Summertime is coming and for most of us that means long days, grilling more meals outdoors and cookouts with family and friends. It also means that all the fatty foods we’ve been avoiding for the past few months so we look good in our swimsuits are about to make a strong comeback! There are a few dogs out there that are definitely, without a doubt going to get into some post barbecue garbage sometime this summer. One of them lives in my house. Most of the time these guys may have some stomach upset, even a few days of diarrhea but that should pass. A few of them, though will end up in serious trouble. Foreign bodies, ulcers and pancreatitis are all on the list. Today we’re going to talk about pancreatitis.There are some cases of mild pancreatitis that are treated less aggressively. I will not really be getting into those cases.
First we should have some idea of what the pancreas is and what it does. The pancreas is a small pink organ that is attached to the stomach and the beginning of the intestines. It has two major jobs. It secretes te hormones involved in regulating blood sugars, insulin and glucagon. It also secretes the enzymes used to break down proteins, starches and fats that we eat.
The enzymes used to break down the things we eat are typically safely stored in granules that need to be activated by a catalyst for them to begin digestion. When the pancreas becomes inflamed this integrity is lost and the enzymes are activated inappropriately. They begin to digest the pancreas itself. This leads to more inflammation in the pancreas and more leakage of enzymes. Eventually the enzymes start to leak out of the pancreas and into the abdomen where they can do serious damage.
Frequently we never find out why a dog has pancreatitis but one of the major causes we know about occurs when the contents of the intestines is refluxed back into the duct that releases the pancreatic enzymes. This is a problem because once in the intestines the pancreatic enzymes are mixed with the activating enzymes. If you move a fluid containing these activating enzymes into the pancreatic duct it will prematurely activate the enzymes within the pancreas. This reflux can happen after a dog ingests a very fatty meal. Similar to heart burn in humans.
Diagnosing pancreatitis is fairly difficult in the dog and cat. The major clinical signs (symptoms) are not eating, vomiting, lethargy, abdominal pain and diarrhea. Those are also the major clinical signs for just about every disease that occurs within the abdomen. Often the leaking pancreatic enzymes will affect other organs as well including the liver, kidneys, intestines and gall bladder. It can also cause problems with the heart, blood vessels and lungs if the enzymes make it into the blood stream. Often a pancreatitis is diagnosed during an exploratory surgery.
There are some blood work and imaging indicators of pancreatitis. In veterinary medicine we look at tests in terms of how well they avoid false negative and false positives. This is called sensitivity and specificity respectively. If a test is very sensitive it is good for ruling diseases out because a negative is a negative. In terms of ruling out pancreatitis in dogs the best blood test we have available to us right now is called a cPLI and it has a sensitivity of about 80%. This means that out of every 10 patients that truly had pancreatitis this test would incorrectly tell us that 2 of them did not have pancreatitis. Ultrasound examination of the pancreas yields similar sensitivity. (If this seems really confusing you are not alone. I guarantee I will get a few emails from veterinarians this week telling me I have this backwards.) My point is that diagnosing pancreatitis 100% is very difficult.
So if we can’t be certain that it is pancreatitis what do we do? Unfortunately there is not a specific treatment for pancreatitis and we are left providing supportive care. In other words we treat what we know we have. This means treating aggressively for pain. Replacing the fluids and electrolytes lost from vomiting, diarrhea and not eating. We will also often give drugs to stop vomiting and keep them from being nauseous. All of my patients with intestinal issues are started on drugs to prevent or treat stomach ulcers. The most important aspect of therapy is fluid therapy, hydrating dogs and cats and keeping their systems “flushing” helps to clear the inflammatory mediators and allow the pancreas a chance to calm down and heal. Dogs and cats, especially cats, will not drink enough to accomplish this feat. This often means they will have to be hospitalized and will get their hydration through intravenous administration.
Pancreatitis is a serious disease with life threatening consequences. Many dogs and cats with pancreatitis do not recover fully and it is not uncommon to lose a patient with pancreatitis even in the face of aggressive therapy. Your vet sees these cases fairly regularly and avoiding this outcome drives them to recommend rapid diagnosis and aggressive treatment.
This is also one of the diseases we see where early diagnosis, intervention and aggressive treatment will be a deciding factor in how things turn out. So please do not ignore it if your normal chow hound of a dog or cat suddenly loses their interest in eating. This is one of those times where being overly cautious is well worth it.
Thanks for reading.