The pancreas is an “L” shaped organ that lies along the stomach and first section of the small intestines (the duodenum). Its purpose is to produce digestive enzymes and hormones to control how we utilize what we eat (insulin and glucagon). There is a small duct that leads from the pancreas into the duodenum for the digestive enzymes to mix with food to aid in digestion.
Pancreatitis is inflammation of the pancreas. Normally, the digestive enzymes produced in the pancreas are inactive until they are released. In pancreatitis, the enzymes become activated while still in the pancreas, causing digestion of the pancreas itself. This causes pain, inflammation and often vomiting. Inflammation from the pancreas causes inflammation of the liver and stomach and toxins from that inflammation can cause systemic inflammation. If enough damage is done to the pancreas itself, its ability to produce insulin can be compromised and diabetes mellitus can result. Most cases of pancreatitis do not cause systemic disease or diabetes, especially if managed promptly.
Often, a specific cause of pancreatitis is never identified, but there are risk factors. Fat appears to play a major role in the development of pancreatitis. A recent high fat meal, or ingestion of food from garbage containing high amounts of fat is the classic precursor to pancreatitis. Some diseases that alter fat metabolism can also predispose dogs to pancreatitis. The most common diseases are diabetes mellitus and hypothyroidism. Obesity can also alter fat metabolism. A rare cause of pancreatitis is a tumor of the pancreas.
Not surprisingly, signs of pancreatitis are typically gastrointestinal in origin. Vomiting, anorexia, diarrhea and painful abdomen are classic signs of pancreatitis. Some dogs have a fever. Signs of mild pancreatitis can be as simple as lethargy.
Diagnosis of pancreatitis can be challenging. In the past, seeing elevated digestive enzymes on a blood chemistry panel (amylase and lipase) was considered evidence of pancreatitis. We now know that isn’t the case since other organ system abnormalities can also cause increases in these enzymes. A lipase test specific for lipase released from the pancreas is available (PLI) and can be run at the time of an appointment to diagnose pancreatitis. This test can stay positive for a period of time, so determining resolution of pancreatitis can be difficult. Radiographs (x-rays) of the abdomen will sometimes show loss of detail or haziness in the area of the pancreas, but it is not a sensitive test for diagnosing pancreatitis. Ultrasound can identify tumors or abscesses of the pancreas and can reveal suspicion for inflammation of the pancreas.
There is no specific treatment for pancreatitis. The most important aspect of management of dogs with pancreatitis is rehydration with fluid therapy. Improving circulation of the pancreas aids in healing the pancreas itself and the rest of the body. With most cases of pancreatitis, hospitalization and intravenous fluid therapy is required. Often, additional medication to control pain and nausea are needed.
Transition to low fat food, typically for life, is advised to try to prevent future episodes of pancreatitis. 7% or less fat on a dry matter basis is ideal. Often, prescription diets are needed to achieve this goal.
Chronic pancreatitis or multiple episodes of acute pancreatitis can damage the insulin-producing islet cells in the pancreas to the point that diabetes mellitus develops. If, or when, that occurs, the dog may require insulin injections to regulate the blood sugar.