Pancreatitis In Your Cat

Ron Hines DVM PhD

  Your pet is a Dog? 

Triad Disease In Your Cat

Why My Cat? 

What Is Going On?

Your cat’s pancreas has the same multiple functions as yours. It is intimately associated with digestion and blood sugar regulation. The pancreas is a pale pink organ with cells dedicated to both those functions inter-dispersed throughout the organ. Cells dedicated to digestion comprise over 80% of the organ’s weight while the remaining cells are dedicated to regulating your cat’s blood sugar level by producing insulin, glucagon and somatostatin. Both portions are critical to your cat’s well-being. Veterinarians used to believe that pancreatitis was more common in dogs that in cats. That is no longer true. ( read here & here ) Many – if not most cases of pancreatitis in cats are part of a general inflammatory disease of cats affecting multiple areas of their digestive tract. I call it triad disease.

Your cat’s pancreatic Inflammation can be a mild chronic problem or it can appear as a sudden event that is substantial and severe. In some feline chronic pancreatitis cases the disease is progressive. In other cases it is so mild that no health issue is recognized. ( read here)  Pancreatitis can occur only once in a cat’s life or it can be a reoccurring event. 

When your cat’s pancreas is inflamed, it leaks digestive enzymes. Because these 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 normal 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 your cat’s stools often change. In a very small number of cases, when the insulin-producing portions of the pancreas are also involved, some cats lose their ability to regulate their blood glucose and become diabetic (however obesity, not pancreatitis, underlies most feline diabetes cases) .

There was a time when pancreatitis was thought of primarily as a disease of dogs. But as cats gained popularity in America, veterinary understanding of their particular sensitivities and health issues grew. We now know that pancreatitis is quite common in cats. When pancreatitis occurs in cats it is usually part of a multi-organ inflammatory problem. Pancreatitis affects cats of all ages and either sex. We seem to see it a little bit more frequently in Siamese than other purebred or random-bred cats. Pancreatitis in cats has no age or sex predisposition.

What Might Be The Cause?

It is seldom that your veterinarian or anyone else can tell you why your cat developed pancreatitis. Veterinarians rarely discover an underlying reason(s). In a few cases physical injuries such as car accidents or a fall from heights were blamed. ( read here) In a few others altercation with dogs or recent surgery were thought to be the reason. In two cases, the use of fenthion-containing flea control products were implicated. ( read here)  On rare occasions, diseases like toxoplasmosis were suspected to be the cause.The consumption of raw fish was once associated with a case of pancreatitis. ( read here) Everything else published or discussed is pure conjecture with little or no evidence to back up conclusions. ( read here) Some veterinarians, after reading the literature on pancreatitis in humans, theorize that pancreatitis in cats might be an autoimmune disease. But there is really no evidence to back that up. What we do know is that in most cases, pancreatitis in cats is only part of a long-term chronic inflammatory process occurring  within several of your cat’s organs all of which are related to food, digestion and nutrition.

Do You Have Suspicion As To The Cause?

Yes.

I believe that oxidative stress related to the ingredients of commercial diets we commonly feed to cats is a major contributing factor. I’ll write more about that farther down this page.

The Acute Form Of Pancreatitis

When your cat develops pancreatitis suddenly, corrosive digestive enzymes produced by its pancreas that are normally confined to the fortified passageways leading to its intestines have begun to leak into surrounding tissue. Depending on the extent of this leakage, symptoms will vary from mild to severe. Those digestive enzymes are very inflammatory. In the most severe cases, that surrounding abdominal tissue is destroyed. (read here ) These cats often arrive at their veterinarian’s hospital dehydrated, due to vomiting and a lack of interest drinking. Their blood sugar level is often low, their blood pressure might be low as well. They often show signs of abdominal pain and the various symptoms of shock. Blood tests revealing low blood calcium level ( hypocalcemia) are a particularly worrisome finding. (read here ) Hypocalcemia occurs in a number of life-threatening situations and must be dealt with immediately. ( read here) In severe cases, transient or even lasting kidney damage is also a possibility. 

