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The pancreas is a small but important organ located just below the stomach, where it connects to the gastrointestinal tract.  The main functions of the pancreas are to help regulate blood sugar levels by producing insulin, and to aid digestive breakdown of food by producing digestive enzymes.

Pancreatitis is inflammation of the pancreas and is a relatively common but unfortunately painful condition in cats. The cause of pancreatitis is not well understood, but there are associations with pre-existing gastrointestinal disease, liver disease, trauma, organophosphate poisoning, and drug reactions.  In dogs, ingestion of very fatty food has been shown to be a risk factor, but this has not been well researched in cats.

Symptoms of pancreatitis include:

• Abdominal pain. This may be difficult to appreciate in cats but can manifest as lethargy, hiding, abnormal posture, and/or reduction in activity levels
• Inappetance – resulting from pain and nausea
• Vomiting
• Fever or a low body temperature
• Icterus (jaundice) if the liver is affected

However these symptoms can occur in other feline illnesses, and so diagnostic testing is necessary to confirm the disease (see below).

Pancreatitis can be acute, with a rapid onset and aggressive symptoms.  Acute pancreatitis can be potentially life threatening in cats.  A feline patient with acute pancreatitis will typically be very lethargic and dehydrated, and will require hospitalisation.

Pancreatitis can also be chronic, with more subtle, intermittent symptoms and can grumble on for a long time, potentially even lifelong.  However cats with chronic pancreatitis will often initially have had an episode of acute pancreatitis. Commonly cats with chronic pancreatitis also have signs of inflammatory bowel disease.

Diagnosis

Cats with acute symptoms will have comprehensive blood tests performed upon admission to hospital to investigate why they are so sick. Common abnormal blood test findings in cats with pancreatitis include mild anaemia, white blood cell disturbances, low protein levels, elevated blood glucose, elevated amylase and lipase (non-specific digestive enzymes), high or low calcium levels, increased liver enzyme values and raised cholesterol.  However these abnormalities are not enough to confirm a diagnosis of pancreatitis as they are non-specific abnormalities and can arise in other diseases.

If there is a suspicion of pancreatitis then a feline Pancreatic Lipase Immunoreactivity (fPLI) test will be run on a blood sample, and if this is positive or high then a diagnosis of pancreatitis is suspected.

If the cat has an elevated fPLI or if a painful abdomen is noted on examination then diagnostic imaging such as x-rays or ultrasound may be performed. X-rays are useful for identifying problems such as a foreign body obstruction or tumour.  Abdominal ultrasound is very useful for helping identify some pancreatitis cases, and also allows us to examine the gall bladder, liver, intestinal wall and abdominal lymph nodes. Concurrent inflammatory bowel disease, and gall bladder disease may be identified in some pancreatitis patients.

Treatment

There is no specific cure for pancreatitis.  In acute patients, supportive care is needed to correct dehydration, alleviate pain and counteract the deleterious effects of pancreatitis on the body.  Typically a patient with acute pancreatitis will receive:

• Intravenous fluid therapy
• Pain relief
• Anti-nausea medication
• Antibiotics – an inflamed pancreas is susceptible to infection
• Calcium and or potassium supplementation if blood results suggest the body is low in these two essential elements.
• Antacids to reduce gastric acid secretion

If a patient is not eating then a feeding tube (o-tube) may be placed to facilitate adequate nutrition and stimulate pancreatic secretion (unless the patient is experiencing vomiting).

If a patient responds well to treatment, they will often be discharged from hospital once they are eating on their own, have a comfortable abdomen, a normal body temperature and no other concerning symptoms. Small, frequent, bland meals of easily digestible food are recommended, and some patients may be discharged with further antibiotics, antacids and pain medication if the veterinarian deems this necessary for the individual.

Some fortunate patients that recover from acute pancreatitis may never have a relapse or develop chronic pancreatitis.  However it is still prudent to be vigilant even years later as pancreatitis can reoccur.

Many recovering acute pancreatitis patients become chronic pancreatitis patients, although some chronic pancreatitis patients may never have experienced an acute pancreatitis episode. These patients may have a persistently elevated fPLI, and may experience relapsing pancreatitis of varying severity.  These individuals often have concurrent inflammatory bowel disease (IBD) and experience the following symptoms:

• Vomiting
• Diarrhoea
• Variable/poor appetite and so struggle to maintain a healthy body mass.
• Variable activity levels

As well as fPLI testing, cobalamin (vitamin B12) levels can be measured as an indicator of gastrointestinal health.  If deficient vitamin B12 can be supplemented by a course of weekly injections.  Chronic pancreatitis patients often require management with one or more of the following: dietary modification, antibiotics, immunomodulatory medications, B vitamin injections and probiotics. The prognosis for these patients is dependent on the frequency and severity of symptoms and response to treatment.

Complications of pancreatitis

The following conditions are associated with cats that have a history of pancreatitis:

Hepatic lipidosis – this is where fatty tissue from the liver is mobilised to provide the body with energy, and often occurs in patients that experience prolonged period of not eating.

Exocrine pancreatic insufficiency (EPI) – the pancreas fails to produce an adequate amount of pancreatic digestive enzymes leading to poor digestion of food and chronic diarrhoea.

Diabetes mellitus – the pancreas produces an insufficient amount of insulin leading to persistently high blood glucose levels and weight loss as the body cannot utilise the glucose.

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