Pancreatitis



Pancreatitis is

It is a common disorder, but is easier to control if caught early. It occurs when dog's pancreas becomes inflamed. The cells become damaged enough to leak digestive into the abdominal cavity, which can result in secondary damage to surrounding organs, such as gall bladder, intestines, or liver. The pancreatitis is a gland located on the right side of the abdomen, it really as no room for it or it's "spills" to go. The pancreas aids in metabolism of sugar (produces hormones such as insulin) and digestion of food (produces enzymes). Pancreas problems can lead to blood sugar levels and issues with surrounding organs. Go to vet for physical examination and blood panel. Pancreas enzyme levels will help with the diagnosis, but full blood work is needed to get an over all view or which organs may be involved.

Dogs that have elevated pancreatic enzyme levels in their blood commonly develop problems in the liver as well. Hepatitis (inflammation of the liver) and Jaundice (yellowing of skin, gums, eys due to bilirubin in the blood) may be secondary to the primary pancratitis. Typically you'll see a rise in the liver enzymes ALT, AST, Bilirubin, ALKP and possibly GGT. More information is below about secondary liver issues.

Cause

The actual cause is unknown, but here are some possible contributors to pancreatitis.
  • A dog who gets into the garbage may bring on pancreatitis by this typicaly not given foods.
  • Eating rancid foods, moldy, spoiled meats. Including a dog possibly finding a dead animal and eating parts.
  • Fatty foods can be a trigger for the diesease to flare up
  • Pork is rummored to cause issues. Many dogs develop this disease suddenly around the holidays.
  • Overweight dogs with high fat diets are believed to be more at risk.
  • Stress is also a contributing factor
  • Viral or bacterial infections
  • Trauma or injury to the abdomen
  • Low protein, high-fat diets may stimulate oversecreation and lead to pancreatitis

    • * it is rarely seen in thin, frequently exercised dogs who are fed low fat balanced diets.
When the pancreas is inflamed, digestive enzymes spill into the abdominal cavity, which can result in secondary damage to surrounding organs, such as gall bladder, intestines, or liver.

Symptoms

Two Forms of sudden onset pancreatitis:

Mild Case (Edematous)

- no multisystem failure, complete recovery
  • The initial symptom in mild cases is partial anorexia, lack of appetite or being a "picky" eater.
    • This is caused by a reaction to the reduced levels of pancreatic juices and secretions
  • Vomiting
  • Oily, gray stool
  • Diarrhea (may contain blood)
  • Depression, Lethargic
  • Excessive water intake or little water intake
  • Weakness
  • Abdominal Tenderness

More severe, hemorrhagic form

- multisystem failure, complications by infection or abscesses
  • anorexia, abdominal pain, vomiting, diarrhea, lethargy, fever, dehydrated, emaciated.

Diagnosis

Blood work, exam, abdominal ultrasound are typical first lines. X-rays show little information with organs. Since symptoms can differ, diagnosis must be combined with laboratory tests, examinations, and ultrasounds.

Lab Test

The vet will run a CBC (Complete Blood Count) and blood chemistry analysis. These test are not specific to pancreatitis, but can give a very good insight into what is going on.

Recently IDEXX Reference Laboratories indroducted the Spec cPL (Canine Pancreas Specific Lipase) Test.

Amylase and Lipase are two enzymes closely watched. They can however indicate other diesease. The CBC helps see the entire "picture". Amylase and Lipase can be increase in diseases such as renal and gastrointestinal disease.

Serum amylase and lipase are generally accepted as tests useful in diagnosis pancreatitis as long as values are at certain levels. Your vet can explain this further.

Liver enzymes (ALT, AST, ALP) are often increased due to the toxins being "dumped" from the pancreas. Bilirubin may be up as well.

Serum amylase

- begins to rise 6 to 12 hours from the onset, it peaks between 24 and 48 hours. It can often reach levels 4 to 6 times higher than the upper limit of normal. It starts to typicaly normalize within 48-72 hours, provided the successful treatment is used. It will return to normal in a few days.

Serum lipase

- elevates around 24 hours after the onset of symptoms. It normalizes within 7 to 14 days. These level takes longer to rise than amylase and will remain elevated longer.

Mild to moderate increases in white blood cell counts genneral occure with pancreatitis

Serum amylase and lipase enzyme levels are often three times normal.

You can learn more on our Blood Work and Lap Reports page

Treatment

*** Need to reset the pancreas from it's role in digestion ***

Most dogs will respond to treatment in a few days. Typically food is with held for 24 hours. Water is given in very small amounts several times a day to avoid dehydration. Keep a very close eye out for it! Fluid therapy may be need.