The Chronic Form Of Pancreatitis

Only a few cats are fortunate enough to experience only a single bout of pancreatitis. Veterinarians might be more successful in preventing the chronic forms of pancreatitis from developing if we only knew what the underlying causes of pancreatic in cats were. I mentioned what I believe, but that is not the most commonly accepted theory among veterinarians today. So one episode of acute pancreatitis is often followed by similar episodes at unpredictable intervals – or by persistent, silent, low-level pancreatic inflammation. As I mentioned earlier it is most common for a number of abdominal organs to be affected by this low-level inflammation as well. In dogs and humans, that is not the case.

Initial attacks of pancreatitis in cats primarily affect the digestive enzyme-producing portions of their pancreas. But with time, the insulin-producing portions can be disabled as well resulting in diabetes. The primary damage occurring in chronic pancreatitis is scarring. Scarring is the replacement of functional tissue with non-functional but space occupying connective tissue. With time, organs experiencing scarring due to low-level inflammation shrink in size because scar tissue tends to contract. The acute and chronic changes of pancreatitis overlap in time, so the terms are imprecise. No test, other than a pancreatic biopsy, is likely to tell the difference between the two and even pancreatic biopsies are quite subjective in their interpretation (pathologists can look at the same slide and disagree). Although no blood test can tell the two forms apart, some veterinarians believe that abnormal blood work results and other data that all return to normal indicate the episode was an acute case while lingering abnormalities indicate that they are already dealing with the chronic form of pancreatitis.    

The 3-organ Chronic Inflammation Or Triaditis

A three-organ system is involved in delivering food nutrients to your cat: its pancreas, its liver and its intestine. Although we are uncertain as to the cause, it is very common for them to be attacked simultaneously. That it is sometimes called Triaditis ( aka cholangiohepatitis ). Which organ symptoms are most obvious and which diagnostic tests indicate the most damage vary from cat to cat, but it is rare for one of the organs to be abnormal while the other two remain completely normal. 

Organ # 1 : Inflammation Of Your Cat’s Pancreas

The chronic changes that occur in your cat’s pancreas are the subject of this article. Long standing pancreatitis affecting the digestive enzyme portions of your cat’s pancreas is also called exocrine pancreatic insufficiency ( EPI ) . In some cases the insulin-producing portions of your cat’s pancreas remain unaffected in others they eventually are damaged as well and the cat has the potential to become diabetic.    

Organs #2 : Chronic Inflammation Of Your Cat’s Liver And Gall Bladder

Unlike physicians, veterinarians use somewhat ambiguous terms to describe what is happening in your cat’s liver. When they do, they generally lump its liver in with its gall bladder. Chole in Latin means bile. Bile is produced in your cat’s liver, but it is stored in its gallbladder. In cats it is called cholangiohepatitis because it is rare for the liver and gall bladder not to be simultaneously affected. The various names applied reflect the microscopic changes that are most prominent in any one cat and the preferences of the pathologist describing them. Your cat’s liver contains a system of branched conduits (its biliary tree) leading to its gall bladder and on out into its upper small intestine (its duodenum) through the cat’s bile duct.  When your veterinarian believes that your cat’s gall bladder and the bile duct leading to its small intestine are the centers of inflammation, your vet is more likely to use the terms cholecystitis, cholangitis or even bile duct obstruction. As in pancreatitis the cause of this chronic inflammation remains unknown. 

Organ #3 : The Intestines – Inflammatory Bowel Disease (IBD)

Many cats with chronic pancreatitis also have chronic or recurrent diarrhea and/or vomit – particularly when blood tests, ultrasound or biopsies show that their liver, gallbladder and/or intestines 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. Read about IBD in cats hereIf biopsies are obtained from your pet due to the suspicion of pancreatitis or exploratory surgery, it would be wise to also take them from upper areas of the cat’s 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 may not. (read here)

