Management of Pancreatitis in Veterinary Medicine

Introduction to Pancreatitis

• Pancreatitis is inflammation of the pancreas

  • Can be acute or chronic in dogs and cats

• Most common in middle-aged animals

• Breed predispositions include:

  • Terrier breeds

  • Miniature Schnauzers

  • Domestic short-haired cats

• Believed to be multifactorial with a genetic predisposition as well as triggering factors (e.g., eating a high fat meal, obesity, or cholangitis, IBS, or renal disease in cats)

Pancreatic Function Basics

• Primary function: Synthesize and secrete digestive enzymes

  • Breaks down protein, fat, and carbohydrates

  • Produces bicarbonate to optimize intestinal pH

Clinical Signs in Dogs

• 90% present with acute vomiting that can be sporadic and mild or severe

• Common symptoms include:

  • Abdominal pain

  • Depression

  • Anorexia

  • Fever

  • Diarrhea

  • Icterus and pale stools potentially if inflammation and swelling is severe enough to cause a bile duct obstruction

• Often preceded by dietary indiscretion 24 hours prior to the onset of vomiting

• Potential triggers:

  • High-fat human food consumption

  • Administration of drugs like corticosteroids

Clinical Signs in Cats

• Highly variable clinical presentation

• Could be similar to dogs with vomiting, diarrhea, and abdominal pain

• Most common signs:

  • Anorexia

  • Lethargy

  • Dehydration

  • Weight loss

• Can present with acute or slow, smoldering course

Key Nutritional Factors: Feeding Approach

• Begin feeding early

• Enteral nutrition preferred

• Benefits include:

  • Intestinal mucosal regeneration → enteral feeding is the most potent for this

  • Decreased cytokine (a messenger related to inflammation) production

  • Reduced catabolism

  • Preserved protein

• Also should add antiemetics (anti-nausea) as soon as possible

Hydration and Electrolyte Management

• Critical to manage fluid loss and prevent dehydration

• Potential electrolyte abnormalities from acute vomiting and diarrhea:

  • Hypokalemia

  • Hypochloremia

  • Hypernatremia/hyponatremia

• Recommend parenteral fluid therapy (IV or SQ) vs. oral to correct electrolyte imbalances

• Protein levels:

• Highly digestible diet (≥85% digestible)

• Dogs: 15–30% dry matter

• Cats: 30–40% dry matter

• Important to avoid excess as free amino acids are a strong stimulus for pancreatic secretions

• Fat content management:

• Dogs: <15% dry matter

• Cats: <25% dry matter

  • *Really just needs to be lower than their original diet

• Solids and liquids higher in fat will empty more slowly from the stomach = increasing pancreas work (e.g., fat in the duodenum causes a release of CCK which delays gastric emptying)

• Low fiber content (<5% dry matter)

• Gel-forming soluble fibers should be avoided as it increases the viscosity of the ingesta and delays gastric emptying

• Moist foods are better as they reduce gastric retention time; warming foods to room temp/body temperature can also be useful