At a glance
What is pancreatitis?
Pancreatitis is an extremely painful inflammation of the pancreas due to premature activation of digestive enzymes which begin to break down and digest the pancreas. Usually, the pancreas protects itself from the digestive enzymes it manufacturers, stores and secretes by secreting them inactivated (zymogens) and activation shouldn’t occur until the enzymes reach the duodenum.
Pancreatitis may be acute (sudden onset) or chronic (persistent). Acute pancreatitis is usually more severe than chronic. Pain can range from mild to severe.
Over time, repeated bouts of pancreatitis can result in scarring of the pancreas, which makes it less efficient and can cause complications. The highest incidence is in middle-aged to senior cats; however, it can occur in young cats and even kittens. Middle-aged to older cats are most often affected by pancreatitis, although it can occur in younger cats and even kittens.
What is the pancreas?
The pancreas is a pale pink, lobulated organ located near the liver and behind the stomach. The pancreas performs both exocrine (secretes enzymes via a duct) and endocrine (secretes hormones directly into the bloodstream) functions.
Endocrine function: Small clusters of cells called Islets of Langerhans are responsible for the production of the hormones insulin and glucagon, which regulate blood sugar.
Exocrine function: Pancreatic juice, a digestive enzyme-rich in sodium bicarbonate which helps break down proteins, fats and carbohydrates. The pancreas secretes pancreatic juice which is collected in the pancreatic duct where it joins with the bile duct from the liver before entering the duodenum.
- Hyperlipidemia – High-fat content in the blood
- Hypercalcemia (high calcium content in the blood)
- Pancreatic duct blockage
- High-fat diet
- Hepatic lipidosis
- Trauma (car accident, fall from a height, abdominal surgery) – Damage to the pancreas may result in enzymes leaking out
More than 90% of all cases of feline pancreatitis are classified as idiopathic (no known cause).
Presenting symptoms are often vague but may include lethargy, anorexia (loss of appetite), hypothermia (reduced body temperature), and less commonly, vomiting and abdominal pain.
Acute cases of pancreatitis can lead to shock and disseminated intravascular coagulation, a condition in which small blood clots develop throughout the bloodstream. Over time, as the pancreas becomes damaged, weight loss occurs, which is due to the pancreas no longer functioning as it should, digesting food. As a result, food passes through the digestive tract relatively undigested, leading to pale coloured, loose, foul-smelling feces and weight loss.
Pancreatitis may run concurrently with other diseases such as cholangitis/cholangiohepatitis, hepatic lipidosis (fatty liver disease), and inflammatory bowel disease. Pancreatitis, cholangiohepatitis and inflammatory bowel disease which run concurrently are collectively known as ‘feline triad disease‘. Complications of pancreatitis due to the destruction of pancreatic cells can include transient or permanent diabetes and exocrine pancreatic insufficiency.
Due to the vague symptoms, which are similar to a host of other disorders, diagnosis can be a challenge, and many cases of pancreatitis go undiagnosed as a result of these non-specific symptoms. Your veterinarian will perform a complete physical examination of your cat and obtain a medical history.
- Baseline tests: Biochemical profile, complete blood count, and urinalysis May be non-specific. Pancreatic enzymes are often normal. Mild elevations of hepatic enzymes ALT can occur. Elevated white blood cells are an indication of inflammation or infection. Mild anemia may be present. The damaged pancreas may affect insulin production, resulting in elevated glucose levels.
- fTLI (feline Trypsin-Like Immunoreactivity): This test measures the concentrations of trypsin-like proteins in serum. Elevated levels may be indicative of pancreatitis.
- TAP (trypsin activation peptide).
- fPLI (feline Pancreatic Lipase Immunoreactivity): A measure of feline pancreatic-specific lipase (an enzyme secreted by the pancreas which breaks down fat) immunoreactivity in serum. Normal levels are 2.0-6.8ug/dL, in cats with mild or resolving pancreatitis, levels may be 6.8-12ug/dL and cats with pancreatitis, over 12ug/dL.
- Ultrasound: The gold standard diagnostic, which may reveal an enlarged and thickened pancreas with dilated pancreatic ducts.
- Laparotomy: Surgical incisions are made in the abdomen to allow your veterinarian to examine the organs. In this case, the pancreas.
Find and treat the underlying cause if one can be found as well as provide supportive care. Morphine or transdermal fentanyl patch will be given to cats to relieve abdominal pain, antiemetics such as metoclopramide or maropitant to manage nausea and vomiting. Cats with pancreatitis are usually reluctant to eat and will require a nasogastric, nasoesophageal or jejunostomy tube to maintain nutrition which is critical in the sick cat. Intravenous fluids to correct dehydration and electrolyte imbalances. If the cat has concurrent chlangiohepatitis, antibiotics will be prescribed.
Once the cat is able to eat on his or her own, feed small frequent and highly digestible low-fat food such as boiled chicken breast or Hills i/d.
The prognosis depends on the severity of the disease, and if hepatic lipidosis or pancreatic necrosis have occurred along with complications (such as DIC) and concurrent illness.
Long term care
Cats who have had pancreatitis are at increased risk of a flare-up, to reduce this feed a low-fat, highly digestible diet.