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pancreatis in dogs and cats - inflammation of the pancreas

By Ness Bird - Nutrition Adviser and RVN CertCFVHNut ©

The pancreas is a large gland behind the stomach that secretes digestive enzymes into the duodenum (where the small intestine starts). These enzymes are normally synthesised, stored and secreted in an inactive state, and protective mechanisms guard against premature activation. However, if they are compromised, the pancreas can start to digest itself, and an inflammatory response occurs. The enzymes can also be forced into other abdominal organs. Bleeding and infection can further complicate matters, and the condition is especially dangerous if the liver and kidneys are affected.

complications

The pancreas plays an important role in maintaining normal blood sugar levels. It contains clusters of cells called islets, which produce hormones. Alpha cells manufacture glucagon (which raises the blood glucose level), and beta cells manufacture insulin (which lowers the blood glucose level). If these cells are damaged due to pancreatitis, the resultant hormone disruption can cause diabetes.

Pancreatitis can also result in a condition called exocrine pancreatic insufficiency (EPI) if the acinar cells (pancreatic cells that secrete digestive enzymes) have been obliterated. Dogs and cats with EPI require enzyme replacement therapy.

Pancreatitis is a serious problem, and one which requires veterinary attention whether it is an acute attack (which is extremely painful and very serious), or a milder, chronic form.

Pancreatitis 1


causes and risk factors


In dogs, pancreatitis is most often seen in older, overweight patients. There does not appear to be the same predisposition in cats. It can be associated with other medical conditions including hypercalcaemia (high blood calcium levels) and hypothyroidism (underactive thyroid gland) in dogs, and cholangiohepatitis, hepatic lipidosis and pulmonary thrombosis in cats. Both species can be affected by diabetes (as previously mentioned) and inflammatory bowel disease. In the case of concurrent disease, it is not always clear-cut as to whether pancreatitis is the cause or effect.

Some breeds of dog are at a greater risk of developing pancreatitis due to inherited hyperlipidaemia / hypertriglyceridaemia (high blood fat levels) including the Miniature Schnauzer, Yorkshire Terrier, Poodle, Beagle, Shetland Sheepdog, Briard and Rough Collie. German Shepherds can develop immune-mediated lymphocytic pancreatitis, which predisposes them to pancreatic atrophy [Wiberg, 2004].

Pancreatitis is frequently idiopathic (of an unknown cause), but may be due to:

Pancreatitis 2

-     A drug reaction (e.g. adverse response to corticosteroids or antibiotics such as tetracycline)

-     Ingestion of high fat foods in dogs (there is no evidence to suggest this causes pancreatitis in cats)

-     Intoxication (e.g. organophosphates or rancid food)

-     Pancreatic duct obstruction or a backflow of the contents of the duodenum into the duct

-     Trauma or injury to the pancreas (e.g. after a road traffic accident)

-     Flukes (a type of parasitic worm)

-     Bacterial or viral infection

-     Impaired blood supply to the pancreas (e.g. due to shock, or bloat in dogs)

-     A tumour within the pancreas

symptoms

The symptoms of pancreatitis in dogs usually include a sudden onset of vomiting. An acute bout is extremely painful, so signs of intense discomfort are usually evident (adopting a tucked up or “praying” position, vocalisation, panting etc). Other common signs may include diarrhoea, lethargy and reluctance to eat. Dehydration is common, and the loss of electrolytes from the body can result in weakness and shock. Some dogs may be jaundiced.

In cats with pancreatitis, vomiting and diarrhoea are not as common. Most affected cats are lethargic and anorexic and may experience sudden weight loss.

diagnosing pancreatitis

Unless you can identify an obvious cause (e.g. your dog stealing fat balls put out for the birds), your vet may first want to rule out other conditions with similar symptoms which may include acute gastroenteritis, inflammatory bowel disease, intestinal obstruction, peritonitis and acute kidney failure.

Some of the diagnostic tests your vet may wish to perform are:

-     Canine pancreatic lipase immunoreactivity blood test (cPLI)

-     Feline pancreatic lipase immunoreactivity blood test (fPLI)

-     Radioimmunoassay of serum trypsinogen-like activity / trypsinogen activation peptide (TAP) in dogs

-     Ultrasound scan

Additional tests may be required if concurrent or related conditions are suspected. 

treatment

A cat or dog suffering from acute pancreatitis will require hospitalisation so that dehydration and shock can be treated, and anti-emetic (anti-sickness) drugs and pain relief provided. Antibiotics may be administered to treat primary infection or prevent secondary infection.

Most vets will want to withhold food until vomiting has ceased to avoid pancreatic stimulation and premature activation of zymogens (inactive enzymes). In cats, vomiting does not always occur, but a short period of nil by mouth may still be of benefit as it is thought that this reduces nausea, especially in animals suffering severe abdominal pain. However, some vets are challenging this approach based on a large body of evidence from human critical care medicine that supports decreased mortality associated with the provision of nutrition as early as possible via the digestive tract [Samareskera et al, 2018].

