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Pancreatitis is an inflammation of the pancreas as a result of inappropriate activation of the digestive enzymes which begin to break down and digest the pancreas. Normally, the pancreas protects itself from the digestive enzymes it manufacturers, stores and secretes. To do this it secretes them inactivated (known as zymogens), they don't become activated until they reach the duodenum. Surrounding tissues such as the liver may become involved.
It may be acute (sudden onset) or chronic (persistent). Acute pancreatitis tends to be more severe than chronic. Your cat may have only one outbreak of pancreatitis or multiple. Pain can range from mild to severe. Over time, repeated bouts of pancreatitis can result in scarring of the pancreas, making it less efficient and leading to complications (listed below).
Middle aged to older cats are most often affected by pancreatitis, although it can occur in younger cats and even kittens.
What is the pancreas?
The pancreas is a pale pink, lobulated organ located near the liver and behind the stomach. The pancreas performs both exocrine (secretes enzymes via a duct) and endocrine (secretes hormones directly into the bloodstream) functions.
Endocrine function: Small clusters of cells called Islets of Langerhans are responsible for the production of the hormones insulin and glucagon which regulate blood sugar.
Exocrine function: Pancreatic juice, a digestive enzyme rich in sodium bicarbonate which helps break down proteins, fats and carbohydrates. This juice is secreted from the pancreas and collected in the pancreatic duct, where it joins with the bile duct from the liver prior to entering the duodenum.
Most cases (around 90%) of pancreatitis cannot be determined (idiopathic). Where a cause is found, it is usually one of the following:
Toxoplasmosis - Infection by the protozoan toxoplasma gondii.
Hyperlipidemia - High-fat content in the blood.
Hypercalcemia (high calcium content in the blood).
Feline infectious peritonitis.
Trauma (car accident, high fall) - Damage to the pancreas may result in enzymes leaking out.
Presenting symptoms are often vague, anorexia (loss of appetite) and lethargy are the two most common symptoms of pancreatitis. Other symptoms include:
- Loss of interest in their surroundings
- Hypothermia (low body temperature)
Acute pancreatitis may also present as:
- Abdominal pain
- Vomiting is commonly seen in dogs and humans, only around 35% of cats vomit.
- Diarrhea, which may contain blood
- Ataxia (loss of coordination)
- Jaundice (yellowing of the mucous membranes)
- Pleural effusion which can result in difficulty breathing
- Weight loss
Some acute cases of pancreatitis may also result in shock and disseminated intravascular coagulation, a condition in which small blood clots develop throughout the bloodstream.
Over time, as the pancreas becomes damaged, weight loss occurs. This is due to the pancreas no longer functioning as it should, digesting food. As a result, food passes though the digestive track relatively undigested, leading to pale coloured, loose, foul smelling feces and weight loss.
Pancreatitis may run concurrently with other diseases such as cholangitis/cholangiohepatitis, hepatic lipidosis (fatty liver disease), and inflammatory bowel disease. Pancreatitis, cholangiohepatitis and inflammatory bowel disease running concurrently are collectively known as 'feline triad disease'.
Complications of pancreatitis due to the destruction of pancreatic cells can include transient or permanent diabetes and exocrine pancreatic insufficiency.
Due to the vague symptoms, which are similar to a host of other disorders, diagnosis can be a challenge and many cases of pancreatitis go undiagnosed as a result of these non-specific symptoms. Your veterinarian will perform a complete physical examination of your cat and obtain a medical history. Some tests he may wish to perform include:
- Complete blood count and biochemical profile - These often come back nonspecific. Pancreatic enzymes are often normal. Mild elevations of hepatic enzymes ALT may be seen. Elevated white blood cells are an indication of inflammation or infection. Mild anemia may be present. The damaged pancreas may affect insulin production, resulting in elevated glucose levels.
- fTLI (feline Trypsin-Like Immunoreactivity) - This test measures the concentrations of trypsin-like proteins in serum. Elevated levels may be indicative of pancreatitis.
- TAP (trypsin activation peptide).
- fPLI (feline Pancreatic Lipase Immunoreactivity) - This test measures feline pancreatic lipase (an enzyme secreted by the pancreas which breaks down fat) immunoreactivity in serum. Normal levels are 2.0-6.8ug/dL, in cats with mild or resolving pancreatitis, levels may be 6.8-12ug/dL and cats with pancreatitis, over 12ug/dL.
- X-ray - To evaluate the pancreas and rule out other possible abdominal disorders.
- Ultrasound can be useful to check the size, shape, and density of the pancreas. An enlarged and thickened pancreas and dilated pancreatic ducts may be seen.
- Laparotomy - Surgical incisions are made in the abdomen to allow your veterinarian to examine the organs. In this case, the pancreas.
- Biopsy of the pancreas, liver or intestines may be of additional help.
If at all possible, find and treat the underlying cause. Supportive and symptomatic treatment is how veterinarians manage pancreatitis in cats. This may include:
- Analgesics (painkillers) for abdominal pain. These may include morphine or transdermal fentanyl patch.
- Supportive care such as intravenous fluids to prevent or treat dehydration and correct electrolyte imbalances.
- Nutritional support is essential, this may be via nasogastric, nasoeosiphogeal or jejunostomy tube if the cat is unwilling to eat. A bland diet such as Hills ID will be fed.
- Antemetics (anti-nausea medication) if vomiting is present.
- Antibiotics may be prescribed if there is an infection present.
- Transfusion of plasma or whole blood may be necessary in severe cases.
- Surgery may be required to remove necrotic pancreatic tissue.
The prognosis depends on the severity of the disease, and if hepatic lipidosis or pancreatic necrosis have occurred along with complications (such as DIC) and concurrent disease.