Cats can be difficult to read. Sometimes they just “don’t look right”. At the Animal Clinic at Thorndale, we will take a careful history and perform a complete physical examination when your cat is not feeling up to its usual self. We will discuss with you our recommendations for those diagnostic tests which will hopefully lead us most efficiently to the answer and getting your furry friend quickly back to health. Pancreatitis is not uncommon in cats, yet is often difficult to confirm as the definitive diagnosis.
The pancreas is an important digestive organ which has two primary functions: 1) to produce enzymes which help in digestion of food and, 2) to produce hormones, such as insulin. The pancreas is located in the right side of the abdomen near the ribs. It lies adjacent to the lower border of the stomach and the first part of the small intestine. Pancreatitis is a disorder of the pancreas that involves an intense inflammatory process. Although pancreatitis occurs less commonly in the cat than in the dog, recent research efforts have demonstrated that it occurs more commonly than previously believed.
Contributing Factors
There are no known age, sex, or breed predispositions for pancreatitis in the cat.
Prevalence
In several studies, pancreatitis was found in 1-2% of sick cats that were evaluated.
Clinical Signs
For many cats with pancreatitis, the clinical signs can be vague or nonspecific. Depression and anorexia were the most commonly reported signs in a study of 40 cats with pancreatitis. In some cats, nausea, vomiting, fever, abdominal pain, and diarrhea will predominate. If the attack is severe, acute shock, depression, and death may occur. Even though there are often no specific markers in the history or on physical examination, it has been shown that there are two primary forms of pancreatitis: an acute (sudden) form and a more long-standing chronic form.
Under normal conditions, the digestive enzymes produced by the pancreas are activated when they reach the small intestine. Food coming into the stomach signals the pancreas to release its enzymes into the pancreatic duct, which joins the common bile duct coming from the gall bladder. The bile and pancreatic enzymes are dumped into the intestinal lumen to mix with food entering from the stomach. Normal digestion actually occurs in the small intestine. The stomach acts primarily as a grinding vat, breaking food into smaller pieces so that once they enter the small intestine, the pancreatic enzymes can digest them into smaller chemical compounds that can be absorbed further down the line. In pancreatitis, the enzymes are activated prematurely within the pancreas itself. This results in auto-digestion of the pancreas. The clinical signs of pancreatitis are often variable, and the intensity of the disease will depend on the extent of organ involvement.
A few cats will recover from an acute episode of pancreatitis and continue to have recurrent bouts of the acute disease. The associated inflammation allows digestive enzymes spill into the abdominal cavity; this may result in secondary damage to surrounding organs, such as the liver, bile ducts, gall bladder, and intestines. In contrast to the reversible changes of acute pancreatitis, chronic pancreatitis can lead to permanent damage of the pancreas.
Causes/Transmission
In more than 90% of cases of feline pancreatitis, a cause is not identified. In dogs, it is often associated with a rich, fatty meal or the administration of cortisone; however, these associations have not been found with feline pancreatitis.
Diagnosis
The diagnosis of pancreatitis is suggested by clinical signs, laboratory tests, and radiographs (x-rays) and/or ultrasound examination, but theses tests are not always diagnostic for the disease. Clinical signs were described above. Laboratory tests usually reveal an elevated white blood cell count; however, an elevated white blood cell count may also be caused by many other things besides pancreatitis. The elevation of pancreatic enzymes in the blood is probably the most helpful criteria in detecting pancreatic disease, but most cats with pancreatitis will have normal levels. Radiographs and ultrasound studies may show an area of inflammation in the location of the pancreas. Unfortunately, many cats with pancreatitis will elude detection with any of these tests. Consequently, the diagnosis of pancreatitis may be tentative in many cases. Other tests, called a TLI and a fPLI, must be sent away to a specific lab. Although results may take a while to be reported to your veterinarian, it can help confirm the diagnosis while treatment is underway.
Treatment
Successful management of pancreatitis is dependent upon early diagnosis and prompt medical attention. Resting the pancreas from its role in digestion best treats mild forms of the disease. The only way to “turn off” the pancreas is to withhold all oral fluids and food (“NPO”). This is accompanied by intravenous fluids to maintain normal hydration and electrolyte balance. In addition, anti-inflammatory drugs are sometimes administered. In severe acute cases, the presence of shock necessitates the immediate and intense use of intravenous fluids and antibiotics.
Prognosis
Prognosis depends on the severity of the disease, extent of damage to the pancreas, development of complications, and the presence of any concurrent diseases. Cats that respond well to initial therapy have a better prognosis than those that present with shock and depression, where as a more guarded prognosis must be expected.
Long-term Effects
If a significant number of cells that produce digestive enzymes are destroyed, there may be serious, long-term complications. Appropriate digestion of food may not be possible, leading to a condition called pancreatic insufficiency. This can be treated by replacing the enzymes with daily administration of enzyme powder in the food. If a significant number of cells that produce insulin are destroyed, diabetes mellitus can result. This can usually be treated with daily injections of insulin. Fortunately, the vast majority of cats recover without either of these problems developing.
Pancreatic Cancer
Unfortunately, some cats suspected of chronic pancreatitis actually have pancreatic cancer. Ultrasound may be helpful in distinguishing cancer from pancreatitis, but a biopsy of the pancreas is required to give a firm diagnosis. Treatment is generally supportive. Options for chemotherapy and radiation can be discussed with an oncology specialist
.