It is thought that once vomiting stops for 24 hours, pancreatic recovery has begun.

They are then started on a bland diet, giving small portions several times a day. The vet may give an antacid or an antibiotic. Probiotics may be given as well to help the pancreas work less. Because bilirubin is excreted through poop, frequent feeding can help pass the excess bilirubin and reduce jaundice.

Diet is VERY important to help with recovery! Make sure to follow your vets instructions closely!

Recovery Diet

  • AVOID HIGH FATS - the pancreas has to work hard to digest fat
  • Diets higher in carbs with low fat and low protein is typically fed for a week or two depending on the severity. After that the the dog's regular food may be slowly worked back in.
  • keep protein 15-30% DMB (dry matter base) (13-23% calories)
  • keep fat 10-15% DMB ( 17% - 23% of calories)
  • Low fiber is prefered at first, since it slows the gastric emptying.
  • Some common recommended foods during recovery are
    • Brown rice, apple sauce, non fat plain yogurt, non-fat cottage cheese, egg whites (yoke has fat), boiled chicken (no skin, no bones), oatmeal, sweet potato (limit do to vitamin A and fiber), pasta. Avoid corn, barley, rye, turkey (turkey is high in trypotophan which stimulates the pancrease)
    • Vet may recommend mixing in an R/X food for pancreatic health. Hill's I/D meets that fat amount mentioned above. However is the liver is involved home cooked or L/D may be looked into to. The main goal is to cure the pancreatitis, as it is the primary cause, the other organs being secondary will have their time, but the primary needs to be dealt with first.
    • The vet may also recommend giving a arrowroot cookie every hour to help maintain blood sugar levels.
  • Small portions several times a day! Regulating glucose is difficult with larger meals given once or twice a day. Giving an arrowroot cookie for vannila wafer every hour or so will help maintain a consistent level of blood sugar.
  • An example of feeding times would be to give breakfast, snack, lunch, snack, and dinner.
    • yogurt does it's best work when given with breakfast and before bed
    • oatmeal goes well with animal protein as it's souble fiber helps remove the ammonia as those proteins are being broken down.
    • dairy proteins are much eaiser to process, as long as the dogs stools stay normal - non fat cottage cheese and non fat yogert are the best options

Dietary Enzymes

Dietary enzymes are heat sensitive and easily destroyed by cooking. Adding a supplement to food may help the dog's system. The theory is if these enzymes are present, the intestines will tell the pancreas not to release any more. This hopoefully will limit the work and damage the pancres has to do. It needs rest.
  • Extract from Pineapple helps digestion (Bromelain)
  • Papain (enxyme from the papya)
  • Gymnema (regulates suger levels in teh blood)
  • Other helpful natural digestive enzyme supplemnts containin: lipase, lactase, protease, cellulose and amylase
  • Vit C, E, and Selenium may help reduce pancreatic damage

Probiotics - Friendly bacteria

These may also be offered by your doctor. Supplements are available. A vet can help you chose the best for your dog. Yogurt is one.

To fully recover, it is recommended the pancreas needs rest for up to two weeks. The recovery diet helps it do just that.

Prevention

Long Term Diet

  • Food again is the key
  • Feed good quality food that is low in fat and has moderate fiber. Feed small, multiple meals to not overload the system
  • No FATTY FOODS. Avoid table scrapes and access to the garbage. Pig ears and such are very fatty. Avoid giving holiday treats, low fat is the key!!!
  • Keep your dog at a healty weight. Even if allowed fatty snacks, and they are fit and exercise, they could still run a risk of developing issues.
  • Once a dog has pancreatitis, it may be easier for them to get it again.
  • Natural digestive enzyme supplement being added to their food can help reduce pancreatic damage, along with Vit C, E, and Selenium.
    • Snow peas & strawberries have been considered safe and are a good sorce of vit C
    • Sweet Potatoes are a source of vit E and fiber
    • Oat bran/Oatmeal is a great source for Selenium. Fish oil caps made from Anchovies contain contain selenium.
  • Limit Zinc intake.
  • Read medication's side effects

Feeding Raw Diet after Pancreatitis recovery

Raw diet tends to make the system work easier. The food is digested well, with little waste. However, you MUST feed lean raw meats. Skin and fat should be removed beforing feeding dogs with a history of pancreatitis. Raw game meats are much healthier for dogs with past pancretitis. Lean protein is the key, it can be found in elk, moose, wild boar, deer, quail, duck. For fiber, pumpkin and sweet potatoe is a good source along with grains such as oatmeal. Raw meat does offer up extra enzymes that help dogs digest their food. Cooking kills these helpful enzymes.

