What is Pancreatitis in Dogs?
Pancreatitis is a painful inflammatory condition of the pancreas which occurs commonly in dogs.
The pancreas is a vital organ that lies on the right side of the abdomen adjacent to the stomach.
The pancreas produces enzymes to assist in food digestion, along with important hormones including insulin, which are vital for regulating the body’s blood sugar levels. When the pancreas becomes inflamed for any reason, the condition is called pancreatitis.
Normally, pancreatic enzymes are produced in an inactive state and travel through the pancreatic duct to the small intestine. Once they reach the small intestine, they are "activated" to begin their work digesting food. In pancreatitis, these enzymes are activated prematurely in the pancreas instead of later in the small intestine. This results in the digestion of the pancreas itself and causes a very painful inflammation of the pancreas along with vomiting and other signs.
What are the Causes of Pancreatitis?
The underlying causes of Pancreatitis are still poorly understood.
Pancreatitis can often be triggered by a fatty meal or inappropriate food ingestion, but can sometimes occur spontaneously.
It is believed there may be a genetic component to the likelihood that a dog will develop pancreatitis. Toxins including zinc and castor beans, along with several medications have also been linked to the condition however studies in this area are lacking. Dogs consuming processed, cooked foods may also be over-represented.
Other causes include pancreatic trauma along with diseases of the biliary tract, pancreatic duct and intestines.
Which Dogs are at Most at Risk?
Pancreatitis can occur at any age and in any breed, however it more commonly occurs in middle-aged to old, overweight and inactive dogs.
Overweight dogs may also suffer more severe cases of the condition. Breeds including Schnauzers, Yorkshire Terriers, Spaniels, Boxers, Shetland Sheepdogs, Collies are over-represented [1]. Also, dogs who are more likely to scavenge or eat inappropriate foods (e.g. Labradors, Beagles, Retrievers) seem to be the victims of pancreatitis more frequently.
Dogs with other endocrine (hormonal) diseases such as Diabetes and Hypothyroidism may have abnormal fat metabolism which can cause hyperlipidemia (high levels of lipids or fats in the blood) which can predispose a bout of pancreatitis. Dogs with Cushing's Disease (Hyperadrenocorticism) and with systemic illnesses may also be higher at risk of developing the condition.
Cats can also develop Pancreatitis.
What are the Common Signs of Pancreatitis?
The most common presenting complaints include:
✔️ Reduced appetite or anorexia
✔️ Nausea or vomiting
✔️ Fever
✔️ Lethargy
✔️ Abdominal pain
✔️ Diarrhea.
Examination findings are often non-specific and can vary widely depending on the severity of the disease. In early and mild cases, signs commonly include mild dehydration, abdominal pain and altered gut sounds (increased/decreased borborygmi).
In many cases, these may be the only abnormalities, however as the condition progresses and increases in severity, variable levels of abdominal pain and dehydration will be encountered and can become severe.
Some dogs will develop a fever, icterus (yellow-tinged gums and sclera), and in severe cases – hypovolemic shock due to severe dehydration.
During an attack of abdominal pain, dogs may take a "praying position", with their rear end up in the air while their front legs and head are lowered onto the floor.
Because these signs or symptoms are quite vague and non-specific, your vet will need to rule our other causes of acute abdominal pain, inappetence and vomiting which can also include: gastroenteritis, toxin ingestion, liver disease, bowel obstruction, renal (kidney) disease, lower urinary tract disease, liver failure and organ torsion to name a few.
How is Pancreatitis Diagnosed?
A strong suspicion of pancreatitis is often gained based on a dog's clinical signs and history, but a more definitive diagnosis is achieved through the use of blood tests and abdominal ultrasound.
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Pancreatitis in dogs
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However, it is important to note that there is not one specific test that is conclusive for pancreatitis, so diagnosis can be problematic.
For example, sometimes blood tests may be normal. A test commonly recommended to assist in the diagnosis of Pancreatitis is the canine pancreas-specific lipase (cPLI) snap test. This test is very affordable and requires only a couple of drops of blood, however false-negative and false-positive results will often occur. A diagnosis of pancreatitis is usually based on a combination of clinical signs and history, with assistance from blood tests and abdominal ultrasound.
