When a dog presents for an acute onset of vomiting, diarrhea, and abdominal pain, pancreatitis will likely be near the top of the differential diagnosis list.
The veterinarian will likely recommend a full diagnostic workup, including a CBC, serum biochemistry, abdominal radiographs, an in-house IDEXX SNAP® cPL and/or a Spec cPL to be submitted to a reference laboratory, and possibly an abdominal ultrasound.
While there is no single test that can be used to definitively diagnose pancreatitis, supportive findings on multiple tests suggests a positive diagnosis. In this case, the dog will typically be treated for pancreatitis.
What causes pancreatitis?
In most cases, we don’t know what caused the dog’s pancreatitis. The majority of canine pancreatitis cases are idiopathic. Some known predisposing factors do exist, however, including dietary indiscretion, obesity, hyperlipidemia, biliary disease, inflammatory bowel disease, and genetic predisposition (Miniature Schnauzers).(1)
The pathophysiology of pancreatitis is poorly understood. In a healthy pet, enzymes known as zymogens are released from the pancreas in an inactive form; these enzymes are activated once they reach the duodenum. In pets with pancreatitis, however, it appears that these zymogens are activated prematurely, within the pancreas. The cause of this premature activation is poorly understood, but activated zymogens within the pancreas lead to autodigestion of the pancreas, inflammation, and the production of free radicals.
How is pancreatitis treated?
There is no definitive treatment for acute pancreatitis. Therefore, treatment is focused on supportive care.
Pets with pancreatitis are typically dehydrated, painful, and nauseated. Therefore, there are three components to effective treatment:
- Rehydration: Dogs with acute pancreatitis are typically dehydrated, with electrolyte and acid-base abnormalities. Lactated Ringer’s solution is often recommended for IV fluid therapy, because studies have suggested that its particular composition may have benefits in human pancreatitis.(2)
- Analgesia: Pancreatitis is painful; all dogs with pancreatitis should receive pain medication. The exact medications to be used depend on the patient. Some pets may be treated with gabapentin or opioids, while others require a constant-rate infusion of ketamine or lidocaine.(2)
- Antiemetics: Even in the absence of vomiting, antiemetic agents should be used to treat nausea and help restore appetite. Maropitant is commonly administered, although other drugs may also be used.
When should dogs with pancreatitis be fed?
Historically, it was recommended to withhold food for three to four days in dogs with acute pancreatitis, in order to rest the GI tract. Recently, however, this recommendation has shifted. It is now recommended that dogs with acute pancreatitis be fed as soon as they are no longer vomiting.(1,2)
In most cases, dogs begin voluntarily eating once nausea and vomiting are controlled. Small meals should be offered initially, then meals may be gradually increased to cover the dog’s entire metabolic requirement. A bland, low-fat diet is typically recommended during recovery from pancreatitis. This diet should be started while hospitalized and sent home with the owner at discharge.
In dogs that are reluctant to eat, a feeding tube may be considered.
Should antibiotics be given to dogs with pancreatitis?
You will likely hear differing opinions on the use of antibiotics in pancreatitis; some veterinarians use them, while others do not.
Pancreatitis is considered to be a sterile inflammatory process(1) and secondary bacterial infection is rare(2), so antibiotics are not considered a standard component of treatment. Some veterinarians worry about intestinal barrier compromise and bacterial translocation, however, and give antibiotics for this reason.
As you spend more time working as a vet tech, you will see that opinions on this issue (and many other aspects of vet med!) vary widely.
References
- Gordon, J. 2011. Pancreatitis in dogs and cats. DVM360.
- Chang, C, Steiner, J. 2016. From diagnosis to treatment: a case of canine acute pancreatitis. Today’s Veterinary Practice.
