Pancreatitis In Your Cat
Ron Hines DVM PhD
If your pet is a Dog go here
What Is Pancreatitis?
Your cat’s pancreas has the same function as yours. 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 cat’s intestine to help digest its food; the other tissue areas (the islets of Langerhans), produce the hormones that regulate your cat’s blood sugar level and digestion (insulin, glucagons and somatostatin). Both are critical to your cat’s well being. Veterinarians used to believe that pancreatitis was more common in dogs that cats. That no longer seems to be the case. (ref1, ref2) Many if not most cases of pancreatitis in cats are part of a general inflammatory disease of cats affecting their digestive tract. I call triad disease.
When your cat’s pancreas is inflamed, the problem is called pancreatitis. Since inflammation can be mild, substantial or severe, all degrees of pancreatitis occur in cats. 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 you; or they can be severe and life threatening.
When your cat’s pancreas is inflamed, it 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 your pet’s abdomen. If the leakage is severe, toxic remnants of destroyed tissue can enter the pet’s blood stream causing body-wide damage.
Repeated flare-ups eventually scar your cat’s pancreas so badly that it cannot perform its duties. 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 changes. Having lost the ability to regulate its blood glucose, your cat may also become diabetic.
There was a time, not that long ago, when pancreatitis was taught as a disease of dogs. But as cats replaced dogs as the most popular pet in America, knowledge as to their particular needs and sensitivities grew. We know that pancreatitis is quite common in cats. However, unlike in dogs, when pancreatitis occurs in cats, it is usually part of a multi-organ problem. Pancreatitis affects cats of all ages and either sex. We seem to see a bit more of it in Siamese cats than other purebreds.
What Caused Pancreatitis In My Cat?
It is seldom that veterinarians can tell you why your cat developed pancreatitis. On very rare occasion, diseases like toxoplasmosis or, perhaps, physical injuries are the cause. Cats appear more adapted than dogs or humans to a high fat diet – so feeding high fat foods probably was not the cause of your cat’s pancreatic problem.
What we do know is that, in most cases, pancreatitis in cats appears to be part of a continuous chronic inflammatory process going on within several of your pet’s organs.
Do You Have Any Suspicion As To Cause?
Yes. I believe that oxidative stress related to diet is a major factor. I write more about that near the bottom of this page.
The Acute Form Of Pancreatitis
Loss of alveolar surfactants – respiratory failure
Fats destroyed throughout body “Webber-Christian Syndrome”
Pancreatic encephalopathy when myelin sheaths dissolve
acute cases can reverse completely
The Chronic Form Of Pancreatitis
When dogs have an attack of pancreatitis, it can be their first and only time. But cats are rarely that fortunate. Any evidence of pancreatitis in a cat is usually a signal that the disease will be a lifelong issue that requires lifestyle changes.
In dogs, intermittent attacks can eventually destroy the pancreas’s ability to produce enzymes. In cats, however, loss of pancreatic function seems to occur as the result of continuous, low-level inflammation. Whereas dogs usually retain the insulin-secreting portions of their pancreas, cats often loose that as well and become diabetic. Whereas pancreatitis can exist as a single isolated problem in dogs, pancreatitis in cats is generally a sign of an inflammatory process that is targeting your cat’s entire nutrient absorption mechanism (stomach, intestines, liver and pancreas)
When pancreatitis predominates in your cat, the signs you see are due to inflammation and loss of the pancreatic acini (see the diagram link at the top of this page). Long term inflammation replaces these enzyme-secreting structures with non-functional scar tissue. This scaring is not always uniform. It can be dispersed in small patches throughout the cat’s pancreas.
3-organ Chronic Inflammation Or Triaditis
Because the three-organ system that is involved in delivering food nutrients to your cat are often attacked simultaneously, it is sometimes called Triaditis (cholangiohepatitis). These three organs are the pancreas, liver and intestine:
Organ # 1 Inflammation Of The Pancreas
The changes that occur in your cat’s pancreas are the subject of this article. Long standing pancreatitis is also called exocrine pancreatic insufficiency or EPI.
Organs #2 Chronic Inflammation Of The Liver And Gall Bladder
Veterinarians use ambiguous terms to describe what is happening in your cat’s liver and generally lump it in with their gall bladder. Chole in Latin means bile. Bile is produced in your cat’s liver but stored in its gallbladder. The term used include cholangiohepatitis because it is rare for the liver and gall bladder not to be simultaneously effected. They are basically all due to the same inflammatory process. The names reflect the changes that are predominating in any one cat and the preferences of the pathologist describing them.
When your veterinarian believes that your cat’s gall bladder and its bile duct leading to its small intestine are the centers of the problem, the vet is more likely to use the terms cholecystitis,cholangitis or even bile duct obstruction.