Abdominal radiographs (xrays) are sometimes helpful and may demonstrate subtle changes in the appearance of
abdominal organs, but once again they are commonly normal or inconclusive.
Ultrasonography remains one of the most important methods to diagnose pancreatitis. A skilled ultrasonographer will identify changes consistent with pancreatitis which usually include an enlarged pancreas and will also identify complications including the more serious pancreatic abscessation and peritonitis.
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| A Veterinary Abdominal Ultrasound being performed |
At the same time, a normal ultrasound does not rule out pancreatitis, hence why it can be an incredibly challenging diagnosis to rule in (ie. confirming this condition exists) OR rule out (ie. confirming this condition does not exist).
Treatment and Recovery of Pancreatitis in Dogs
The successful management of pancreatitis will depend upon early diagnosis, prompt medical therapy and will be based largely upon the severity of clinical signs.
In very mild cases of pancreatitis which are detected early and before dehydration develops, the treatment is supportive, by "resting" the pancreas and allowing the body to heal itself. This involves only offering frequent, small, bland, low fat meals, along with oral medications to help relieve pain, prevent vomiting and protect the gut. In these mild and early-detected cases, hospitalisation may not be required.
However, as the condition progresses and dehydration worsens, hospitalisation will often be required for 24 to 72 hours for intravenous fluid therapy to correct hydration, electrolytes and acid-base disturbances. Intravenous pain relief, anti-emetic and gut-protective medications will also be required. Antibiotics may need to be administered if concurrent infection is suspected which may be indicated by a fever and abnormalities in the red and white blood cell counts.
With severe cases and where complications develop, intensive care using aggressive doses of intravenous fluids and medications to counteract shock are required. Such complications can include hemorrhagic pancreatitis, pancreatic abscessation and peritonitis (infection in the abdomen). In these cases, dogs may need several days to a week in hospital under intensive care to recover fully. Rarely, surgery may be indicated in extreme cases.
Case Study: “Axle” - 10-year Border Collie x Kelpie
Axle’s owner Scott got in touch when he noticed his appetite had been reduced for a few days and he seemed lethargic and simply “not himself”.
By the time he had booked in a Pawssum Vet visit for the following day, Axle had developed vomiting plus his lethargy had worsened. Upon initial examination, I found Axle to be clinically very well besides showing signs of mild dehydration, mild abdominal pain, and he was around 5kg overweight.
Initial therapy consisted of an injection of Cerenia to prevent nausea/vomiting for 24h, a pain relief injection and Lectade (an oral electrolyte drink designed to correct dehydration and electrolyte imbalances).
At this stage, Scott was advised to feed Axle only very small meals of boiled chicken/rice for the next 8h, encourage him to drink the Lectade, monitor him closely for any other changes and we arranged a recheck for the following day. Eight hours later, Axle was in a similar condition. He had not yet responded to treatment and remained lethargic, reluctant to eat or drink and whilst the initial pain relief injection seemed to improve things for a few hours, he once again seemed uncomfortable.
His owner Scott was worried that he wasn’t improving and my clinical exam confirmed that his condition was deteriorating despite treatment: I noticed that his dehydration and abdominal pain had worsened and he was now developing a temperature or fever. Based upon these findings, I recommended he was admitted to hospital for more aggressive therapy and Scott agreed.
Axle had an intravenous catheter inserted into his foreleg and we started him on IV antibiotics, IV pain-relief and additional anti-nausea medications.
At this point, a blood test was undertaken which showed no major abnormalities besides the usual electrolyte disturbances of a dog with vomiting.
His cPL (Canine Pancreatic Lipase) test showed a negative result, however knowing that false negatives are common (i.e. a negative result will commonly occur in positive cases), I was still highly suspicious of pancreatitis based on his signs and the rule-out of other other conditions with a similar presentation.
At this stage, Axle wasn’t thrilled about being in hospital and was very brave but mostly slept for the next few hours.
An abdominal ultrasound was performed which confirmed his pancreas was inflamed but thankfully, all other abdominal organs were in good health.
At this stage, a diagnosis of pancreatitis was confirmed based upon the combination of clinical signs, bloodwork and ultrasound findings hence treatment was continued according to the initial plan of pain relief, anti-emetics and gastro-protectants.
