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Pancreatitis in Cats

What is the pancreas?

The pancreas is a vital organ which lies on the right side of the abdomen. It has 2 main functions:

  1. To produce enzymes which help in food digestion (carbohydrates, proteins and fat)
  2. To produce hormones like insulin and glucagon, which regulates blood sugar level

What is pancreatitis?

Pancreatitis is a condition where the pancreas becomes inflamed. In a healthy animal, digestive enzymes produced by the pancreas are activated when they reach the small intestine. However, with pancreatitis these enzymes are activated prematurely in the pancreas itself, causing a lot of pain! The inflammation associated with pancreatitis can also lead to digestive enzymes spilling into the abdominal cavity. This may result in secondary damage to surrounding organs, such as the liver, bile ducts, gall bladder and intestines.

Pancreatitis can present acutely (sudden onset) or chronically (slow onset). There are 2 main forms of acute pancreatitis: the mild oedematous and the more severe, haemorrhagic form. Chronic pancreatitis are usually cases where there are often no symptoms as it develops slowly over time. Chronic pancreatitis can also be a result of repeated events of acute pancreatitis.

Pancreatitis was thought to be very rare in cats in the past but has now been recognised more frequently. This may be a result of cheaper and more sensitive diagnostic tests available to diagnose cat pancreatitis. In cats, pancreatitis is often associated with the inflammation of the liver and intestine as well, this is commonly referred to as triaditis (inflammation of the pancreas, liver and intestine).

What causes pancreatitis in cats?

In over 95% of the cases, the cause of pancreatitis is unknown. Unlike in dogs, there is no clear link between the ingestion of a fatty meal and the occurrence of pancreatitis yet. A few infectious diseases such as Toxoplasmosis, chronic intestinal diseases like inflammatory bowel disease, liver disease, gallbladder disease or diabetes have been thought to contribute to pancreatitis.

There is currently no known breed, gender or age predisposition to pancreatitis in cats.

What clinical signs should I be looking out for?
These can be variable and the intensity of the disease will depend on the quantity of the enzymes that are prematurely activated. Most pancreatitis is very painful!

  • Some common symptoms are:
  • Vomiting and weight loss (about 50% of the cases)
  • Nausea and hypersalivation
  • Fever
  • Abdominal pain (about 10-30% of the cases)
  • This may be due to the fact that cats are very good at hiding pain
  • Diarrhoea
  • Hunched back
  • Inappetence/ anorexia

In severe cases, acute shock, depression, and death may occur.

How is pancreatitis diagnosed?
The diagnosis is based on:

    • Clinical signs>
    • Full blood test
      • The elevation in pancreatic enzymes is often present in cats with pancreatitis. However, some cats with pancreatitis may have normal values of pancreatic enzymes. Many cats will have an elevation of liver enzymes as well as electrolyte changes due to vomiting. A full blood test also helps us to rule out other diseases that can also show similar signs as pancreatitis.
    • Specific pancreatitis blood tests
      • The feline pancreatic lipase immunoreactivity (fPLI) tests for a specific marker for pancreatitis which increases with pancreatic inflammation. This test comes in two forms:
        1. The SNAP test which gives us the results within 10 minutes
        2. The Spec fPL which requires blood to be sent to the laboratory
      • The fPLI is currently the most sensitive (the ability to identify a patient with a disease) test to diagnose pancreatitis in cats but it may miss mild and chronic pancreatitis. The Spec fPLI may be slightly superior to the rapid test in detecting these cases.
    • Imaging- usually abdominal ultrasound ± radiographs
      • The ultrasound helps us to visualise changes in the pancreas to determine the presence and severity of the pancreatitis. Ultrasound examination by a trained professional is capable of diagnosing up to ⅔ of the cats with pancreatitis. At the same time, it helps us to visualise other organs to rule out other causes that may have contributed to similar clinical signs. Radiographs may not be particularly useful in visualising the changes in the pancreas but may be recommended as a modality to rule out other disease processes that can present with similar clinical signs.

How is pancreatitis treated?
Successful management will depend on early diagnosis and prompt medical therapy.

Some common treatment options are:

      • Administration of intravenous fluids
        • The intravenous fluids are important to keep your furbaby hydrated and maintain electrolyte balance.
      • Anti-vomiting and anti-nausea medication
        • Most animals with pancreatitis will be presented with vomiting. Maropitant is an antiemetic that will help to reduce the discomfort from vomiting and reduce the risk of dehydration. Maropitant also decreases nausea to encourage eating in the early stages of pancreatitis. Maropitant have also been shown to decrease abdominal pain in animals.
      • Gastric acid suppression
        • Gastric acid suppression drugs may be indicated if your cat is showing signs of gastric ulceration (vomiting blood or has darkened digested blood in the faeces) and if your dog has increased risk of developing oesophagitis (inflammation of the oesophagus) from regurgitation and acid reflux.
      • Antibiotics
        • Some cats with pancreatitis may require treatment with antibiotics if we suspect infection.
      • Pain relief
        • Pancreatitis can cause pain and discomfort. One or a combination of pain relief medications may be used depending on the level of inflammation.
      • Nutrition
        • It is now proven that the earlier a cat gets back to eating, the better the prognosis is for a swift recovery. It also prevents other complications of anorexia such as hepatic lipidosis. Appetite stimulants like Mirtazapine can be used to encourage your cat to start eating. A feeding tube may be necessary if the appetite stimulant is not sufficient to encourage the cat to start eating.

What is the prognosis for pancreatitis?
It depends on the extent of the disease initially and how the animal reacts to the treatment.
Mild cases should recover with no long-term effects. However, there are long-term complications that may follow severe or repeated pancreatitis:

  • If a significant number of cells that produce digestive enzymes are destroyed, it will result in a lack of proper food digestion. This is known as exocrine pancreatic insufficiency and can be treated with daily administration of enzyme tablets.
  • If a significant number of cells that produce insulin are destroyed, diabetes can result and insulin therapy may be needed.

Pancreatitis can be a very painful disease. If you think that your furbaby is presenting signs of pancreatitis, please do not hesitate to reach out to your veterinarian. The prognosis of pancreatitis is generally good for milder forms that receive supportive treatment early. If left untreated, pancreatitis can lead to severe consequences such as sudden death.