Liver Disease Secondary to Pancreatits

Because the pancreas is located in the retroperitoneal space with no capsule, inflammation can spread easily. The close proximity of the two organs and the bile duct results in some degree of hepatitis (liver inflammation) whenever the pancrease becomes inflammed. Treat the pancreatits and the liver disease will regress. It is considered normal to see elevated liver enzymes after a bout of pancreatitis. The common bile duct that is shared by the liver and the pancreas is often invovled when the pancreas inflames. Often times this leads to some liver damage (which is usually reversible) with pancreatitis. The liver enzymes can also take a few weeks to come down.

When the pancreas inflames, it is common to see the elevated liver enzymes AST, ALT, ALP, GGT, Bilirubin along with the pancrease enzymes Amylase and Lipase.

From only what I can gather while reading up on values, this what the supportive info I can gather:
  • Elevated ALP & GGT seem to indicated the common bile duct is affected. The external compression of the ducts by the inflammed pancreas affects the drainage of bile.
    • When ALP is created by the liver, it produced by the cells lining the ducts which bile flows, and increases indicate bile flow obstruction.
    • Large elevations with GGT are more commonly associated with pancreatitis and bile duct obstruction. They are used to detect bile duct injury.
    • Bilirubin often increases along with ALP & GGT, if there is an obstruction within the liver or bile duct so that the bilirubin cannot be released into the intestine, blood levels will also elevate.
    • If the duct is bothered, the AST & ALP my increase or sometimes not. The albumin and gloubin usually stay normal. Cholesterol usually increased.
      • The compressed duct causes backflow into the liver, damaging the cells, and releasing more AST & ALP
  • Increased liver enzymes, ALT, and AST may occur in pancreatitis
    • ALT levels typically peak two to three days after liver injury and return to normal in one to three weeks if the liver injury resolves
    • Since the liver an pancrease are so close, with the pancreas inflamation, the release and activation of digestive enzymes in and around it can damage the liver as well, causing hepatocelluar injury (liver cell injurty). The hepatocyte damage( liver cell damage) results in the ALT/AST increase.
    • The inital rapid increase of these two enzymes indicates the acute process of the pancrease spilling it's jucies all over the place.
    • The slow rise may indicate bile duct obstruction. If the GGT, AKLP, and Bilirubin are increased they suggested bile duct involvement. The increase in ALT and AST may continue to be seen. This all together indicates the involvement of the duct is most likely the cauase of the continued increase.

    Once the injury to the duct is repaired (pancreas is no longer inflamed and the duct has no compression and allowed time to repair any inflammation secondary to the pancreas), these values should begin to decrease. You most likely will see a drop in GGT, AKLP and Bilirubin indicating the duct is recovering. This drop will most likely occure after the pancreas values have returned to normal.


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Links that helped me:

Grayhound - Duffy’s Bout with Pancreatitis: Causes and Treatment of Canine Pancreatitis

Pancreatitis.doc

Those pesky elevated liver enzymes

Liver Health for Pets - Denamarin, Denosyl, and Marin

NZYMES.COM: Official Site! Natural Supplements for Pets and People www.nzymes.com Biliary Obstruction

Complete Blood Count (CBC) / Blood Chemistry

Abnormalities detected by standard CBC and blood chemistry analysis are not specific to canine pancreatitis and can be highly variable. A leukocytosis with a left shift is common. Toxic change may be associated with acute pancreatic necrosis. A relative polycythemia or anemia can be seen. Azotemia is a common finding and can be either pre-renal due to dehydration or due to secondary acute renal failure. Liver enzyme activities (ALT, AST, ALP) are often increased, probably due to hepatic ischemia or hepatic damage caused by toxic products from the pancreas. Additional findings include hyperbilirubinemia due to hepatocellular damage or cholestasis, hyperglycemia caused by hyperglucagonemia, stress, or damage to pancreatic islet cells, hypocalcemia associated with hypoalbuminemia or calcium deposition, hypercholesterolemia, hypertriglyceridemia, and hyperlipidemia.1,3,5

Diagnosing Pancreatitis in Dogs and Cats by Laboratory Methods
Laura D. West, DVM and Frederic S. Almy, DVM, MS, Diplomate ACVP
Class of 2007 (West) and Department of Pathology (Almy), College of Veterinary Medicine, University of Georgia, Athens, GA 30602-7388





**** Many of us are not vets or even close to an expert on these topics. Many articles have come from hours spent online reading and talking with others while trying to figure out what is best. If you have any questions, or information to add, feel free to contact me at web@dobermandata.com

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