Pancreatitis In Your Dog
Ron Hines DVM PhD
What Occurs In Pancreatitis?
Your dog’s pancreas has the same functions that your pancreas has. It is a pale pink organ with two functions and two different areas of inter-dispersed tissue types that have different responsibilities. One of the tissue types, the pancreatic acini glands, produce enzymes that are released into your pet’s intestine to help it digest and absorb the food it eats. Damage to that portion is responsible for sudden (acute) pancreatitis. (read here) The other tissue areas (the islets of Langerhans ), produces the hormones that regulate how your dog processes those nutrients once they are absorbed ( that area secretes insulin, glucagon and somatostatin ,an inhibitor of the first two) Both are critical to your pet’s well being. It is not unusual for both portions to be affected as time goes by 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.
The inflammation pancreatitis is unpredictable. It can be mild, it can be substantial or it can be severe. All degrees of pancreatitis occur in dogs. The inflammation can be sudden or it can be a smoldering chronic problem. It can be progressive or it can remain a minor manageable issue your pet deals with throughout its life. Pancreatitis can occur only once in a dog’s lifetime, or it can occur again and again. When the signs are mild and barely noticeable pet owners might ignore them or attribute it to something else. Some have reported that perhaps 2 out of 135 dogs will develop a pancreatic problem sometime in their life.
An inflamed pancreas leaks digestive enzymes that were intended to digest food. Because these digestive enzymes, once freed from the aceni (individual enzyme-producing glands), inflame and destroy the dog’s own tissues that they encounter, they can cause severe pain within the pet’s abdomen. If the leakage is severe enough, toxic remnants of destroyed tissue can enter your pet’s blood stream causing body-wide alterations and damage. Luckily cases that severe are infrequent.
Repeated bouts of inflammation will eventually scar your pet’s pancreas to the point that it cannot perform its other important functions. When that happens, your pet might loose weight since it is no longer able to digest and obtain enough nutrients from the food it eats (maldigestion-malabsorption syndromes). The color and consistence of the dog’s stool usually changes – often to a lighter color. And having lost the insulin it needs to regulate its blood glucose, the pet 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 dog to have multiple digestive tract problems in addition to pancreatitis ( read here ). Pets that are already suffering from diabetes, Cushing’s diseases or hypothyroidism are more prone to develop pancreatitis as well. ( read here )
The most common problem that is mistaken for pancreatitis in dogs is pica – the desire to eat non-food items. Read about that here. That could be leaves and twigs, stones, rotten edibles or the stools of other animals, etc. That is why I always have owners bring me several stool samples and pass them through a fine sieve. Pica can be a purely psychological issue, it can be exacerbated by digestive tract issues such as inflammatory bowel disease.
Why Did This Happen To 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 malfunctions when it is exposed to too much circulating lipids (fats=triglycerides). 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. ( read here ) 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, guest or neighbor.
In some miniature schnauzers, a genetic defect, (a mutation of the PSTI gene) seems to be responsible for the high blood lipid problem and subsequent attacks of pancreatitis (familial hyperlipidemia) ( read here )
Dachshunds, Yorkshire terriers, Silky terriers and Skye terriers appear to get more than their fair share of pancreatitis. No one knows why, but lap dogs tend to be indulged by their owners in what they are willing to eat and not eat.
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. ( read here )
Anything that inflames, damages or blocks the pancreatic duct or passage that conveys pancreatic enzymes from your dog’s pancreas to its intestine can cause a backup of digestive enzymes into the dog’s pancreas. That can also 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 ( also read here ), certain antibiotics, diuretics, anti-epileptic ( read here ) and anti-cancer medications ( read here ) appear to have contributed to the onset of pancreatitis. 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 Or Sudden Form Of Pancreatitis
I mentioned that there are two forms of pancreatitis, a smoldering long-term problem and a sudden substantial attack. It is the acute attacks are the most frightening to dog owners. They are also the most dangerous; so they are the most described online and in scientific studies. Acute pancreatitis attacks appear to be quite painful to pets. They come on without much warning. The pain is due to the abdominal inflammation generated by leaking pancreatic enzymes.
The Chronic Form Of Pancreatitis
Repeated bouts of acute pancreatitis or a smoldering issue eventually destroy your dog’s ability to produce digestive pancreatic enzymes : trypsin , chymotrypsin, lipase , phospholipase A2, lysophospholipase, cholesterol esteraseand amylase . 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. ( see here ) 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.
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 Read about pain control in dogs here . 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).
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 ( autodigestion ) 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 Are My Veterinarian Likely To 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 ( WBC and blood chemistry panel ) 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 lab work results are key – as I will go on to explain.