Hepatic lipidosis

Hepatic lipidosis or fatty liver disease is a problem rather unique to cats. When it occurs in humans it is usually the result of alcoholism. When it occurs in cats due to pancreatitis, triad disease or some other illness, it is due to your cat being unable to metabolize (utilize, mobilize) its body fat stores for needed energy. Read much more about hepatic lipidosis in cats here. For reasons unknown, cats that will not or cannot eat have problems shifting their metabolism over to relying on their body’s stored fat to provide needed energy. Instead of “living off their fat” cats that are not eating deposit their fat stores in the cells of their liver cells (hepatocytes). Once enough fat has accumulated in these liver cells to cause them to swell, these cells can no longer perform their normal chores of protein synthesis, carbohydrate metabolism and detoxification of wastes. That will often be reflected in the blood tests your veterinarian runs by an increase in  bilirubin   ,   ALT  ,  ALP (aka alk phos or AP) and a decrease in its blood albumin level. The skin and gums of cats developing this problem often turn yellowish (jaundiced) – another common warning of liver problems. You might notice that first on the inner side of your cat’s ears and/or the white outermost portions of its eyes (itssclera). For your cat to avoid hepatic lipidosis it is extremely important that everything possible be done to tempt it to eat. A flavorful meat or tuna broth or top-dressing is sometimes accepted when ordinary food is not. Appetite stimulants such as Entyce® or Mirtaz® might be helpful. When none of that works, a feeding tube needs to be placed into your cat’s stomach to deliver the nutrients it needs.

Diabetes

Although diabetes in cats is pancreas-related, it is not currently considered part of triad disease. As I mentioned, diabetes is a problem usually seen in overweight cats. You can deal with weigh issues in your cat in other ways. ( read here ) But it is conceivable that diabetes might occasionally occur when chronic pancreatitis destroys the areas of your cat’s pancreas that are dedicated to producing insulin (its islets) or that several health issues are occurring in your cat at the same time. You can read an article about diabetes in cats here.

What Are The Signs Of Pancreatitis In Cats?

No signs are specifically diagnostic for pancreatitis. All could be caused by a great number of other health issues. Signs vary depending on the severity of the pancreatic inflammation. Cats that are having a typical episode of acute pancreatitis just don’t feel good. They might sit erect, looking off in space, with their paws tucked under them and their eyes partially closed – like the cat above. They might find it hard to find a comfortable position. Your  cat might be more lethargic than usual (~95% are) and not as interested in its surroundings as it normally is. Most cats with pancreatitis begin to eat less (~90% do), drink less and become dehydrated (~80% do). Consequently, they loose weight and become dehydrated. When the pancreatic inflammation is more severe, cats will often pant or mouth breath. A few vomit and/or have diarrhea. A few run fevers. Subnormal temperatures (below 37.9 C/100.3 F) are very worrisome signs. These cats are obviously in pain. They meow, hiss or bite when their tummies are squeezed or prodded. If the pancreatitis is associated with liver problems or has been present for some time, your pet’s stools may be lighter in color and greasy in texture due to a lack of pancreas-produced digestive enzymes and bile.

With time, when the acute pancreatic inflammation subsides, your cat’s appetite should return. In fact it might eat more than before it became ill. But these cats, when destined to lapse into chronic pancreatitis as they commonly do, tend to never regain their prior weight because they no longer produce enough of the enzymes they need to digest and absorb sufficient food nutrients. Food passing through their digestive tract undigested may cause their stools to be loose, pale and smelly. This leads to bacterial overgrowth in their digestive tract with undesirable organisms. Some of these cats show temporary improvement when treated with metronidazole. Others get misdiagnosed as having a primary giardia or tritrchomonas infection, others yet with food allergies.

Could My Cat’s Life Be In Danger?

With good supportive in-hospital care, the vast majority of cats survive the attack that brought them to their veterinarian’s hospital. If your veterinarian can induce your cat to eat, you are well on your way home. Good supportive care often includes intravenous or subcutaneous fluids, anti-inflammatory corticosteroid medications, correction of electrolyte (blood ion) and blood acidity imbalances and medications that address vomiting or diarrhea should either be an issue. Cats do not like veterinary hospitals. Being hospitalized is very stressful to them.  But if you yourself can spend time at the hospital, petting, reassuring and talking to your cat, it is more likely to heal. That and loving, individualized, nursing care from a truly dedicated staff are the keys to success. Return of appetite is a better positive indicator than any laboratory test in determining when it is time for your cat to go home. You know your cat’s personality better than anyone. If you think your cat is more likely to eat at home than in an institution, suggest one of the veterinary nurses drop by your home to administer treatments that are beyond your capacity or have a housecall veterinarian assist you. That is always safer than being bitten. Once your cat has been stabilized, it will most likely be a  candidate for a special diet (preferably one you prepare at home) and occasional medications throughout its life should they also be required. With that special care your cat should live a very long time.

What Tests Will My Veterinarian Run?

