CHRONIC PANCREATITIS IN CATS
Pancreatitis is inflammation of the pancreas, a gland which assists with digestion and controls blood sugar levels. Pancreatitis can be acute (sudden and short-lived) or chronic (longer duration); cats with chronic pancreatitis may have flare-ups at varying intervals.
Clinical signs include:
- Decreased appetite
- Weight loss
- Abdominal pain
What does the pancreas do?
The pancreas is a glandular organ which lies between the stomach and small intestine. It has two main functions: the production of hormones which regulate blood sugar (insulin and glucagon) and the production of digestive enzymes, which are secreted through a duct into the intestine. Normally, the digestive enzymes are safely stored within the pancreas, but when it becomes inflamed (as occurs with pancreatitis) these enzymes escape and begin digesting the pancreas itself. The living tissue becomes further inflamed and the tissue damage quickly involves the adjacent liver. This tissue damages results in the release of toxins into the circulation which can cause a body-wide inflammatory response which can prove fatal in certain cases due to respiratory failure or brain damage.
What causes pancreatitis?
Little is known about the underlying cause of pancreatitis in cats, and in most cases an initiating factor cannot be determined. Risk factors are believed to include trauma (e.g. getting hit by a car or falling from a height), chronic kidney disease, certain infectious agents, inflammatory bowel disease, organophosphate insecticide exposure and the use of certain medications.
The condition known as feline triaditis involves inflammation of the pancreas, liver and intestines.
How do you diagnose pancreatitis?
Chronic pancreatitis can be challenging to detect and diagnose, as the symptoms and blood test results can often be mild, vague and easily confused with other diseases. For these reasons the condition has typically been under-diagnosed in the past.
Ultrasound imaging is often used to see if there are any changes in the pancreas. However, the pancreas can be difficult to detect on ultrasound, and so this technique may not detect pancreatitis in every cat with the disease. Certain findings on routine blood tests are suggestive of pancreatitis, but are not specific for the condition. Thankfully there is now a specific test for feline pancreatitis which can be run in the lab at the Grove Lodge Hospital in Worthing. This gives us a more accurate way of diagnosing the condition, and hence we are now able to diagnose more cases, which would have previously been missed.
How do you treat pancreatitis?
Pancreatitis is a difficult condition to treat, and the aim of therapy is usually management of the condition rather than cure. The mainstays of treatment are intravenous fluid therapy (a drip), diet, pain control and supportive care including anti-sickness medication.
INTRAVENOUS FLUIDS - Since cats with pancreatitis are often dehydrated due to ongoing vomiting or diarrhoea, intravenous fluids will improve hydration and aid restoration of the natural balance of electrolytes within the body. They will also maintain perfusion to the damaged pancreas, which is vital to minimise ongoing damage. The fluids will also help to flush out the toxins that tend to build up and often improve blood parameters.
DIET - Once vomiting has stopped or reduced food can be introduced, and there is evidence that this aids recovery. In fact, cats can become at risk of developing other problems involving the liver if they do not eat for prolonged periods, so feeding little and often is usually advised. A feeding tube may be fitted if the cat refuses to eat, and this allows food intake to be managed. You will be advised specifically on the best diet for your pet.
PAIN CONTROL - Initial management of pain typically involves the use of injectable opioid drugs, but subsequently special skin patches can be use to maintain patient comfort. This can be left on for 5 days at a time, and can be worn when the cat comes home as long as special precautions are followed (an information sheet will be provided if your cat is discharged with a pain relief patch).
SYMPTOMATIC TREATMENT - Other medications including anti-sickness medication, gastroprotectants (antacids and anti-ulcer drugs), antibiotics, vitamin B12 and anti-inflammatories are often used to make the cat feel more comfortable and to help reduce the level of inflammation within and around the pancreas.
Uncommon complications of chronic pancreatitis
DIABETES MELLITUS - Extension of inflammation within the pancreas can lead to progressive destruction of the part of the pancreas which produces the hormones which control blood glucose. Eventually this can result in the development of diabetes mellitus and the need for insulin injections.
EXOCRINE PANCREATIC INSUFFICIENCY - Chronic inflammation of the pancreas can lead to a reduction in functional pancreatic tissue and therefore a reduction in the amount of digestive enzymes produced. This results in an inability to adequately digest food within the intestine, resulting in weight loss, increased appetite and increased faecal volume. In these cases, animals may require digestive enzyme supplements.
What is the prognosis?
The prognosis for cats with chronic pancreatitis is variable and cannot always be predicted. For animals with mild, uncomplicated disease, the prognosis is usually good if diet and pain can be managed. However, for animals that have severe disease with frequent acute episodes or complicating diseases, the prognosis is guarded and quality of life should be considered carefully. Sometimes the kindest treatment is painless euthanasia to alleviate suffering. Your vet is here to discuss these difficult decisions with you and will help to guide you to the best outcome for your pet.