PANCREATITIS

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• Pancreatitis is inflammation of the pancreas, which can be:

  • Acute

  • Chronic

  • Acute-on-chronic

• Pathophysiology:

  • Premature activation of pancreatic enzymes leads to tissue damage.

  • Can cause local inflammation, systemic consequences (e.g., SIRS), and multi-organ failure.

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Signalment

• Breed Predilection:

  • Any breed can be affected, but overrepresented breeds include:

    • Schnauzer, Yorkshire Terrier, Spaniels, Boxers, Shetland Sheepdog, Collies.

• Age & Range:

  • Typically affects middle-aged to older dogs.

  • Often overweight or with a history of dietary indiscretion.

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Causes

• Unknown but commonly associated factors:

  • Dietary indiscretion (e.g., high-fat foods).

  • Toxins (e.g., zinc, castor beans).

  • Pancreatic ischemia due to hypotension or anesthesia.

  • Surgical manipulation involving the pancreas.

  • Pancreatic or biliary disease.

  • Pancreatic trauma.

  • Idiopathic (no identifiable cause).

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Risk Factors

• Obesity: Increases risk.

• Endocrine diseases:

  • Diabetes mellitus

  • Hypothyroidism

  • Hyperadrenocorticism (Cushing’s disease)

• Hyperlipidemia

• Idiopathic cases (unknown causes).

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Pathophysiology

• Premature activation of pancreatic enzymes leads to:

  • Proteolysis of pancreatic tissue.

  • Inflammation and free radical production.

  • Systemic inflammatory response syndrome (SIRS) may result in:

    • Organ dysfunction (e.g., liver, kidneys, lungs).

    • Peritonitis, respiratory distress, renal injury, DIC (disseminated intravascular coagulation).

• Local consequences:

  • Increased capillary permeability, edema, hemorrhage, and necrosis.

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 Clinical Signs

• Common Clinical Signs:

  • Decreased appetite or anorexia.

  • Lethargy.

  • Vomiting and/or diarrhea.

  • Abdominal pain (especially in the cranial abdomen).

• Physical Exam Findings:

  • Nausea: Lip licking, salivation.

  • Dehydration.

  • Abdominal pain upon palpation.

  • Altered gut sounds: Borborygmi.

  • Fever and possible jaundice (icterus).

  • Signs of shock: Hypotension, tachycardia.

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Diagnosis

• Clinical Diagnosis: Based on history, clinical signs, and diagnostic tests.

• Laboratory Findings:

  • CBC: Elevated PCV (dehydration), inflammatory leukogram, thrombocytopenia.

  • Biochemistry:

    • Elevated liver enzymes (hepatocellular or cholestatic).

    • Elevated bilirubin.

    • Electrolyte imbalances.

  • Lipase & Amylase: Poor sensitivity and specificity for pancreatitis.

  • Canine Pancreas-Specific Lipase (cPLI):

    • High sensitivity (≥82%) and specificity (96%).

  • Additional Tests:

    • Abdominal ultrasound: Commonly used to identify changes in the pancreas (hypoechoic pancreas, thickening, surrounding inflammation).

    • Abdominal radiographs: Usually nonspecific but may show details in the right upper quadrant.

    • Advanced imaging (e.g., CT scan): Rarely used due to cost.

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Treatment

• Inpatient vs. Outpatient Care:

  • Mild to moderate cases: Outpatient treatment with fluids, medications.

  • Severe cases: Hospitalization and intensive care.

• Medical Treatment:

  • Fluid therapy: Crystalloids and colloids to correct dehydration, restore perfusion, and support SIRS.

  • Pain management: Opioids (e.g., fentanyl, methadone), ketamine, lidocaine, epidural analgesia.

  • Antiemetics: Maropitant (Cerenia) or ondansetron to control vomiting and nausea.

  • Gastric Protection: Proton pump inhibitors (pantoprazole), H2 blockers (famotidine).

  • Antibiotics: Rarely needed unless bacterial infection is suspected.

• Nutritional Support:

  • Early enteral feeding: Prevent villous atrophy and promote recovery.

  • Feeding tubes:

    • Nasogastric tube: Easier placement, allows gastric suctioning.

    • Esophagostomy tube: More long-term option, allows enteral feeding.

    • Jejunal tube: Requires endoscopy or surgery, used if gastric feeding is not tolerated.

  • Parenteral nutrition (TPN): Considered in select cases where enteral feeding is not possible.

• Surgical Treatment:

  • Rare, but indicated for complications like abscesses, biliary obstruction, or when diagnosis is unclear.

  • May involve lavage, debridement, or placement of feeding tubes.

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