Of course your veterinarian will want to perform a physical examination on your cat. However there are no specific physical signs that announce “pancreatitis”. As I mentioned, your cat might indicate to your veterinarian that its abdomen is tender. Sometimes a firm, inflamed pancreas can actually be felt through the abdominal wall. Your veterinarian will probably pinch (lift)  your cat’s skin to check for normal springiness. If it fails to snap back promptly, your vet will be suspicious that your pet is dehydrated. Veterinarians also observe skin color closely for signs of  jaundice /yellow –  an indication of liver or blood destruction issues. Well-organized veterinary hospitals weigh all pet every time they visit. Since pets can’t talk, unintended or unexplained weight loss is one of the most accurate signs of internal health issues.

Laboratory Tests:

Routine blood panels and urine examinations (urinalysis) are not very helpful to your veterinarian in making a diagnosis of pancreatitis. The chief value of these tests are in ruling out other health issues. But those tests are the logical starting off point for any sick cat. Cats with the acute form of pancreatitis often do have an elevated white blood cell count – particularly early in their pancreatitis episodes. About 60% of cases in one study had high neutrophil counts accompanied by lower than normal lymphocyte counts. (read here ) Abnormal blood electrolyte (sodium:potassium  & chloride) levels are common because so many cats with pancreatitis are dehydrated and/or experiencing vomission and/or diarrhea. Liver-related  enzymes (ALP , ALT &  bilirubin) are often elevated (in ~80%). The cat might have a moderately elevated BUN as well. That could be due either to dehydration that concentrates the blood or due to actual direct effects on its kidneys. In cats, blood sugar (glucose) goes up (spikes) with many sudden heath issues (including fear & stress). That is the case in feline pancreatitis as well. Although they are products of the pancreas, high, low or normal blood lipase and/or amylase are not significant indicators of pancreatitis in cats. About a quarter of cats with pancreatitis are anemic. You can find all the normal blood values for your cat here.

There are two blood tests that might be 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 helps to produce to digest the protein in its diet. The vast majority of pancreatic “pro-trypsin” moves directly from your cat’s pancreas to its intestine through its pancreatic duct. But a very small portion naturally enters your cat’s blood stream. When that amount is too low, we know that your cat’s pancreas is not producing enough of it (pancreatic insufficiency or EPI). When the amount in the blood is too high, we know that the pancreas is leaking more than it should into the blood stream due to inflammation. However there is some controversy as to the accuracy of this test in diagnosing pancreatitis in cats. Some feel these tests are very accurate in identifying cats with pancreatic problems, others are less convinced. ( read here )

Pancreatic Lipase Immunoreactivity (aka Spec fPL, FPLI, specific feline pancreatic lipase test)

As I mentioned, ordinary blood lipase enzyme level determinations on your cat’s blood will not help determine if it has pancreatitis. That is because other areas of the cat’s body, besides the pancreas, produce lipase. But a more sensitive  radioimmunoassay test that zeros in on only the specific type of lipase produced in your cat’s pancreas has become available in recent years. Cats with substantial acute pancreatitis have levels of this pancreatic form of lipase that are higher than they should be and cats with substantial pancreatic scaring and loss (insufficiency) have lower levels than they should. However, the test is not as effective in detecting cats with mild to moderate acute or chronic pancreatitis or predicting outcome. (read here  & here )

An Ultrasound Examination

The ultrasound machine is as important to your veterinarian in the 21st Century as the stethoscope was in the 20th. It is such a priceless way to see what is happening inside your cat’s body in real time. However it can be quite difficult to accurately interpret the fine details of the internal images your veterinarian sees. So maximum information is likely to be obtained when the veterinarian interpreting the images is specially trained to do so. In the hands of a highly skilled veterinary ultrasonographer, the exam will detect a bit less than half of the cases of acute pancreatitis in cats. The veterinarian interpreting the images will be checking for increased pancreatic thickness, blurring of margins and changes in echogenicity of the pancreas and the fat that surrounds it. Ultrasound is also quite helpful in detecting the liver and intestinal changes that commonly accompany pancreatitis in cats. It is also an excellent way to rule out other abdominal conditions that might be mistaken for pancreatitis. If there is even the slightest doubt in your veterinarian’s mind as to what the images might mean, they can be sent electronically to a board-certified veterinary radiologist. Ultrasound findings suggestive of pancreatitis still need to be confirmed through agreeing laboratory blood test results.

