FELINE PANCREATITIS

PANCREATITIS IN THE CAT

MOST OF US HAVE HEARD OF THE PANCREAS BUT AREN’T REALLY SURE WHAT IT IS.

PANCREATITIS IS POTENTIALLY A METABOLIC DISASTER. HERE’S WHY:

The normal pancreas has a number of safeguards in place to keep its digestive enyzmes securely stored. If these enzymes escape and become active, they will digest the body! This is exactly what happens when the pancreas gets inflamed: the enzymes escape, become inappropriately activated, and begin digesting the pancreas itself. The living tissue becomes further inflamed and the tissue damage quickly involves the adjacent liver. Toxins released from this rampage of tissue destruction are released into the circulation and can cause a body-wide inflammatory response. If the pancreas is affected so as to disrupt its ability to produce insulin, diabetes mellitus can result; this can be either temporary or permanent.

• Pancreatitis can be acute or chronic (acute cases can reverse completely).
• Pancreatitis can be mild or severe (acute cases tend to be more severe and mild cases may not even require treatment).

ACUTE VERSUS CHRONIC PANCREATITIS

The acute self-digestion described above can be a disaster. The patient stops eating, becomes painful and nauseated during the episode which can be life-threatening. Most cases, however, are more slowly smoldering in cats with long term weight loss, appetite reduction, and intermittent nausea or diarrhea. Cats with chronic low grade pancreatitis can flare up into more acute episodes requiring hospitalization. Many apparently healthy cats are found to have pancreatitis incidentally, in which case, if there are no symptoms, the test results are simply tracked over time or addressed with simple management such as diet and/or probiotics. There is no specific treatment for pancreatitis beyond support of natural healing function and controlling other diseases that may be contributing to pancreatic disease.

WHAT CAUSES PANCREATITIS IN THE CAT?

There are many possible factors contributing to pancreatitis in cats but intestinal disease seems to be especially prominent on the list. Intestinal disease of a chronic nature leads to altered ability of the intestine to absorb and move nutrients. Consequently, the bacterial flora that populates the intestine become altered as well leading to a bacterial community with fewer "beneficial" organisms and more "bad bacteria." These bad bacteria produce toxins that contribute to the intestinal disease situation and can literally crawl up the pancreatic duct into the pancreas and cause infection and inflammation there. They can do the same thing to the liver by crawling up the bile duct as well, easily done in the cat as the pancreatic duct and bile ducts share the same opening. For many cats, control of pancreatitis involves control of the intestinal disease and possibly liver disease as well.

Of course there are other potential causes of pancreatitis:

• Trauma (getting hit by a car or falling from a great height). Trauma might also occur during abdominal surgery.
• An active feline distemper infection.
• Toxoplasma (a special parasite) infection can involve the pancreas (though it almost always involves other tissues as well).
• Infection with certain parasitic flukes that colonize the pancreas or liver.

Exposure to organophosphate insecticides. (These are not used in feline flea products but might be used in the garden for insect control).

IF YOUR CAT HAS PANCREATITIS, WHAT MIGHT YOU OBSERVE AT HOME?

In the dog (and human) this condition is associated with a lot of nausea and abdominal pain. According to one recent study in cats, though, only 35% of cats with pancreatitis showed vomiting and only 25% appeared to have abdominal pain. Fever is a possible sign but often the temperature will drop instead. Lethargy and appetite loss are consistent signs. Nearly all cats with pancreatitis lose their appetites and about half of cats with pancreatitis will have been affected long enough to show weight loss.

Approximately 40% of cats with hepatic lipidosis have pancreatitis as the underlying cause.
Hepatic lipidosis represents a special liver failure that stems from
appetite loss/inadequate calorie intake and complicates pancreatitis tremendously.
For more information on hepatic lipidosis click here.

