Pancreatitis

Pancreatitis is acute or chronic inflammation of the pancreas. It may be caused by infection, or irritation from the pancreas' own production of digestive enzymes. Pancreatitis, whether chronic or acute, usually requires a lowering of dietary fat levels, which can be tricky to combine with the low-carb diet required by diabetics. This condition plus diabetes usually requires a custom-designed medium-carb diet.

Signs

While both dogs and cats can suffer from chronic pancreatitis, the species differ when it comes to signs of it. Dogs tend to have repeated acute episodes while cats appear to have gradual inflammation with difficult to pinpoint signs of illness. Some research indicates that male cats are more prone to be sufferers of chronic pancreatitis than females^[1]. Having diabetes puts dogs at a greater risk of acute pancreatitis^[2].

Concurrent with Diabetes

There is evidence to suggest that chronic, subclinical (unable to be ascertained through present testing methods) pancreatitis is common in canines with diabetes^[3]. A study conducted by Drs. Fleeman and Rand puts the estimate of canine diabetics with pancreatitis--either acute^[4] or chronic^[5]--at about 40%^[6]. Dr. Fleeman also states that it is chronic pancreatitis and the damage it causes to the organ that is responsible for 1/3 of canine diabetes cases^[7]; Dr. Greco echoes this thought^[8].

This 2000 lecture given at the District of Columbia Academy of Veterinary Medicine regarding managing acute pancreatitis in dogs and cats refers to an (uncited) study suggesting that cats with pancreatitis are quite sensitive to insulin^[9]. A 1989 study of persons with pancreatitis-caused diabetes also seems to point to the same effect in humans^[10], noting that those in the study had low glucagon levels which did not respond normally. The lack of normal glucagon action, which raises blood glucose levels, appears to indicate problems with the way the body responds to hypoglycemia. It goes on to mention that their epinephrine responses to insulin-related hypoglycemia is also abnormal. With epinephrine aka adrenalin acting counter to insulin by raising blood glucose levels, this would seem to further signal problems with the way the body is able to respond to hypoglycemia for those with pancreatitis and diabetes.

Another human-based study^[11] suggests that there is a correlation between the endocrine pancreas associated with diabetes and the function of the exocrine pancreas associated with pancreatitis. Insulin-dependent diabetics were rated as having the most severe exocrine pancreas deficit. Those who were able to control their diabetes with oral medications in the sulphonylurea class were deemed as having intermediate exocrine pancreas deficit. Those who were able to control their diabetes with oral medications of the biguanide class--with or without the help of diet alteration and those who are diet-controlled without any medications, were considered to be free from exocrine pancreas deficit.

Causes

Some possible causes of pancreatitis:

Obesity/Overweight: This is true for many dogs diangosed with pancreatitis. It is also more likely to develop when a high-fat diet is being fed.

Hyperlipidemia:or high fat content in the blood. The levels of fat in the blood often rise after eating, but for those without hyperlipidemia, this is a temporary state. Metabolic problems in both pets and people can prevent the removal of fat from the blood. Some studies show that hyperlipidemia can be a cause of pancreatitis^[12]. A low-fat or restricted fat diet is suggested for all diabetic dogs, as it may prevent pancreatitis^[13]

Infections--from either viruses (viral) or bacteria (bacterial) can cause pancreatitis in dogs and cats.

Injury: An injury or trauma to the abdominal area can result in injury to the pancreas; this can mean possible pancreatitis.

Diagnosis

Pancreatitis is often hard to diagnose^[14]. Tests include the serum TLI (Trypsin-Like Immunoreactivity)^[15], and the feline or canine PLI (Pancreatic Lipase Immunoreactivity)^[16], available from the gastrointestinal laboratory at the College of Veterinary Medicine at Texas A&M University. Turnaround from that lab often takes several days. A canine-specific PLI test is also commercially available through IDEXX Laboratories as the Spec cPL™ Test^[17]. Dr. Williams, who is the director of the GI Lab mentioned above, gave this presentation before the World Small Animal Veterinary Association in 2004^[18]. He notes no specific signs or symptoms which definitely point to pancreatitis in cats. Labwork for dogs has more clear-cut signs of abnormal values than the results can for cats. Some cats have normal lab results and also have pancreatitis^[19].