X-rays (radiographs)

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 Or Ultrasound-Guided 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 triad disease associated with it occur at a microscopic level. So you veterinarian will obtain as many tiny snippets of tissue (biopsies) and/or needle aspirates as necessary and send them off to a pathologist. Sometimes your veterinarian can obtain these valuable biopsy and aspirate samples without surgery. That can be done by directing an appropriate size and length needle using an ultrasound machine to visualize its passage; or by using the assistance of an apparatus called a laparoscope. A more traditional method is to actually surgically open your pet under general anesthesia (an exploratory laparotomy). 

What Treatment Options Does My Veterinarian Have For My Cat?

There is considerably more agreement among veterinarians and greater depth of knowledge regarding successful treatment options for acute (sudden) bouts of pancreatitis than there is for the management of chronic pancreatitis. Repeated flare-ups of pancreatitis once the disease becomes chronic respond equally well to the medications that aided your cat during its first pancreatitis episode. But since the underlying cause of chronic or recurring pancreatitis in cats remains unknown, it is hard to suggest specific diets, medications and lifestyle changes that might make those episodes less frequent or totally prevent them. To date, everything you might read is conjecture – mostly borrowed from what appears to help humans. Unfortunately the top underlying causes of pancreatitis in humans are excessive alcohol consumption, autoimmune disease, gallstones, trauma and the use of immunosupressive drugs such as azathioprine – none of which are likely to pertain to your cat.

A key factor in the occurrence of  pancreatitis and triad disease in cats may lie in the trypsinogen your cat’s pancreas naturally produces. It is designed to digest (hydrolyze) dietary proteins. Cats and humans have very different genetically-programmed protein needs and energy storage pathways. ( read here & here ) As I mention many times in my articles, commercial cat food companies continue to insist on adding low cost carbohydrate ingredients in far too great a quantity to cat foods. Cat’s bodies were not designed by Nature to metabolize them. It really doesn’t matter if its from peas, barley, potatoes or corn, starch is starch. Cat food companies such as Royal Canin/Mars and Iams/Procter & Gamble push back hard against that notion. (read here & here ) I believe that they are motivated by economics and necessity rather than basic feline needs and nutritional science. The Companies also find the high carbohydrate content necessary in order to hold (bond) their kibble products together. (read here ) Cat food companies quickly realized that they needed to control the carbohydrate/cat message. They significantly fund veterinary nutrition departments and you have to reach quite a way back in time to find articles that were not written under their influence. ( read here , here  &  here )

When your cat is experiencing an acute attack of pancreatitis, your veterinarian will do everything possible to stabilize its vital systems and decrease pancreatic inflammation. Those include:

Fluid Therapy

This often requires placing a catheter into one of your cat’s veins and administering fluids in a slow drip. Nothing should be given to your cat orally when it is in an acute crisis. These intravenous fluids (IV fluids) correct dehydration when it is present, maintain blood pressure when shock is an issue, and flush toxins from your pet’s body through increased urine flow. Your vet can give other medications required to your cat, either through the catheter already placed in its vein or by intramuscular injection. Acute pancreatitis is a fast-moving condition that requires careful, continuous, monitoring and quick decisions. The IV fluids given vary in their composition. They are often based on Ringer’s lactate. If the cat is hypoglycemic, more glucose is added. When the reverse is true, fluids containing glucose are avoided. When blood becomes too acidic or bicarbonate falls too low,  Na+HCO3will be added to the intravenous fluid mixture. The amount of intravenous fluid best given is dependent on your veterinarian’s estimate of your cat’s degree of dehydration and circulatory volume.  

Additional Warmth When Appropriate

Your veterinarian 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. Cats do not tolerate NSAIDs such as aspirin well. Never give them to your cat. 

Supplemental Oxygen

If your cat is having difficulties breathing, your veterinarian will probably supply it with supplemental oxygen.

Medications To Control Vomiting And Diarrhea

The majority of cats with pancreatitis do not vomit and even fewer have diarrhea. However, if your cat is nauseous, veterinarians have medications such as maropitant (Cerenia®) that are effective in controlling that. Antacids are sometimes helpful as well. Diarrhea is not a common side effect of uncomplicated pancreatitis. But if your pet is experiencing diarrhea there are medications to deal with that as well (eg  aminopentamide /Centrine®)  Some vets who suspect IBD as being a part of your cat’s illness will also add vitamin B-12 by injection.

