I. What is the Pancreas?

The pancreas in the dog is a thin, tan colored organ located near the stomach. It has two parts, or lobes. The right lobe of the pancreas lies near the stomach and the left lobe of the pancreas lies alongside the beginning of the small intestine, the duodenum. The right and left lobes connect at the body of the pancreas.

The pancreas performs two very important functions in the body. It makes enzymes that digest proteins, fats, and carbohydrates, and it makes insulin, which helps the body absorb and use glucose (sugar). The pancreas makes at least nineteen different digestive enzymes that are secreted into the small intestine before and during a meal. The pancreas is stimulated to secrete digestive enzymes in three stages:

• The sight, smell, and anticipation of food initiate pancreatic enzyme secretion.


• When the stomach stretches as it fills with food, more enzyme secretion is stimulated.


• When the duodenum stretches, the pancreas secretes more enzymes

As the stomach and small intestines empty and the meal ends, the secretion of pancreatic enzymes stops.

II. What is Pancreatitis?

Pancreatitis is defined as inflammation in the pancreas. It is a complex disease that is not well understood yet. In many cases, the cause of acute (sudden onset) pancreatitis in dogs is unknown. Some things that are thought to increase the risk of developing pancreatitis include:

• Obesity


• Eating a fatty meal or having a high fat diet


• Having a high level of fat in the blood (hyperlipidemia)


• Some drugs such as corticosteroids


• Some toxins, such as anticholinesterase insecticides


• High level of calcium in the blood (hypercalcemia)


• Blocking of the pancreatic duct so digestive enzymes cannot be secreted into the small intestine


• Trauma

After some, usually unknown, initiating event, pancreatic enzymes are released into the pancreas and surrounding tissue instead of into the small intestine. The reason for this is not well understood at this time. The enzymes start to digest the pancreas itself and cause severe inflammation where they are released into surrounding tissue. Severe inflammation and destruction of the pancreas can lead to shock, fluid loss into the abdomen, spontaneous bleeding, acute kidney failure, difficulty breathing, or death. Not all cases of pancreatitis become this bad. Pancreatitis is most commonly seen in middle-aged female dogs.

III. What to Watch for at Home – Symptoms

The most common symptom that is seen with pancreatitis is vomiting. In very mild cases, the vomiting may only last for 12-24 hours and no other symptoms may be present. In more severe cases, other symptoms are present. They include:

• Depression


• Lack of appetite


• Abdominal pain


• Fever


• Diarrhea


• Dehydration


• Rapid heart rate


• Weakness

If your dog is vomiting and has any of the other symptoms listed above, it is very important to see the veterinarian as soon as possible. Dogs with acute pancreatitis can get worse rapidly.

IV. The Veterinary Visit – How to Diagnose Pancreatitis

Pancreatitis is not easy to diagnose. The combination of vomiting with other symptoms may suggest pancreatitis, but many other diseases cause vomiting, depression, fever, and abdominal pain. If a patient has a history of a recent high-fat meal or is taking certain drugs, this may increase the suspicion that pancreatitis is present. Diagnostic tests that are used to make a diagnosis of pancreatitis include:

• Complete blood work, which includes a complete blood count and biochemical profile, may show many different changes. One of the most significant is a high white blood cell count with an increase in the number of immature white blood cells that are seen (leukocytosis with a left shift). Changes in electrolyte levels and evidence of dehydration may also be seen on the bloodwork.


• Pancreatic enzyme tests should be done as well. These are blood tests that look for elevated levels of specific pancreatic enzymes. Amylase and lipase are two commonly evaluated pancreatic enzymes. Elevation of amylase and lipase does not only occur with pancreatitis, but also with other diseases. Therefore, they are of limited value in diagnosing pancreatitis. Other tests which may be more specific are the canine TLI (trypsin-like immunoreactivity) and canine PLI (pancreatic lipase immunoreactivity). These tests are better indicators of whether or not pancreatitis is going on.·


• Abdominal x-rays may not show any specific changes with pancreatitis. X-rays are used to help rule out other causes of severe vomiting in dogs, such as a foreign body obstruction.


• Abdominal ultrasound is the best way to visualize the pancreas. Finding the pancreas on ultrasound does require a skilled operator.

A diagnosis of pancreatitis is made by evaluating the results of all of the tests mentioned above together with the results of the physical examination and the history of the patient. If results are not conclusive, it is best to treat a patient aggressively, as if they do have pancreatitis.

V. Treatment

Treatment is aimed at rehydrating the patient, preventing further dehydration, and trying to prevent further pancreatic secretion. The course of treatment will depend on how severely affected a particular patient is. Therapy may include:

• Placement of an IV catheter.


• IV fluid therapy to replace fluid lost due to vomiting, help maintain blood pressure, and prevent further dehydration. Potassium may be added to fluids to replace potassium lost in vomit and diarrhea.


• Antibiotics given IV to prevent infection of the pancreas.


• Medications given IV to help control nausea and vomiting.


• Pain medication to help ease abdominal pain.


• Many veterinarians withhold food from dogs with pancreatitis until they have not vomited in 24 hours. This may decrease the secretion of pancreatic enzymes and slow the damage to the pancreas. Newer information suggests that feeding a dog with pancreatitis may be alright unless a dog is vomiting severely. An assessment of whether or not to feed an individual patient should be made by the attending veterinarian based physical examination findings, the condition of the dog, and the experience of the veterinarian. If food is withheld, it is gradually reintroduced when the patient stops vomiting. Bland, low-fat, low-fiber food is usually used during recovery.


• For dogs that are vomiting and not eating longer than 4-5 days, total parenteral nutrition may be necessary (feeding through an IV).

The length of time a dog will need to be hospitalized varies greatly and depends on how severely ill they are. Treatment continues until the patient stops vomiting, starts eating, and bloodwork has begun to return to normal. Most dogs need at least three to five days of therapy. Those dogs that need therapy longer than this have a poorer prognosis for recovery. Since the cause of pancreatitis is not well known, episodes of pancreatitis may recur. Severe pancreatitis or recurrent pancreatitis can lead to diabetes or to a decreased ability to digest food (exocrine pancreatic insufficiency or EPI).