by Roger Ross, DVM
The pancreas is a small, spongy, gland attached to the upper intestines just below the stomach.
There are two major cell types in the pancreas, once of which produces insulin. When something goes wrong with these insulin producing cells, the result is diabetes.
Insulin regulates/assists the transfer of glucose into cells. Cells without adequate glucose are sick, dying cells.
The second major cell type in the pancreas produces digestive enzymes that enter the upper intestines through ducts and aid in the breakdown of fats, starches, and proteins.
There are 3 basic diseases of the associated with the pancreas besides diabetes:
1. Pancreatitis: when the gland is infected or inflamed.
2. Pancreatic insuffiency: when that part of the pancreas that normally makes digestive enzymes simply isn't performing well.
3. Pancreatic cancer: nearly always fatal.
Pancreatitis is the most common of these 3 proplems in small animal medicine.
The pancreatic enzymes made by the pancreas are vital for good digestion, but if they leak out of the pancreatic ducts, these enzymes cause severe inflammation and severe pain to the pancreas or surrounding tissue.
It's a little vague as to why this sometimes happens, but it does, and especially if ...
your pet gorges or over eats
your pet gets a high fat treat or meal or has a high fat diet
your pet doesn't get enough exercise
Obestity, cancer, infection, steroid use, certain medications, and adrenal gland disease are all possible underlying causes.
Certain breeds like Miniature Schnauzers are more prone than others breed to get this disease.
Cats are not prone to the disease. But people are and all the same underlying factors are important; over eating, obesity, lack of exercise, high fat diet etc.
Signs include abdominal pain, vomiting, depression, weakness, dehydration, vascular irritation, rapid heart and respiratory rates. GI upset, and lack of appetite. Basically the patient just feel terrible. I tell my students; if you can't find anything else specifically wrong in an obviously sick patient... start thinking about pancreatitis.
Diagnosis: Sometimes easy. Sometimes not so easy.
The symptoms of not eating and just feeling lousy aren't proof of pancreatitis... lots of problems could account for these symptoms.
We have simple, inexpensive, in clinic test kits for amylase and lipase which, if strongly positive, tells us that your pet has pancreatitis. These are the easy cases. But these tests aren't very sensitive or reliable which is why some cases are difficult to detect.
So we will often have to do repeat tests, more sohphisticated tests, and/or abdominal radiographs and/or ultra sound to help confirm the suspected diagnosis of pancreatitis and to rule out other problems with similar symptoms such as abdominal obstruction and intusseception.
Blood ammonia level testing is a superior and much more accurate test for pancreatitis but ONLY IF your vet has this test available which is RARE.
Ammonia in the blood is only stable for minutes so the test has to be run right away with very expensive equipment. Sometimes vets working next door to a human hospital lab have an arrangement to do this test in their lab. I understand that an ammonia meter much like a glucose meter may be available soon. But so far, (2014) it's not on the market, at least in a reasonable price range.
Pancreatitis is a complicated disease.
It can be acute and happen once in a dog's lifetime or it can become chronic.
It can cause rapid death due to the side effects or consist of only a mild pain that resolves in a few days.
Side effects include shock, blood clotting problems, and heart, liver, and kidney disease.
Treatment: This varies but involves controlling all the side effects of the disease; pain, dehydration, vomiting,blood clotting, shock, etc.
Severe cases will need hospitalization, IV Fluids, and parental antibiotics. They will need medication to control nausea. I like to also give activated charcoal to coat the upper intestines and reduce inflammation and absorb toxins.
Restricting food for 2 days helps. This is a case where giving special treats rich in fat or sugar trying to get your pet to eat does harm.
Antibiotics: because the pancreas is exposed to the bacteria in the intestines, an unhealthy pancreas is often infected as well.
Higher Fiber, low carb diets and weight control are the mainstay for long term prevention/treatment
Exocrine Pancreatic Insufficiency
Exocrine Pancreatic Insufficiency (EPI) is what we call the disease when the pancreas simply aren't producing enough pancreatic enzymes needed for digestion.
This is usually caused by atrophy of the pancreatic cells for reasons unknown. There is certainly a genetic factor involved though, as German Sheperds and Collies are more prone to this disease than other breeds.
This disease is most common in young dogs under 6 years old.
Weight loss despite a good appetite
Foul smelling, sloppy stools. Often pale in color.
The most reliable test for EPI is assay of serum TLI (trypsin-like immunoreactivity).
I'm an old timer now, and the old test was to put a piece of unexposed xray film in a test tube of the patient's stool. If the patient has a normal amount of digestive enzymes, then we'd expect the emulsion on the xray film to be digested off. If the emulsion is still there after 20 minutes, then we suspected insufficient enzymes !
Response to treatment is another valid test; if the stools get better after giving supplemental digestive enzymes, then we can conclude that there was an insufficiency.
Most EPI patients can be successfully managed by supplementing each meal with pancreatic enzyme extracts (Pancrezyme). Additional measures such as antibiotics, dietary modification, vitamins or steroid therapy may be helpful.
Enzyme replacement is the key to treating EPI. Enzymes must to fed with every meal with two meals per day being sufficient to promote weight gain. Diarrhea and the ravenous appetite should resolve in a few days and weight gain of ½ to 1 pound per week should be expected.
A low fiber regular maintenance diet is helpful