Pancreatitis

Pancreatitis Is Inflammation of the Pancreas 

In pancreatitis, inflammation disrupts the normal integrity of the pancreas. Digestive enzymes that are normally safely stored are released prematurely where they digest the body itself. The living tissue becomes further inflamed and the tissue damage quickly involves the liver. Toxins released from this array of tissue destruction are released into the circulation and can cause a body-wide inflammatory response.

Pancreatitis can cause disseminated intravascular coagulation, or DIC, which is a massive uncoupling of normal blood clotting and clot dissolving mechanisms. This leads to abnormal simultaneous bleeding and clotting of blood throughout the body.

Pancreatic encephalopathy (brain damage) can occur if the fats protecting the central nervous system become digested.

Pancreatitis can be acute or chronic, mild or severe.

What Causes Pancreatitis 

In most cases we never find out the cause, but we do know some events that can cause pancreatitis:

• Reflux of duodenal contents into the pancreatic duct. The pancreas has numerous safety mechanisms to prevent self-digestion. One of these mechanisms is the fact that the enzymes are stored in an inactive form. They are harmless until they are mixed with activating enzymes. The strongest activating enzymes are made by duodenal cells, which mean that the digestive enzymes do not actually activate until they are out of the pancreas and mixing with food in the duodenum. If duodenal fluid go back up the pancreatic duct and into the pancreas, enzymes are prematurely activated and pancreatitis results.

• Concurrent hormonal imbalance predisposes a dog to pancreatitis.

• Trauma to the pancreas as from a car accident or even surgical manipulation can cause inflammation and thus pancreatitis.

Signs of Pancreatitis

The classical signs in dogs are appetite loss, vomiting, diarrhea, painful abdomen, and fever.

Making the Diagnosis

Blood levels of amylase and lipase (two pancreatic enzymes) have been used to test for the disease. When their levels are especially high, this is felt to be a sign of pancreatitis. They can elevate dramatically with intestinal perforation, kidney disease, or even dehydration.

A newer test called the PLI or pancreatic lipase immunoreactivity test has come to be important. Lipase is one of the pancreatic digestive enzymes and small traces are normally present in the circulation. A regular lipase level measures all forms of lipase, not just those of a pancreatic source; this test is specific for pancreatic lipase.

Radiographs can show a widening of the angle of the duodenum against the stomach, which indicates a swelling of the pancreas.

Ultrasound detects 68% of cases and provides the opportunity to observe other organs and collect fluid from the belly. This test may be the best.

In some cases, surgical exploration is the only way to make the correct diagnosis.

Treatment

The passage of food through the duodenum is a strong stimulus to the pancreas. In the treatment of canine pancreatitis we do not want any stimulation of the pancreas; we want the pancreas to rest. This means no food and no water for 2 to 3 days.

Fluid support will generally require potassium supplementation. Blood pH must be tracked as well. A critical patient with pancreatitis will need 24 hour care and blood test monitoring several times a day.

Pancreatitis is a painful condition and pain management is very important in recovery. Injectable pain medications or continuous drips can be used effectively to control pain. Additional medications to control nausea are also commonly used. Antibiotics are often used because even though pancreatitis is not a bacterial disease, bacterial invasion from the diseased intestine is a common occurrence.