As one of the symptoms of pancreatitis is inappetence, some patients will require the administration of appetite stimulants, and / or the delivery of nutrients via a feeding tube. In very severe cases, the administration of essential nutrients by intravenous infusion may be necessary. This is known as parenteral nutrition, and it is considerably more complex than a regular infusion to correct dehydration (which only supplies fluids and electrolytes).

Serum cobalamin (vitamin B12) is often low in cases of pancreatitis, so levels should ideally be measured, and supplementation given if required. Loss of appetite can be symptomatic of a vitamin B12 deficiency, but the vitamin itself is thought to have a pharmacologic effect as an appetite stimulant.

Cats are susceptible to a very serious condition called hepatic lipidosis (fatty liver disease) if their bodies are in starvation mode. When an animal is undernourished, fat is transported to the liver to be converted to energy. Cats, however, cannot convert large stores of fat, and the subsequent build up prevents normal liver function. Therefore, cats cannot and should not go without food for very long (usually no more than 24-36 hours).



nutritional management of pancreatitis in dogs
The release of the most potent stimulator of pancreatic enzymes (cholecystokinin) is triggered by long chain fatty acids, amino acids and hydrogen ions. Therefore, the first feeds for a dog with pancreatitis are usually comprised of a digestible carbohydrate source (e.g. well-cooked rice) rather than fat or protein-rich ingredients. If tolerated, small amounts of foods containing good quality protein but low amounts of fat (e.g. low-fat cottage cheese or skinless chicken breast) can be gradually introduced.

During recovery, the diet should not supply more than 18% of its energy from fat, which is why a veterinary diet (or very low-fat, cooked fresh food) is usually fed initially. Although the  Arden Grange Light dog food  supplies 19.8% of its calories from fat, which is a little higher than this recommendation, it may be a good compromise (fed soaked, and little and often) in cases where a dog is not tolerating other foods very well. As mentioned later in the article, sometimes some flexibility is needed to suit an individual animal’s needs. The general recommendations for dogs who have recovered, or have a past history of the condition, are that the diet supplies a maximum of 10% fat on a dry matter basis (see pet food labelling and comparisons later in the article), and that the food is highly digestible and made to a fixed formula. The inclusion of supplements to support the immune and digestive system such as the antioxidant-rich plant extracts, prebiotics and nucleotides in our food may be beneficial too. Our Light dry food and Sensitive Partners canned food meet all these criteria. Our Light diet is our lowest fat dry dog food, and this supplies 7.5% fat on an as fed basis (8.15% dry matter).

The general recommendations for dogs who have recovered, or have a past history of the condition, are that the diet supplies a maximum of 10% fat on a dry matter basis (see pet food labelling and comparisons later in the article), and that the food is highly digestible and made to a fixed formula. The inclusion of supplements to support the immune and digestive system such as the antioxidant-rich plant extracts, prebiotics and nucleotides in our food may be beneficial too. Our Light dry food and Sensitive Partners canned food meet all these criteria.

Our Light diet is our lowest fat dry dog food, and this supplies 7.5% fat on an as fed basis (8.15% dry matter).

Our Partner's Sensitive (white fish and potato) wet food is also low in fat and could be a consideration too. There is 2% fat in this product on as fed basis (10% dry matter).

As with any dog under veterinary care, it is important to ask your vet’s professional opinion as to suitability before considering a change of diet.

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nutritional management of pancreatitis in cats


In cats, extreme fat restriction is not so critical, but there is still evidence to support the use of lower fat diets such as the  Arden Grange Light cat food . The fat content of this product is 11% as fed (11.96% dry matter).

Cats can be susceptible to triaditis, which is concurrent chronic pancreatitis, inflammatory bowel disease and cholangiohepatitis (inflammation of both the liver and the biliary system). IBD is often linked to food allergies, so a further challenge when providing an appropriate diet (in addition to it being extremely palatable, highly digestible and not too high in fat) is that it also should provide a novel protein and carbohydrate source. Additional liver support in the form of antioxidants may be beneficial, and copper restriction is usually necessary in the event of liver dysfunction (because increased concentrations of copper can cause oxidative stress that can then lead to further liver cell damage and inflammation).

As with the Arden Grange dog foods, the Light cat food is highly digestible and made to a fixed formula. It contains supplements to support the immune and digestive system and excludes some of the more common ingredients responsible for adverse food reactions (i.e. wheat / gluten, unspecified cereals, beef, soya and dairy products).