Organ #3, The Intestines – Inflammatory Bowel Disease (IBD)
Many cats with chronic pancreatic also have chronic or recurrent diarrhea – particularly when biopsies show that their livers are also chronically inflamed. It is usually the upper two sections (duodenum & jejunum) of their small intestine that are most inflamed. IBD is actually a catch-all term that includes a number of discrete conditions with a variety of causes.
If biopsies are taken from your pet due to the suspicion of pancreatic, they should also be taken from those upper areas of the intestine. This is because another chronic problem, lymphocytic-plasmacytic gastroenteritis (LPG) , can cause the same symptoms. The treatment of the two conditions, IBD and LPG are not entirely the same; LPG usually improves when cats receive corticosteroids, IBD due to triad disease does not.
Hepatic lipidosis or fatty liver is a rather unique problem of cats. When it occurs in pancreatitis or triad disease it is due to your cat just not feeling like eating and being unable to metabolize its fat stores. Follow the link for a complete explanation.
For reasons we can not explain, cats that are not eating have problems shifting over to using their body fat stores. Instead of “living off their fat”, cats that are not eating deposit their fat stores in the cells of their liver (hepatocytes). Once enough fat has accumulated in these liver cells to cause them to swell, they can no longer do their normal chores of protein synthesis, carbohydrate metabolism and detoxification of wastes. (That will often be reflected in the bloodwork your vet runs by an increase in bilirubin, ALT, ALP (=alk phos) and a decrease in albumen.)
Cats with this problem often turn yellow (jaundiced). You will notice that first on the inner side of their ears and the whites of their eyes (sclera).
For your cat to get well, it is extremely important that everything possible be done to tempt it to eat. When that doesn’t work, a feeding tube needs to be placed into your cat’s stomach to deliver the nutrients it needs.
Diabetes is not a part of triad disease. It is usually a problem in overweight cats, but it can also occur when chronic pancreatitis destroys the areas of your cat’s pancreas that produce insulin. You can read an article about diabetes in cats here.
What Are The Signs Of Pancreatitis In Cats?
Cats that are having an episode of acute pancreatitis don’t feel good. They often sit erect, looking off in space, with their paws tucked under them and their eyes partially closed – like the cat above.
These cats are lethargic and not interested in their surroundings. Most eat and drink less and, consequently, they loose weight and become dehydrated. If the problem is severe, they often pant or mouth breath. A few vomit or have diarrhea. A few run fevers. Subnormal temperature (below 100.5F) is a very worrisome sign. Many are uncomfortable or meow when you prod or squeeze their tummies. If pancreatitis or associated liver problems have been present for some time, your pet’s stools may be lighter in color.
With time, your cat’s appetite can return. In fact, they can eat more than before. But they never regain their prior weight because they no longer produce the enzymes they need to absorb the food. Food passing through their digestive tract undigested may cause their stools to be loose, smelly and pale. This leads to bacterial overgrowth with undesirable organisms. Some of these cats get treated with metronidazole which often does bring about temporary improvement. Others get misdiagnosed as having a giardia infection.
Could My Cat’s Life Be In Danger?
With good care, the vast majority of cats survive the attack that first brings them to the veterinary hospital. If your veterinarian can induce your cat to eat, it should do well and return home. Cats hate veterinary hospitals. If you yourself can spend time at the hospital, petting, reassuring and talking to your pet, your cat is more likely to heal. That and loving, individualized, nursing care are the keys to success.
Once your cat has been stabilized and sent back home, it will most likely need a special diet and occasional medications throughout its life. With that special care, it should live a very long time.
What Tests Will My Veterinarian Run?
Your veterinarian will want to perform a physical examination of your cat. There are no specific physical signs that announce pancreatitis. Your cat might indicate to your veterinarian that its abdomen is tender and sometimes, a firm, inflamed pancreas can actually be felt. Occasionally neurological signs accompany pancreatitis.
Your veterinarian will pinch your cat’s skin for normal springiness. If it fails to snap back promptly, your vet will know your pet is dehydrated. Your vet will also look closely for signs of jaundice /yellow. Your vet may notice that your pet has lost weight since its last visit.
Standard blood panels and urine examination will not be very helpful in getting your veterinarian to a diagnosis. They are the logical starting off point with any sick cat, but the results are never diagnostic. Cats with pancreatitis sometimes have an elevated white blood cell count. Electrolyte (sodium, potassium, chloride) changes are common because so many cats with pancreatitis are dehydrated. Liver enzymes (ALP etc. & bilirubin) are often elevated and may cat have moderately elevated BUN levels due to dehydration. High, low or normal blood lipase or amylase are not significant in cats with pancreatitis. About a quarter of cats with pancreatitis are anemic. You can see the normal values for your cat here.
