrhea
Decreased appetite
Visibly painful abdomen; abnormal or hunched posture
Lethargy, playing less, depression
Weight loss
Hiding more or becoming more clingy
Other signs related to concurrent disease

The course of the disease can be acute or chronic, depending on inciting factors. Dogs most
commonly present for vomiting, while cats most commonly present for decreased appetite. In
chronic cases, signs may wax and wane, worsening in times of stress. Cats commonly present
with concurrent disease related to liver and gastrointestinal tract
Some dogs and dog breeds are also more genetically predisposed to pancreatitis than others.
Miniature Schnauzers are considered at higher risk for pancreatitis. No age or sex predilection
has been identified.

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Diagnosis
Unfortunately, pancreatitis can be difficult to diagnose. The gold standard for diagnosing it is
obtaining biopsies (wedges) of tissue to be evaluated by a pathologist (histopathology); this
requires surgery to obtain the sample of the pancreas. While this is the only way to say 100%
that pancreatitis is present, there are other tests that are supportive of a diagnosis of pancreatitis.

Amylase and lipase: These are fairly non-specific blood tests to evaluate for pancreatitis
in dogs. A portion of patients with pancreatitis will have increased amylase and lipase
concentrations. Other diseases can elevate these values, too. There is no correlation
between elevation of these values and pancreatitis in cats.

Radiographs (x-rays): Some patients with pancreatitis will show changes on abdominal
radiographs. Decreased detail may be seen due to fluid build-up in the abdomen
secondary to the inflammation with pancreatitis. You may also see slight change in the
positioning of the gastrointestinal loops. Abdominal radiographs are also used to rule out
non-pancreatitis diseases that can cause similar signs such as gastrointestinal foreign
bodies. Pancreatitis can also cause fluid accumulation around the lungs (pleural effusion).
Therefore, chest radiographs are sometimes recommended.

Abdominal ultrasound: This test allows us to see within the abdominal organs in much
more detail than radiographs. We can see the pancreas to see if there is enlargement,
thickening, masses within the pancreas, or changes in brightness of the pancreas (often
darker with acute pancreatitis and brighter with chronic pancreatitis). The area around
the pancreas (mesentery) can also be evaluated for changes (often bright with acute
pancreatitis)

Pancreatic lipase immunoreactivity assay (PLI): This is a blood test that looks at a more
specific type of lipase that comes from the pancreas. It is more sensitive and specific
than the basic lipase test, although there are still false positives and negatives with this
test. For dogs, there is an in-house version of the test. For cats and for some cases in
dogs, we send out the blood for a PLI test to be run at an outside laboratory (usually
Texas A&M).

Serum biochemistry: Patients with pancreatitis may have changes in some of their liver
enzymes (increase with inflammation or irritation of the liver) and even bilirubin.
Bilirubin is processed by the liver and excreted by the gall bladder through the bile duct.
The bile duct runs right by the pancreas and with severe inflammation of the pancreas,
this duct can become partially obstructed, leading to high bilirubin. Albumin, one of the
main proteins in the blood, can decrease secondary to inflammation or ulceration within
the gastrointestinal tract. Globulin, another protein within the blood, can also become
low with a gastrointestinal ulceration. Pancreatitis can also lead to electrolyte
abnormalities.

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No test is 100% diagnostic for pancreatitis. Linking laboratory abnormalities with the history
and clinical signs helps us to arrive at a tentative diagnosis, as well as rule out other causes. A
high PLI (pancreatic lipase immunoreactivity) test result, along with concurrent clinical signs,
helps to rule in pancreatitis. An abdominal ultrasound may show inflammation associated with
the pancreas and possibly effusion if severe.

Treatment:
No specific cure for pancreatitis exists; accordingly, treatment is symptomatic and supportive.
Intravenous fluids, pain relief, anti-nausea medications, and nutritional support are commonly
administered. Feeding is controversial, but helps to maintain the integrity of the gastrointestinal
tract. Other, more specific, treatments are also given for the inciting cause, if identified. Serial
blood tests may also be necessary.

Anti-nausea medications:
o Metoclopramide (Reglan) This medication helps to decrease nausea and can
increase the motility of the stomach and upper intestines. It can be given in
hospital as a continuous infusion. We can give it as a pill or liquid every 8 hours
at home. Side effects are rare with this medication.
o Anzemet/Zofran: These are two medications that can be used to decrease nausea.
Typically, Anzemet is given injectibly in the hospital. Zofran, a similar
medication, comes as a pill that can be given at home. Usually, we give Zofran
(ondasetron) every 12 hours. Side effects are rare with these medications.
o Cerenia: This medication can be used to decrease nausea. It can be given under
the skin in the hospital or as a pill at home. Unfortunately, you can only give this
medication for 5 days in a row and then have to stop giving it for several days to
ensure that the blood levels do not become too high. We used this medication in
both dogs and cats, although it is considered off label in cats at this time. This
medication can also be used to treat motion sickness in dogs.

Gastroprotectants:
o Antacid medications:

Famotidine (Pepcid) This medication is a H2 blocker antacid. It can be

given every 12 24 hours. You can buy it at most pharmacies. You
should by the generic version of this medication, as it is the same thing as
brand name Pepcid but costs significantly less.

