Dog - Pancreatitis

What is pancreatitis?

Pancreatitis is inflammation of the pancreas.  This is a large gland on the anterior (head end) right side of the abdomen.  It has two functions:

1. An exocrine function - producing enzymes essential for the digestion of food.  These flow via the pancreatic duct and ultimately enter the duodenum.
2. An endocrine function - Hormones are produced by special cells, the Islets of Langerhans, situated on the surface of the pancreas.  The most well known of these is insulin.  This is carried to the tissues of the body via the bloodstream.

Is pancreatitis common?

Pancreatitis is a relatively common disease in the dog.

Does it affect any particular breed or type of dog?

There appears to be no age, breed or sex predisposition.

Acute pancreatitis

There are two main forms of acute sudden onset pancreatitis:

1. The oedematous form.  With this the pancreas swells (becomes oedematous) and is painful.   This form is often associated with eating a large fatty meal.
2. The haemorrhagic (bleeding) form.  This in its most severe form may cause death very rapidly, often because of shock due to the severe abdominal pain.

 If dogs recover from the acute form they may have recurrent bouts of the disease, known as chronic, relapsing pancreatitis.  The inflammatory process associated with the condition allows digestive enzymes to leak into the abdominal cavity.  This can result in further damage to surrounding organs, such as the liver, bile duct, gall bladder and intestines.  

What is the cause?

Several factors are believed to be responsible.  These include obesity, infection and disturbances of immunity.  Many cases are also classified as idiopathic (i.e. cause unknown).  Digestive enzymes produced by the pancreas are normally activated only when they reach the small intestines.  With pancreatitis, these enzymes are activated prematurely in the pancreas itself which results in digestion of pancreatic tissue.

What are the clinical signs?

Diagnosis is often difficult since during an attack dogs show fever (pyrexia), vomiting and diarrhoea (which is often blood stained).  This can occur with other diseases such as infectious gastroenteritis.

Acute abdominal pain is usually a feature and to relieve this many dogs adopt a 'praying position' by standing on their hind legs with their head and forequarters lowered to the ground.  In very acute attacks shock, depression and death may occur.

How is a positive diagnosis made?

• Clinical signs
• Laboratory tests
• Diagnostic imaging (x-rays or ultrasound examination)

The elevation of pancreatic enzymes in the blood is probably the most helpful sign but unfortunately some dogs with acute pancreatitis have normal levels.  Radiographs (x-rays) and ultrasound studies often show an area of inflammation in the pancreas.   Sometimes a positive diagnosis is impossible and treatment then has to be based on tentative diagnosis alone.

What is the treatment?

If suspected, it is important that nothing is given by mouth.  The stimulus of material in the digestive tract will only increase the signs.  Successful management depends on early diagnosis and treatment.  In the mild form of the disease the aim is to prevent stimulation of the pancreas.  Food and all oral fluids are withheld.  Intravenous therapy (a drip) is used to maintain normal fluid and electrolyte balance.  In addition, antibiotics and anti-inflammatory drugs are sometimes administered.  Shock also has to be treated by intravenous fluid therapy.

What are the chances of recovery?

Prognosis depends on the response to the initial treatment.  Obese dogs presenting with severe shock and depression carry a guarded prognosis.  Most of the mild forms of acute pancreatitis do have a good prognosis.

Are there any long-term problems?

Severe or repeated pancreatitis may carry three possible long term complications.

1. If a significant number of cells producing digestive enzymes are destroyed, a condition known as exocrine pancreatic insufficiency may follow.  This is particularly common in the German Shepherd dog although other breeds are affected.  It arises when 90% or more of the cells producing the digestive enzymes (exocrine cells) have been destroyed.  Long term supplementation will then be required.
2. If a significant number of the insulin producing cells (Islets of Langerhans) are destroyed, diabetes mellitus (DM) can result.  Long term insulin therapy may be needed.  
3. Occasionally due to the leakage of pancreatic digestive enzyme, damage to other abdominal organs may occur.