There are two blood tests that are very helpful in diagnosing pancreatitis in cats. One is the serum trypsin-like immunoreactivity test and the other, the pancreatic lipase immunoreactivity test.
Serum trypsin-like immunoreactivity (aka TLI, fTLI)
Trypsin is one of the enzymes your cat’s pancreas produces to digest food. The vast majority of trypsin moves directly from your cat’s pancreas to the intestine through the pancreatic duct. But a very small portion naturally enters the cat’s blood stream. When that amount is too low, we know the cat’s pancreas is not producing enough of it (pancreatic insufficiency or EPI). When the amount in the blood is too high, the pancreas is leaking more than it should into the blood stream due to inflammation. There is controversy as to the accuracy of this test. Some feel it is very accurate in identifying cats with pancreatic problems, others less so.
Pancreatic Lipase Immunoreactivity (aka Spec fPL, FPLI, specific feline pancreatic lipase test)
As I mentioned, ordinary lipase determinations on your cat’s blood will not help determine if your pet has pancreatitis. This is because other areas of the body, besides the pancreas, produce lipase. But since 2002, a more sensitive (radioimmunoassay) test that zeros in on only the lipase produced in the pancreas has become available. Cats with substantial acute pancreatitis and cats with substantial pancreatic scaring (insufficiency) can usually be identified with this test. The test is not as effective in detecting cats with mild to moderate disease.
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 interpreting the images if the machine’s full potential is to be met.
In the hands of a highly skilled ultrasonographer, ultrasound will detect a bit less than half of the cases of acute pancreatitis in cats (depending on the skill of the radiologist). Ultrasound is also quite helpful in detecting the liver and intestinal changes that commonly accompany pancreatitis. It is also an excellent way to rule out other abdominal conditions in your cat that might be mistaken for pancreatitis.
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 are not very helpful in diagnosing pancreatitis. But your veterinarian may suggest them to rule out other problems that might be causing your cat’s abdominal pain.
Endoscopy/ Exploratory Surgery and Biopsy
Sometimes, the only way to determine what is happening in your cat, is to go in and have a look. Most of the changes that occur in pancreatitis and diseases associated with it occur on the microscopic level. So you veterinarian will obtain as many snippets of tissue (biopsies) and needle aspirates as possible to have sent off to a pathologist.
Sometimes, the veterinarian can obtain these biopsy samples without surgery by directing a biopsy needle with an ultrasound machine; or using an apparatus called a laparoscope. But a more common way is to actually surgically open your pet under general anesthesia (exploratory laparotomy).
What Treatment Options Does My Veterinarian Have Available For My Cat?
The treatments your veterinarian will begin depend on the stage at which you present your cat for care.
If your cat is experiencing a severe, acute attack, your veterinarian will do everything possible to stabilize its vital systems. Those include:
The most important treatment to do this is placing a catheter into one of your cat’s veins and administering fluids in a slow drip. Nothing can be given to your cat orally when it is in an acute crisis. These intravenous fluids correct dehydration when it is present, maintain blood pressure when shock is an issue, and flush toxins from the pet’s body through increased urine flow. Your vet will give other medications either through the tube in its vein or by intramuscular injection. Acute pancreatitis is a fast-moving condition that requires careful, continuous, monitoring and quick decisions.
Additional Warmth When Appropriate
Your vet will try to bring your pet’s body temperature up to normal range if it is dangerously low (and bring it down should it be dangerously high).
If your cat is having difficulties breathing, your vet will probably supply it with oxygen.
Medications To Control Diarrhea and Vomiting
The majority of cats with pancreatitis do not vomit or have diarrhea. However, if your cat is nauseous, we have medications to control that (antiemetics). Antacids are sometimes helpful as well. If the pet is experiencing diarrhea, there are medications for that as well.
Some vets who suspect IBD as a part of the cat’s illness will give vitamin B-12 injections.
Analgesics To Control Pain
Pain control is very important for your cat’s recovery as well as for its comfort. Medications that work best are all narcotics. The choice is between injectable narcotic (buphrenophine, butorphanol, meperidine, etc.) and transdermal patches (fentanyl = Duragesic®) you can read more about pain control in general here and just in cats here.
Counteract Disseminated Intravascular Coagulation = DIC If There Are Suspicions It Is Occurring.
If the pancreatitis attack is very severe, your cat may go into shock (vascular collapse) or even develop a life-threatening condition called disseminated intravascular coagulation or DIC. 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. There is no standard treatment for DIC that all veterinarians agree on. It is such a complicated process that for every suggested treatment technique, there are an equal number of veterinarians who give plausible reasons why that technique should not be performed. Being a crisis situation, it does not lend itself well to controlled studies in pets or people so the same uncertainty affects human physicians confronting DIC. ( read here ) Minute-by-minute monitoring, Intravenous fluid administration and preventing system crashes as they occur is the best we can do at this time.