Analgesics To Control Pain

Pain control is very important for your cat’s recovery as well as for its immediate comfort. The medications that work best are all narcotics. The choice is between injectable narcotic such as oral buprenorphine or transdermal patches (fentanyl = Duragesic®). You can read more about pain control in general here and specifically in cats here.

Counteract  Disseminated Intravascular Coagulation =  DIC When There Are Suspicions That It Is Occurring.

If your cat’s pancreatitis attack is very severe, it might go into shock (vascular collapse) or even develop a life-threatening condition called disseminated intravascular coagulation or DIC. DIC is a paradoxical blood clotting malfunction where the pet’s blood is simultaneous failing to clot (bleeding) and clotting at the same time throughout its body. Needless to say, it is an emergency. There is no standard treatment for DIC that all veterinarians agree on. The natural blood clotting process is such a complicated mechanism 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, DIC does not lend itself well to controlled studies in pets or people, so the same uncertainty affects human physicians confronting a case of DIC. (read here ) In some cases, heparin might be indicated, in others it might make the situation worse. Minute-by-minute monitoring, intravenous fluid administration, body temperature support and preventing body system crashes as they occur is the best we can do. We veterinarians tend to focus on circulatory system collapses (dangerously low blood pressure and heart dysfunction) because they are the most lethal. 

Consider Administrating Antibiotics

Pancreatitis in cats is very rarely due to an infectious disease that would respond to antibiotics. However, the stress of pancreatitis can weaken your cat’s general immune system. So antibiotic protection is sometimes given, particularly when your veterinarian is worried that your pet’s liver, gall bladder or small intestine might be involved as well. Because pancreatitis in cats rarely occurs alone, there are many valid reasons for your veterinarian to administer them to your cat – even though they are not suggested treatments for the various forms of pancreatitis that occur in humans. 

Consider Administering Corticosteroids When Appropriate

If your cat’s circulatory system collapses into a shock-like state, your veterinarian might want to give it corticosteroids as well. Many veterinarians also administer corticosteroids short term in an attempt to decrease pancreatic inflammation or when coexisting inflammation of the liver or intestine is suspected based on your cat’s blood work results, ultrasound examinations and/or biopsies. There are no studies I know of that determined if giving corticosteroids such as prednisolone or dexamethasone help end attacks of acute pancreatitis in cats. But they have been found to be beneficial to dogs and humans suffering from pancreatitis. ( read herehere  , here , here & here ) If your veterinarian decides that corticosteroids are warranted, one needs to keep close track of your cat’s blood sugar level because corticosteroids have also been implicated in the onset of diabetes in cats. 

Nutritional Support

Most cats with pancreatitis are reluctant to eat. There are a few that will still nibble and there was a time when veterinarians would attempt to “rest” those pet’s pancreas by not allowing the cat to eat. That has fallen out of favor because of the fear of hepatic lipidosis . We now know that restoring food intake as quickly as possible is an important step toward your cat’s recovery. So appetite stimulants such as mirtazapine (Mirtaz®) or capromorelin (  Entyce®/Elura® ) are often given. Neither are entirely free of side effects, but they can usually be minimized by adjusting the dosage downward. Mirtazapine often reduces the tendency to vomit as well. It is available as a transdermal cream to be applied to the cat’s ear. Eating anything is always better than eating nothing. So it can be unwise to attempt to suddenly change a sick cats diet from what it was used to eating at home to what might be a better long-term diet. That can be done later when your cat feels better and then in gradual cautious steps. 

When cats cannot or will not eat on their own, feeding them other than by mouth ( enteral feeding) is often the best solution. In cats, that involves placing a tube that enters your cat’s nose and reaches its stomach (a nasogastric tube). Alternatively it can enter through an incision in the cat’s esophagus and terminate in the stomach (esophagostomy tube). It is common for veterinarians to use one of these two methods in cats with severe cases of pancreatitis.  (read here ) The first can be done with no more than a local anesthetic; the second requires general anesthesia – always more risky in seriously toxic cats. The benefit of the esophagostomy procedure is that thicker food formulas can be fed. That is beneficial when your veterinarian anticipates that the tube will need to stay in place in your cat for more than a few days. Cats can also be fed intravenously with products designed for total parenteral nutrition  (non-oral). However the survival rate of cats forced to rely on these intravenous products is somewhat low. (read here

Treatment Strategies For Chronic Pancreatitis:

Will A Special Diet Help?

