Ask Dr Iain-Pancreatitis

 

If you have an animal health question please contact Dr. Iain at

askdriain

 

Hi Dr. Iain,

I would like to know a few things about pancreatitis.

1. How is it acquired?

2. How is it diagnosed?

3. How is it treated?

4. What sort of diet is needed? Samples please.

5. What is the likelihood of it re-occurring?

Many thanks,

Beth Canavan

 

PANCREATITIS (a.k.a. in emergency clinics, the consequence of feeding your dog c**p!)

Contrary to what some people think, being a vet isn’t always easy and the vomiting dog can be a real dilemma. There are many possible causes and although taking a history can take you a long way towards a diagnosis, sometimes we need the help of blood tests and radiographs .Even then, it may be inconclusive and if the vomiting isn’t resolving with treatment, a vet can end up recommending an exploratory surgery. I’m not the only vet who has opened up a vomiting dog expecting to find a foreign body blocking the intestine but instead discovered pancreatitis. I know there must be at least another somewhere but fortunately nowadays with blood tests that detect pancreatic specific lipase, this sort of thing doesn’t happen as often.

Typically a dog with pancreatitis is going to be vomiting. Not just a couple of episodes and still wagging their tail, but depressed and intractable vomiting. The pancreas is a slither of pink tissue that is nestled against the beginning of the small intestine as it leaves the stomach. It has two main functions. Firstly, it has an endocrine function where it produces insulin, but that’s another discussion. Secondly, it has an exocrine function where it produces several digestive enzymes that it releases into the small intestine via the pancreatic duct. The most common cause of pancreatitis is when we have fed our dog something that is just too fatty for their digestive system to cope with and it doesn’t matter if they have had the same food before. When the pancreas is just too over stimulated by a fatty meal it actually activates the digestive enzymes too soon, so that the enzymes start digesting the pancreas itself rather than just the food in the gut. This is a very painful disease. The digestive enzymes damage everything in the vicinity including the stomach and hence the vomiting. The bowel can stop moving because of local inflammation which doesn’t help reduce the vomiting or pain. This local peritonitis can allow bacteria to enter the bloodstream from the gut and cause life threatening septicaemia. The adjacent liver can also be damaged and even obstruction to the flow of bile from the liver via the bile duct can occur. Cardiac arrhythmias can occur due to the release of enzymes from the damaged pancreas into the bloodstream. All these things lead to dehydration, cardiovascular shock and a painful death in some cases if left untreated.

So, if we see a dog that is depressed, sore on abdominal palpation and vomiting, we’ll wonder about pancreatitis, especially if it’s Christmas Day or there has been something inappropriate recently fed. Common culprits are things like pork, bacon, turkey, sausages, roasted meats, salami, ice-cream, dessert dishes, raiding compost or rubbish bins or just regularly helping out at home by licking the BBQ hotplate clean! If the dog is fairly bright and no foreign body is palpable and they may have eaten something inappropriate, then the vet may take blood sample and institute some pain relief and/or antiemetic (anti-vomiting) medication and advise resting the stomach for up to a day at home. Then we will tell you to start small bland meals and gradually wean back onto a normal diet (minus the BBQ sausages) and to revisit if the vomiting persists. This is important, because a mild pancreatitis and gastritis can be similar. While both can settle with conservative treatment, it is the pancreatitis that more likely will not and so we would then work up the case and treat more aggressively.

If the dog is quite depressed, painful on abdominal palpation even sometimes seeking cool surfaces to lie on and so trying to reduce the inflammation going on inside their tummy, then we would normally admit and work up the case immediately. This dog is likely to be dehydrated, running a temperature and may even have jaundice if the liver is involved. Fluid therapy to counter dehydration and shock is the main treatment while resting the stomach and therefore the pancreas, for up to a few days. Most dogs feel too sick to want to eat by this stage and may just be vomiting fluid, whether they have been drinking or not. Pain relief is very important and many dogs will get morphine or similar drugs even continually through their intravenous drip. Antiemetic drugs and sometimes antibiotics may be indicated. Blood tests will be run and this is what normally makes the diagnoses. If the vet is concerned that a foreign body or other surgical intestinal disease could be the cause, then while waiting for blood results they may take a radiograph to look for evidence of these but instead may see changes associated with pancreatitis such as localised fluid and gas.

Blood tests will often show high white blood cell counts, electrolyte abnormalities, evidence of dehydration and possibly liver damage. Most vets will test for Amylase and Lipase levels. These are pancreatitic enzymes that are usually in very low levels in the bloodstream but with pancreatitis they will increase dramatically. The problem for vets in the past were cases that were mild and had moderate increases in these enzymes because they can be increased with some non-pancreatic diseases that can cause vomiting too, such as neoplasia, liver and renal disease, hence the occasional unnecessary exploratory. Nowadays, laboratories can test for a pancreatic specific lipase which makes diagnoses much simpler.

Things are never uncomplicated. Pancreatitis can occur in cases of trauma, with neoplasia of the pancreas and sometimes as a result of ascending infections or reflux from the small intestine amongst other things. So sometimes it just happens and the dog hasn’t eaten something inappropriate, but they usually have!

When the patient goes home we will normally recommend a bland low fat diet for awhile such as Hills i/d diet before gradually weaning back onto a normal healthy diet. If the pancreatitis was really severe or is a repeated episode, then we may recommend a lifelong low fat diet such as Hills w/d or Eukanuba low residue or a balanced low fat homemade diet. Yes, having a previous episode makes you more at risk of having another, especially a dog who is overweight or if they already have diabetes or other hormonal disease. A dog that has repeated pancreatitis is at risk of destroying so much pancreatitic tissue that they become diabetic and/or suffer permanent exocrine pancreatic deficiency where they require digestive enzymes added to their food. These dogs usually present with chronic diarrhoea.

I know what Beth and some other members are saying, “what about Iain’s bitch Veronica?” She’s overweight because Lois allows her to steal other dog’s food not because I feed her c**p !!

 


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