Consider Administrating Antibiotics
Pancreatitis in cats is very rarely an infectious disease. However, the stress of pancreatitis can weaken the cat’s general immune system. So antibiotic protection is sometimes given, particularly when your veterinarian is worried that the pet’s liver, gall bladder or small intestine may be involved as well.
Consider Administering Corticosteroids When Appropriate
If your cat’s circulatory system collapses into a shock-like state, your veterinarian may give corticosteroids. Many veterinarians also administer corticosteroids short term when coexisting inflammation of the liver or intestine is suspected because of blood work results, ultrasound examinations or biopsies.
There was a time when veterinarians attempted to “rest” your pet’s pancreas by not allowing cats with pancreatitis to eat. That has fallen out of favor because of the fear of hepatic lipidosis and the fact that most cats can accept and benefit immediately from nutrients that are placed directly into their small intestine. If the cat is not retching or vomiting and is reasonably strong, most veterinarians will place a feeding tube in its stomach or upper intestine (jejunum) within a day or two of arrival. If that is not successful, the cat can be fed through its IV tube using human products for total parenteral (non-oral) nutrition.
Treatment Strategies For Chronic Pancreatitis:
Will A Special Diet Help?
Yes. Cats with long-standing pancreatic problems no longer produce enzymes of digestion in sufficient quantities. For them to thrive, you will need to take that into consideration when feeding them. The proteins and fats that they need will be harder for them to absorb, and the chronic intestinal inflammation (IBD) that often accompanies pancreatitis makes it harder for them to handle fiber. This irritation can also lessen the amount of vitamins they absorb from their foods. Many will need to be coaxed with a savory diet in order to hold a healthy body weight.
Felines have a unique requirement for a high level of fat in their diet. So the low-fat, moderate protein and high carbohydrate diets suggested for humans and dogs with pancreatitis do not work well in cats. You can find recipes for low fiber, high protein diets here.
Does My Cat Need Any Special Supplements?
Yes. The pancreatic digestive enzymes your cat lacks are available commercially. They work best when purchased in powder form or when the tablets are crushed and mixed with your cat’s food. Slowly tailor the amount to what is required to maintain your pet’s body weight and control diarrhea and flatulence.
Vitamins are other nutrients that cats with chronic pancreatitis have difficulty absorbing. Vitamin B12 levels in particular, are often low in cats with chronic pancreatitis.(ref). I am also a big believer in providing pets with all chronic inflammatory diseases with increased amounts of antioxidants like vitamin E. Some owners find that cats respond better to B-vitamin injections than to oral forms of the vitamin. (I prefer injectable vitamin products that are Benzyl alcohol and other preservatives free and that come in individual dose vials.)
Is Pancreatitis Likely To Reoccur In My Cat?
Chronic pancreatitis in cats is a disease that can be managed, but not cured. The first 72 hours after an acute attack should tell you if your cat can reach a stable, manageable condition. Mild cases, and those that show slow but steady improvement should do just fine. A low-stress lifestyle from then on and individualized nutrition are the keys to preventing future flare-ups. Pancreatitis affects the exocrine portion of your cats pancreas (ref) – the portions that produce digestive enzymes. But the other portions that produce insulin can eventually be damaged as well. (ref)That sometimes leads to diabetes.
Why Are Cats So Prone To Diseases Involving Oxidative Stress?
Cats seem to be particularly sensitive to chronic inflammation.
Vaccinations that cause no tumors in dogs, cause fibrosarcomas in cats. (ref) Perplexing and unexplained chronic mouth inflammations are unique to cats. Inflammatory thyroiditis leading to hyperthyroidism is overly common in cats.
The mechanism for all of this is probably the release of inflammatory cytokines. (ref) There is a statistical connection between eating canned, fish-flavored cat foods and hyperthyroidism. (ref1, ref2 )
I once worked for SeaWorld. There I became quit familiar with the wholesale fish industry that supplies fish for pet food. Fresh fish does not end up in the can or kibble you feed your cat. What does end up in that can and kibble are fish products that sat too long on the dock or stored, processed fish meal and fish-plant waste that is susceptible to lipid peroxidation. (ref) That’s why a 5.5 oz can of Friskies Ocean Whitefish cat food will costs you $0.44; but 5.5 oz of whiting fillets costs $3.78
Oxidative stress has also been associated with eating rancid fish oils. (ref) I suspect that many of the cats that develop pancreatitis and other triad diseases have just not been eating a healthy diet.
In the marine park business we gave vitamin E and antioxidants to counteract the peroxides found in in fish.