As we suggest for dogs under veterinary care, it is important to ask your vet’s professional opinion as to the suitability of a product before considering a change of diet for your cat.

weight loss concerns

Many dogs and cats with pancreatitis are overweight, but weight loss as a result of pancreatitis can be dramatic. It is therefore a viable concern that a low-fat diet may not be able to help an underweight dog or cat back up to their healthy target. However, an animal can still maintain or even gain weight if fed a low-fat food providing it is well accepted and digested, and that the correct amount of food is eaten to meet the daily calorie requirement. Our Light dry diets include a feeding guide for weight maintenance as well as weight loss.

supplements

Probiotics are recommended for many digestive conditions, but generally not in cases of pancreatitis. This is because current data is insufficient to draw a conclusion as to whether probiotics may have harmful or beneficial effects in human patients with this condition [Tian et al, 2018]. Prebiotics (which are included in the Arden Grange recipes) are not the same as probiotics and may be of benefit. Prebiotic FOS can only be broken down by the friendly gut bacteria, and when this takes place, the energy that is produced is utilised by the beneficial flora and enables them to reproduce efficiently. A thriving colony of the good gut bacteria may limit the growth of pathogenic bacteria. Prebiotic MOS act as a gut security guard, mopping up pathogenic organisms and helping to transport them out of the body.

omega-3 fatty acids

Omega-3 fatty acids, particularly DHA, may be beneficial for dogs and cats with a history of, or predisposition to, pancreatitis because it can lower triglyceride levels and has antioxidant and anti-inflammatory properties [Jeong & Kim, 2017]. Care should be taken with oily supplements, although extremely high doses would be needed to cause or contribute to pancreatitis (usually on top of a diet already high in fat). The krill in the Arden Grange dry products is a very good source of DHA.

pet food labelling and comparisons

Although looking at nutrient percentages can be helpful in establishing whether the diet is low in fat, be aware that wet and dry food cannot be directly compared on what is known as an “as fed” basis. This is the percentage of fat shown on the label.

To compare wet and dry foods, you need to convert the “as fed” percentage to “dry matter”. This means taking the moisture content out of the equation.

Example calculation for Arden Grange Partners Sensitive wet food with 2% fat and 80% moisture: 1. Subtract the moisture content from 100 [100-80 = 20]

2. Divide the fat content by your answer to No.1 [2 divided by 20 = 0.1]

3. Multiply your answer to No.2 by 100 [0.1 x 100 = 10]

The answer is 10% fat on a dry matter basis.

This illustrates how what might appear to be a lower fat wet product on the basis of the label, can actually work out higher than a dry food on a dry matter basis.

Wet foods are significantly lower calorie and therefore have much higher feed portions than dry products. This could be problematic in an inappetent animal, although conversely, many animals find wet foods more palatable. Soaking dry foods may improve palatability.

Our Sensitive Light / Senior is higher in fat on a dry matter basis than the recommended 10% (13% dry matter). If, however it is proving difficult to encourage a dog to eat enough of a lower fat product to meet his or requirements for nutrients and calories, and he or she is subsequently losing weight and condition, then it may be an acceptable compromise to use a small proportion in conjunction with a lower fat product.

Sometimes what’s best in theory isn’t always completely applicable in practice, hence why a degree of flexibility may be needed in order to tailor a diet that is best suited to an individual, especially if there are any ingredients that are known to be problematic for the dog or cat that need to be avoided. Do be guided by your vet first and foremost, however.

general tips

-     Check your vet is happy for you to undertake a diet change (if the bout of pancreatitis has been very recent and your pet is doing well on his or her recovery diet, it may be advisable to keep him or her on this for sufficient time to allow the digestion to settle down. 

-     Introduce new food gradually (unless an animal is very poorly tolerating the current diet, in which case an earlier change could be indicated).

-     Feed little and often – this gives the gut less work to do at any one time, and means less fat to handle at any one time.

-     Soak dry food for about 30 minutes prior to serving to soften it – this is easier on the oesophagus which may be inflamed and sore as a result of the acidic vomit which is often symptomatic of pancreatitis.   

-     Withhold treats or extras until your cat or dog is well recovered. If your vet is agreeable to you reintroducing any additions once the digestion has settled down, make sure these are low-fat and nutritionally valuable so they won't give the digestion a lot of work for little benefit.

-     Keep a close eye on your cat or dog’s appetite, body weight and condition and faecal output. -     Make sure your cat or dog is clearing his or her bowl if he or she is taking medication in food.

important information

As a responsible and ethical company, Arden Grange fully appreciates the caution that must be taken when discussing the potential benefits of nutritional supplements. It is against the law to make medical claims. Whilst these ingredients are safe and natural and may be beneficial to some of the cats and dogs fed on Arden Grange, we must highlight that their inclusion is not a substitute for veterinary intervention in the case of a sick animal.  

references

Wiberg, M. (2004). Pancreatic acinar atrophy in German shepherd dogs and Rough‐coated Collies. Etiopathogenesis, diagnosis and treatment. A review. Veterinary Quarterly, 26(2), pp.61-75.

Samarasekera, E., Mahammed, S., Carlisle, S. and Charnley, R. (2018). Pancreatitis: summary of NICE guidance. BMJ, p.k3443.

Tian, X., Pi, Y., Liu, X., Chen, H. and Chen, W. (2018). Supplemented Use of Pre-, Pro-, and Synbiotics in Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis of 13 Randomized Controlled Trials. Frontiers in Pharmacology, 9.

Jeong, Y. and Kim, H. (2017). A Mini-Review on the Effect of Docosahexaenoic Acid (DHA) on Cerulein-Induced and Hypertriglyceridemic Acute Pancreatitis. International Journal of Molecular Sciences, 18(11), p.2239.