The following day, Axle appeared to have turned a corner and had started to show interest in food for the first time in 3 days. His hydration levels were improving thanks to the intravenous fluids. Furthermore, his follow-up blood tests confirmed that no complications had ensued.
When his owner Scott came to visit, he was thrilled to see that Axle’s waggy tail had returned and he was seeming to be gradually returning to his usual happy self.
After another 12 hours of treatment Axle was given the all-clear to go home but on strict instructions to avoid high-fat and over-processed foods.
For the past 6 months, Axle has gone incredibly well on a home-prepared diet that consists primarily of raw, lean meat (primarily raw kangaroo), along with vegetables and a small amount of brown rice.
What is the Prognosis for Pancreatitis?
The prognosis depends upon the severity of the disease when diagnosed and the response to initial therapy. Dogs that present with shock and depression can have a guarded prognosis.
However, most of the mild forms of pancreatitis have a good prognosis, especially if treatment is instigated early before the dog becomes severely dehydrated. Dogs that are not treated may progress to the hemorrhagic form and suffer severe consequences, including sudden death. However, fatalities from pancreatitis are quite rare.
Most dogs will recover without long term consequences. However, once a dog has had an episode of pancreatitis they are more likely for the disease to re-occur.
Some dogs develop chronic pancreatitis, which refers to a continuing, low-grade inflammation of the pancreas. A dog with chronic pancreatitis may develop intermittent, acute flare-ups and hence require long-term management.
Dogs that develop chronic or recurrent pancreatitis or suffer a complicated case of the condition are at risk of developing pancreatic fibrosis and long-term complications can ensue. This means the pancreas has suffered long-term damage and is no longer able to perform some of its vital functions.
For example, if the pancreas can no longer produce the hormone insulin, which is vital to regulate blood sugar levels, this results in the development of Diabetes Mellitus which may be temporary or permanent.
Dogs with Diabetes need to have injections of insulin once or twice daily along with regular blood tests to monitor blood glucose levels.
Similarly, if the pancreas can no longer produce digestive enzymes, the dog can develop Exocrine Pancreatic Insuffiency whereby they are unable to digest food properly, resulting in weight loss, loose stools and other complications if left untreated. This condition will also require long-term management with diet and digestive enzyme / B12 supplementation.
What is the best Prevention for Pancreatitis?
It is recommended that dogs who have had pancreatitis in the past are fed a bland, low-fat diet and all treats and fatty foods are avoided. Some dogs respond better to a raw food diet.
Because overweight and inactive dogs are at higher risk of developing pancreatitis, along with a long list of other medical conditions, keeping your dog at an ideal body weight and providing regular exercise is vital.
Ask your vet what your dog’s ideal weight should be at each checkup. You can also get an idea of whether your dog is the correct weight by running your hands along their spine and ribs.
If they are overweight, you will need to apply a little pressure to feel their ribs and spine. Your pet should also have a clearly defined, tucked in waist line when you look from above and from the side. If they have a waist, you will be able to see a smaller width of body between the back of his rib cage and his hips (like an hourglass).
If your dog has no visible waist and looks wider in the space between his rib cage and hips, then he is overweight. Any extra wideness in your dog’s middle is the equivalent of ‘love handles’ in people and are a definite sign of being overweight which means your dog will be prone to health complications.
written by Dr Louisa Fenny for Australian Dog Lover, January 2019 (all rights reserved)
References
[1] Pancreas. Washabau RJ. In Washabau RJ, Day MJ (eds): Canine and Feline Gastroenterology—St. Louis: Saunders Elsevier, 2013, pp 799-848
About the Writer
Dr Louisa Fenny graduated from Murdoch University in 2005 and is a member of the Veterinary Surgeons Board of WA and the Founder of Wilderness Warriors, a not-for-profit wildlife organisation.
After more than a decade as a vet, Louisa finds it incredibly rewarding to be a part of the close bond between people and their pets and she's passionate about educating the community about small animal care.
She loves to take a holistic approach to preventative health care and incorporate natural based diets when appropriate.
Louisa has also featured in national TV show Desert Vet which looks at the life of her veterinarian dad, Rick Fenny.