Treatment

It may be very tricky to treat, also. It can cause insulin resistance, dehydration, and also nausea and vomiting, all of which complicate diabetes. Pets can also begin drinking more water. For the most part, they also commonly show a higher than normal temperature when the disease is in its beginning stages. As pancreatitis progresses, the body temperature may go below normal^[20].

Some recommended treatments to ask your vet about include:

"resting" the pancreas by withholding^[21]^[22]all food, water and oral medications for a time frame set by your vet. Subcutaneous fluids bypass the oral route; in avoiding the oral route, the pancreas is also avoided. Medical term for this is "nil per os", or "nothing by mouth".
antioxidants to help reduce the inflammation.
pancreatic enzymes to compensate for pancreatic insufficiency^[23], but only when indicated by the TLI.
Vitamin B12 injections, especially in the case of existing bowel issues
Subcutaneous fluids to combat dehydration. These can be given at home.

Complications of Pancreatitis

Chronic pancreatitis can lead to maldigestion syndrome in which the pancreas fails to produce enough digestive enzymes^[24]. A severe attack is capable of damaging the exocrine pancreas, which produces the digestive enzymes and the endocrine pancreas, which produces insulin. Having a severe attack also puts one at risk for developing chronic pancreatitis^[25].

Case Studies

See Category:Pancreatitis cases for examples of cats and dogs with pancreatitis and their diets and treatments. This FDMB thread link below^[26] and followups^[27] deal with alternatives and treatments.

References

[1] Hills Pet Products-Owner's Guide to Pet Care-Pancreatitis

[2] Beyond Insulin Therapy: Achieving Optimal Control in Diabetic Dogs Drs. Fleeman & Rand-U-Queensland 2005

[3] Dr. Rand, et. al.-Chronic Subclinical Pancreatitis is Common in Diabetic Dogs-University of Queensland 2004

[4] Image Illustrating Acute Pancreatitis

[5] Image Illustrating Chronic Pancreatitis

[6] Veterinary Clinics of North America-Small Animal Practice-2001-Management of Canine Diabetes-Drs. Fleeman & Rand

[7] Beyond Insulin Therapy:Achieving Optimal Control in Diabetic Dogs Drs. Fleeman & Rand-U. Queensland, 2005

[8] Better Medicine E-Newsletter-June 2006

[9] Pettalk.com-Feline Diabetes

[10] PubMed-Diabetes Care 1989-Pancreatic Diabetes Mellitus

[11] Journal of Clinical Pathology 1984-Exocrine Pancreatic Function in Diabetes Mellitus

[12] Hills Pet Care Products-Owner's Guide to Pet Care-Pancreatitis

[13] Beyond Insulin Therapy: Achieving Optimal Control in Diabetic Dogs Drs. Fleeman & Rand-U-Queensland 2005

[14] Felinediabetes.com-Pancreatitis

[15] Texas A & M University-Gastrointestinal Laboratory-TLI Test Information

[16] A & M University-Gastrointestinal Laboratory-PLI Test Information

[17] IDEXX Laboratories-Canine Pancreas-Specific Lipase Spec cPL™ Test

[18] WSAVA 2004-Pancreatitis in Cats

[19] Hills Pet Products-Owner's Guide to Pet Care-Pancreatitis

[20] Hills Pet Products-Owner's Guide to Pet Care-Pancreatitis

[21] Hills Pet Products-Owner's Guide to Pet Care-Pancreatitis

[22] Feline Pancreatitis-Drs. Foster & Smith-Pet Education Library

[23] Peteducation.com (Drs. Foster & Smith)-Pancreatic Insufficiency

[24] Purina ONE Health Library-Diabetes Mellitus

[25] CNN.com Health Library-Pancreatitis Overview

[26] FDMB-Pancreatitis Discussion

[27] FDMB-Pancreatitis Discussion Followups

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