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Ranitidine (Zantac) This medication helps to increase gastrointestinal

motility and reduces the amount of acid within the stomach. It is usually
given every 12 hours. This medication can be bought over the counter at
pharmacies, but often needs to be specially compounded for smaller
patients.

Omeprazole This medication is a protein pump inhibitor (PPI) antacid.

They have been shown to have strong antacid properties than H2 blockers.
This medication can be bought over the counter at pharmacies, but often
needs to be specially compounded for smaller patients. This medication is
usually given once a day.

o Ulcer protectants

Sucralfate (Carafate) This medication coats any ulcerations that are

present to form a protective barrier, which allows the ulceration to heal
faster. Sucralfate must be given on an empty stomach and cannot be given
at the same time as other medications as it will decrease how well these
other medications are absorbed. Rarely, this medication can cause
constipation.

Barium This medication can be used to coat ulcers in the stomach and
can coat all the way down to the colon to decrease irritation that can lead
to diarrhea. This medication cannot be given at the same time as food or
other oral medications. This medication can cause significant lung
problems if the patient vomits it and inhales it into the lungs. When
barium passes in the stool, it makes the feces a chalky white color.
Barium can cause constipation.

Pain medications
o Tramadol This is one of the most common oral pain medications on which we
send canine pancreatitis home. There is a large dose range for dogs; we usually
start with at least every 6-8 hours dosing. The main side effect is sedation; if the
patient becomes too sedate, you should cut the amount of medication or the
frequency that you administer it.
o Buprenex This medication can be given to cats or small dogs for pain relief. It is
absorbed by the gum in the mouth so when you give it, you should not aim for it
to go down the throat. The main side effect is sedation; if the patient becomes
too sedate, you should cut the amount of medication or the frequency that you
administer it.

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o Fentanyl patch This medication is a patch that goes on the skin through which
fentanyl (a pain medication) can absorb in a continuous manner. In general, it
takes about 12 hours for this medication to start working and it tends to last 3-4
days in most dogs and cats. The main side effect of this medication is sedation. It
is really important not to let your pet or any small children get ahold of this patch.
If a dog, cat, or human eats the patch, it can cause a potentially fatal dose of
fentanyl to be absorbed all at once.

Anti-diarrhea medications:
o Metronidazole (Flagyl) This medication is an antibiotic that has antiinflammatory properties in the gastrointestinal tract. Side effects are rare but
include decrease appetite. Neurologic side effects including seizures can occur
but usually only occur if higher doses (> 30 mg/kg/day) are given.

Probiotics:
o FortiFlora This medication is a probiotic, good bacteria for the patients
gastrointestinal tract. Human studies show that probiotics can reduce the severity
and complication rate in pancreatitis and can decrease the length of
hospitalization needed. FortiFlora is one type of probiotic that is specifically
made to taste good to dogs and cats. It can be sprinkled on the patients food or
mixed with a small amount of water and given via a syringe. One packet is given
once a day.

Prognosis:
Prognosis for dogs and cats varies depending on severity of the disease and on the inciting
causes. For example, pancreatitis resulting from dietary indiscretion typically carries a better
prognosis than cases with more severe inciting causes, such as cancer.

Complications:
Several sequalae can occur secondary to pancreatitis.

Gastrointestinal ulceration Ulcers within the stomach and intestines can occur
secondary to the inflammatory reactions seen with pancreatitis. These ulcers can cause a
patient to lose blood, be nauseous, have a decreased appetite, or have diarrhea. Often we
will treat pancreatitis patients with antacids such as famotidine (Pepcid) or omeprazole
(Prilosec) to decrease the amount of stomach acid and, therefore, reduce the risk of ulcers

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forming. If ulcers are already present, we use sucralfate (Carafate) to help bind to the
ulcer as a protective layer to allow faster healing.

Low serum albumin This is the main protein in the blood. A pets albumin
concentration can decrease with pancreatitis secondary to the severe inflammatory or due
to ulceration of the gastrointestinal tract. Albumin is responsible for keeping the fluid
component of blood within the blood vessels. Therefore, when the albumin concentration
falls, the fluid may leak out of the blood vessels and between the surrounding cells. This
process can lead to edema under the skin (usually seen first in the feet, muzzle, and
underside of the abdomen), fluid within the abdomen (peritoneal effusion), fluid around
the lungs (pleural effusion), or fluid within the lungs (pulmonary edema).

Blood clots due to the severe inflammatory response that can be seen with pancreatitis,
the body may be more prone to developing blood clots. In dogs and cats, the most
common location the blood clot goes to is to the lungs. If this occurs, the patient will
acutely have severe difficulty breathing (increased respiratory rate and effort). Blood
clots can also go to the legs (acutely not able to use that leg, very painful, often cold to
the touch), gastrointestinal tract (acute worsening of severe vomiting and diarrhea), the
kidneys, the heart (collapse, difficulty breathing, or acute death), or brain (seizures, coma,
or acute death).

Follow-up:
Long-term monitoring of PLI for chronic pancreatitis cases is useful. If the patient has
developed low albumin or high bilirubin, we usually recommend rechecking blood work to
verify that these values have normalized.

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