Yes.

Cats with long-standing pancreatic problems often no longer produce the enzymes of digestion in sufficient quantities. For them to thrive, you will need to take that into consideration when feeding them. Those enzymes are available in supplemental powder and tablet form. Your cat’s return to its healthy body weight and normal stool consistency are the best judges of nutritional success.  If there might be other special dietary needs for cats with acute or chronic pancreatitis has never been determined. Most veterinarians will suggest that from now on you feed your cat one of the many commercial diets sold as highly digestible  for cats prone to intestinal issues (“gastrointestinal diets”). My suggestion is that you prepare your cat’s diet at home and avoid carbohydrates entirely. Some studies suggest that high levels of arginine and methionine in your cat’s future diet might be beneficial. So might added B-12. Turkey and  chicken are excellent sources of arginine and eggs, meat and fish are excellent sources of methionine and B-12. Your home-prepared diet needs to include a mineral supplement. I often suggest BalanceIT products: or MeatComplete: The proteins and fats that your cat needs will be harder to absorb if chronic intestinal inflammation (IBD) and liver issues that often accompany pancreatitis is part of your cat’s problem. IBD also makes it harder for cats to handle fiber. I would avoid added fiber unless constipation or diabetes are also health issues. The intestinal inflammation that accompanies IBD can also lessen the amount of vitamins your cat is able to absorb from its food. Many cats will need to be coaxed with a savory diet dressing in order to hold (maintain) a healthy body weight. Read more about home-prepared pet diets here. Make diet changes very gradually and do not attempt them during acute episodes or flare-ups. We don’t want to aggravate weight loss and malnutrition with new food aversion. 

Is My Cat’s Pancreatitis Likely To Reoccur?

If you cat has had two episodes of pancreatitis, or if your cat’s blood test values did not fully return to normal after the first episode, it is likely that various forms of digestive tract issues will remain a chronic intermittent problem. Chronic pancreatitis in cats is a disease that can be managed, minimized, but rarely cured. At least not with the treatment options and nutritional advice commonly given today. A low-stress lifestyle and individualized nutrition are the keys to preventing or minimizing future flare-ups. Pancreatitis, with or without liver and intestinal involvement, results in inflammation that over time results in scaring (fibrosis). Scarred organs never perform quite as well as they did before. Purchase a good scale. Keep a diary of your cat’s body weight. A healthy stable body weight is a sign of success and more important than any tests we veterinarians have to offer. Many disease of cats and people have an element of genetic susceptibility. If you breed cats, keep that in mind.

Why Are Cats  So Prone To Diseases Involving Oxidative Stress?

Cats seem to be particularly sensitive to chronic inflammation, a form of oxidative stress (OS) . Read about OS and inflammation hereVaccinations that cause no tumors in dogs, periodically cause fibrosarcoma tumors in cats. ( read here ) Perplexing and unexplained chronic mouth inflammations are also 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. ( read here ) In keeping with this feline high sensitivity to oxidative stress, there is a statistical connection between eating canned, fish-flavored cat foods and hyperthyroidism. ( read here  & here ) Fresh fish and other meat ingredients fit for human table consumption never end up in the cans or kibble you feed your cat. What does end up in that can are fish and fish products that sat too long on the dock, stored and processed fish meal and fish-plant waste that are all highly susceptible to lipid peroxidation and the liberation of destructive free radicals.  (read here , here , here & here ) That’s why a 5.5 oz can of Purina Friskies Ocean Whitefish cat food once costs you $0.44; while a 5.5 oz of whiting fillets set you back $3.78   Of course, prices for both are quite a bit higher today. Cats love oily fish and the mouth feel of animal derived fats. Cat food manufacturers love to add fish-derived oils to all their products so they can tout their rich omega-3 content. But the sources of these ingredients are all very subject to lipid peroxidation which liberates highly destructive inflammatory compounds. (read here ) You can substitute any meat ingredient you see on the can or sack of cat food and the story would be essentially the same. Rest assure what went into the sac or tin you fed you cat looked nothing like the beautiful images that were on the label. 

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