Pancreatitis

Pancreatitis was once thought to be a rare disease process in cats however, better diagnostic tests (such as feline specific pancreatitic digestive markers and ultrasound) as well as an appreciation that cats are more prone to a chronic, smouldering form of the disease has led us to realize that, and other GI inflammatory diseases, are more common.

​What is pancreatitis?

Pancreatitis refers to inflammation of the pancreas. The pancreas is a vital organ located in the right side of the abdomen. It has two functions:  1) to produce enzymes that help in digestion of food and, 2) to produce hormones such as insulin. When the pancreas becomes inflamed, the disorder is called pancreatitis. There is no age, sex, or breed predisposition.
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There are two main forms of pancreatitis: an acute (sudden onset) form and a chronic form.  Acute severe, hemorrhagic pancreatitis can be a life threatening condition in cats whereas the chronic form can go undiagnosed for years as the symptoms are often more subtle.  The end result of ongoing pancreatitis is fibrosis (scar tissue) of this organ and eventual loss of function.  Loss of pancreatic function can show up clinically as diabetes or as a disease called “exocrine pancreatitic insufficiency” where the body cannot make enough digestive enzymes and food is not properly absorbed.

​What causes pancreatitis?

The cause of pancreatitis is not known. There may be more than one cause. In dogs, it is often associated with a rich, fatty meal however, these associations have not been found with feline pancreatitis.  Biopsies in chronic pancreatitis show non-infectious inflammatory cells (lyomphocytes and plasma cells) making an immune mediated cause possible.  As some affected cats are prone to food sensitivities and allergies, this disease may be more similar to Chrone’s disease in people in which food can act as a trigger but is not the whole picture.  As the immune system is influenced by stress, this may be a concurrent risk factor.

What are the clinical signs of pancreatitis?

The clinical signs in acute pancreatitis are often of acute shock, severe pain, lethargy, fever, vomiting and require immediate medical attention.  The symptoms in chronic pancreatitis are often non-specific and can include periods of anorexia, lethargy, hiding, abdominal pain, reluctance to play, diarrhea, or vomiting.  As cat owners, we will often tolerate a certain amount of hairballs or “recreational vomiting” but if this is occurring weekly or multiple times in a month it may indicate underlying disease and should be discussed with your veterinarian. 

How is pancreatitis diagnosed?

The diagnosis of pancreatitis is challenging and is based on clinical signs/history, laboratory tests, imaging (x-rays and/or ultrasound) and pancreatic biopsy.  Laboratory tests usually reveal an elevated white blood cell count; however, an elevated white blood cell count may also be caused by many other conditions. The elevation of pancreatic enzymes in the blood is probably the most helpful criteria in detecting pancreatic disease, but many cats with pancreatitis will have normal levels.  If the liver is also involved then there may be changes in liver enzymes or the bile flow marker bilirubin.  Some cats with chronic pancreatits may be diagnosed as diabetics but who respond to low levels of insulin or go in and out of remission. Radiographs and ultrasound studies may show an area of inflammation in the location of the pancreas. Unfortunately, many cats with pancreatitis will elude detection with any of these tests. Consequently, the diagnosis of pancreatitis may be tentative in many cases. 

Exploratory surgery with biopsy collection is the only definitive way to diagnose pancreatitis (and also rule out more severe diseases such as pancreatic cancer).  Biopsy allows the tissue to be examined at the cellular level.  Unfortunately, this requires anesthetic, which is not without risk, and the concept of surgery is frightening but when answers are needed, it is the best way to go.  At the time of biopsy, often times samples will be taken from other organs including liver, intestines, and lymph nodes to provide a complete picture of what is going on in the abdomen.

How is pancreatitis treated?

Treatment of acute pancreatitis generally requires hospitalization and intensive therapy.  Treatment of chronic pancreatitis is less clear as there is no proven therapy that applies to every case.  Often times we focus on symptomatic and supportive care such as pain management, controlling nausea, controlling dehydration, using appetite stimulants, feeding GI friendly diets, using anti-oxidants to limit damage, etc. so therapy is really tailored to each individual case.  As the pancreas is needed in cats to absorb the vitamin B12, supplementation may be needed long term to prevent deficiency.

​Will my cat recover?

The prognosis depends on the extent of the disease when presented and a favorable response to initial therapy. Cats that present with shock and depression have a very guarded prognosis. Most of the mild forms of pancreatitis have a good prognosis.

Will there be long-term problems?

A consequence of the chronic inflammation of the pancreas is that normal tissue is replaced by non-functional scar tissue.  It is this loss of function that causes of the most significant consequences of chronic pancreatitis:

1. Exocrine pancreatic insufficiency: If a significant number of cells that produce digestive enzymes are destroyed, a lack of proper food digestion may follow. This is known as pancreatic insufficiency and can be treated with daily administration of enzyme tablets or powder in the food.
2. Diabetes: If a significant number of cells that produce insulin are destroyed, diabetes mellitus can result. This can usually be treated with daily injections of insulin.