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 lab work 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 led to the development of a much more sophisticated and accurate test for pancreatic lipase, the cPL test offered by Idexx Laboratories. The pancreas-specific lipase test is Antech Laboratories/VCA’s version. These test are positive in about 75% of dogs with acute pancreatitis. All emergency animal hospitals and many day clinics should have the equipment and test materials on hand to provide these or equally sensitive results (eg SNAP cPL, Spec cPL, VetScan cPL Rapid Test, Precision PSL, etc.).
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 ). ( read about that test here )
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 blood work test 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. But diagnostic laboratories always compete, promote and favor the tests they market. Others found the TLI test to be just as helpful.
The ultrasound unit has become as important to the veterinarian of 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 veterinary ultrasonographer, can detect over half of the cases of acute pancreatitis. Your veterinarian is a generalist like me, trained to be reasonably competent in many areas of veterinary medicine. It is always wise for critical examinations like ultrasound for a suspected case of pancreatitis to be performed and interpreted by a veterinarian who only does ultrasound and other imaging technique interpretations.
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 in your dog – things like swallowed foreign objects, intestinal blockages, bloat or tumors. Large university veterinary centers own CAT scan (CT) and MRI machines. Both can be helpful in the frustrating cases when other standard tests fail to give a hard answer as to why your pet has abdominal pain.
A Pancreatic Biopsy
Occasionally, your veterinarian will still remain perplexed as to the cause of a pet’s abdominal health issues. Tests results may come back with a report that sits on the fence time-after-time leaving no one sure as to what the problem is or how to proceed – tentative reports that use the words probably, likely or possibly. You might 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 your pet’s abdomen or guiding a small biopsy needle to specific areas with an ultrasound machine will allow your veterinarian or a specialist to collect tissue samples that are sometimes the only way to get to a concrete diagnosis. Even pancreatic biopsies are not fool proof. Pathologists can differ on their interpretations of what is seen under the microscope and the dog’s pancreatic inflammation can be limited to small, dispersed areas that can be missed when obtaining the samples.
What Treatment Options Are Available For My Dog?
When your pet is suffering from the shock of a sudden case of severe pancreatitis, your veterinarian will focus on stabilizing your 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 the dog’s blood in proper proportion, maintaining your pet’s body temperature and providing its body with supplementary oxygen when required. Those severe cases require intravenous fluids and, perhaps, oxygen and other heroic efforts.
Pets also receive medications to combat pain and nausea. They usually receive antibiotics as well. In addition, some pets might need treatment for DIC, bicarbonateto maintain a normal blood pH, potassium supplementation, corticosteroids to combat shock, and even blood transfusions.
Longer term, many dogs with pancreatic issues benefit from antacids and vitamin B injections, pancreatic enzyme supplements and a very bland, easily-digested or predigested diet given in small portions throughout the day.
We want to give your pet’s pancreas a period for rest and renewal. So veterinarians often suggest that nothing, other than specific liquids or perhaps broth, go into your pet’s mouth for several days.
Will A Special Diet Help?
Diets designed to be easily digested and low in fat often do help prevent relapses. If your dog is overweight, slowly and gently returning it to a trim weight is important. I know that diet and weight loss is easy for veterinarians to recommend and hard for dog owners to accomplish. Read some of my suggestions that might lead to success 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® . But you can also prepare an easily-digested diet for your dog yourself. You can find some of recipe suggestions here. Whichever you choose, feed your dog more frequently during the day with smaller amounts. I personally feed my dog slow-cooked deboned chicken quarters with the fat drained off in addition to a top quality cat kibble that agrees with his digestive system better than dog chow.
Try to keep your homebody or sedentary dog’s diet low in fat (~5-10%) and only moderately high in protein (~20%). Both protein and fat require your dog’s pancreas to work harder. 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 and gastritis. If this is solely a pancreatic issue you can supplement your dog’s diet with moderate amounts of high fiber vegetables to supply it with additional fiber. In certain situations, like diabetes or chronic constipation, fiber can be beneficial, but most dogs thrive on low fiber diets similar to their ancestral all-meat diet.
As I mentioned early, garbage-scrounging hounds and fast food treats often trigger pancreatitis flareups. Col. Sanders is no friend of your dog. Nor is the Pizza Hut delivery man. ( see here )
Does My Dog Need Any Special Supplements?
If your dog has documented chronic pancreatic problems, it will not absorb fats and oils from its food well. 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 an appropriate 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 human vitamin tablets be crushed. I do not know if dogs possess the enzymes necessary to dissolve human pill coatings which might contain lactose. Balance IT™ is now a commonly used vitamin source.
There are also two essential fatty acids that your pet with pancreatic issues 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 them in your pet’s food. If these products help your dog, I still would not return it to a 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 Lower The Chances Of Future Attacks?
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 do 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.