MAKING THE DIAGNOSIS

The diagnosis of pancreatitis has been made substantially simpler with the development of the SPEC-FPL and PSL tests, which stand for Specific Feline Pancreatic Lipase and Pancreatic Sensitive Lipase respectively. The SPEC-FPL test can be run as an in-house test kit that yields a positive (or negative or even a numeric value depending on the equipment used) in a matter of minutes. The PrecisionPSL® test can be run by Antech reference labs but does not have an in-house test kit.

These tests are based on the "PLI" test, which stands for Pancreatic Lipase Immunoreactivity, a test which is available only at certain veterinary university diagnostic laboratories. Lipase is one of the pancreatic digestive enzymes and small traces are normally present in the circulation. These levels jump dramatically during pancreatitis and thus the diagnosis can be made non-invasively without the expense of ultrasound. This form of testing is actually more sensitive than ultrasound which means it can pick up pancreatitis in a milder state.

Of course, pancreatitis can be diagnosed on ultrasound as the inflamed pancreas becomes swollen and exhibits texture changes typical of inflammation. Pancreatitis can also be diagnosed by biopsy during surgical exploration as well though there is controversy as to whether removing a piece of pancreas actually generates additional inflammation. The advantage of surgical exploration, however, is that other organs can be sampled to get a more complete picture of what is happening in the abdomen overall.

The SPEC-FPL and PrecisionPSL tests have become common additions to basic feline blood work and their elevations are commonly picked up in cats with no symptoms of any kind. The significance of this suggests (but does not necessarily confirm) an unhealthy bowel population is present and has overgrown and is either elaborating material that is inflaming the pancreas or has actually invaded the pancreas. If the cat genuinely has no symptoms, treatment is not necessary; however, it may be prudent to consider a hypoallergenic diet or the addition of probiotics (live cultures of beneficial bacteria) to the food to assist in recolonizing the bowel into a healthier microbe community.

HOW IS THE CAT TREATED?

There are three parts to treatment: removing the cause of the pancreatitis (this is usually not possible since the cause is only rarely known), general support and symptomatic relief through the inflammatory crisis, and monitoring and instituting protection against the disastrous complications listed above. Intravenous fluid therapy is used to support the pancreatic vasculature and combat any dehydration from vomiting or diarrhea. This simple act of perfusing the pancreas enables damaging inflammatory biochemicals to be flushed away and healing to begin.

Medicines are used to control pain and nausea. In the dog, high fat diets are important predisposing factors for pancreatitis but this appears not to be true for cats. Pre-existing inflammatory bowel disease seems to bear more feline relevance so treatment in that direction seems more appropriate (steroids, antacids, probiotics, low residue diets or hypoallergenic diets). Anecdotally, digestive enzyme supplementations are felt to be helpful in some cases. In the past, food restriction was included in treatment to rest the sensitive pancreas but newer thinking is that the entire GI tract heals faster when food is passing through it.

A NOTE ON VITAMIN B12

The healthy pancreas manufactures a substance called "intrinsic factor" which is necessary for the absorption of vitamin B12 (cobalamin) from the diet. The unhealthy pancreas does not make enough intrinsic factor and deficiency ensues when pancreatitis becomes chronic. This leads to an unthrifty and often anemic cat. Since dietary B12 cannot be absorbed without intrinsic factor, the traditional solution is to provide B12 by injection, usually at home, once or twice a week and periodically thereafter. Vitamin B12 levels can be tested to determine if supplements are needed or, since the injections are relatively inexpensive and have a broad safety margin, sometimes they are simply prescribed without testing. A new oral B12 supplement has become available recently; its manufacturer claims to have solve the intestinal absorption problem.

PROGNOSIS

How the cat does in the long run depends on how severely ill he or she is and what accompanying conditions are present. If the cat survives the episode of acute pancreatitis there is a good chance that he or she will live a normal life thereafter. Chronic cases of pancreatitis may, however, wax and wane for years requiring a permanent diet change and chronic medication administration.

Page last updated: 4/22/2023