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That's Pancreatitis?!

Do you know what pancreatitis looks like ultrasonographically? Well you are about to.

First, pancreatitis is pancreatic inflammation. The pancreas is responsible for making enzymes of digestion as well as insulin. Inflammation of this organ can cause vomiting, diarrhea, anorexia/inappetence, lethargy, and abdominal pain. In severe cases, it can cause bleeding abnormalities and even death. Pancreatitis can also cause a build-up of fluid in the abdominal cavity, although it is typically minimal to mild and is usually self-limiting.

No one really knows what causes pancreatitis, but it is thought that the enzymes the pancreas produces somehow get activated within the pancreas before they reach the gut, and essentially start to digest and inflame the pancreas rather than working on the ingesta within the gut. The pancreas contains enzyme inhibitors, but it is thought that they get overwhelmed somehow which leads to pancreatitis.

The pancreas, liver, and gastrointestinal tract are all intimately associated and disease in one can precipitate inflammation in another. Although we see this most commonly in cats, we are discovering it more and more in dogs where diseases like inflammatory bowel disease or even upper intestinal foreign bodies can trigger a bout of pancreatitis. Diabetes Mellitus is also a known predisposing cause of pancreatitis in both dogs and cats, although this is not surprising since it is due to pancreatic dysfunction specifically of the insulin producing areas. In dogs, consumption of foods rich in fat can also lead to the development of pancreatitis.

The diagnosis of pancreatitis can involve a clinical suspicion, but most often involves abdominal ultrasound which picks up approximately 66% of cases and/or pancreatic specific lipase measurements (blood test). Here is an example of ultrasonographic pancreatitis:

As you can see, acute pancreatitis often presents ultrasonographically as an enlarged, dark pancreas surrounded by bright white tissue.

The treatment for pancreatitis is supportive in nature and consists of a combination of fluids, early feeding (returning to feeding as soon as possible after the illness begins), gastroprotectants/stomach protectants, pain medications if needed, and antibiotics if needed. Pancreatitis is not caused by infections in dogs and cats, and so antibiotics are typically used if there is concern that the gut has becoming inflamed enough to allow bacteria to reach the blood stream. There is a new medication on the market designed to target pancreatic inflammation in order to improve the clinical signs. Steroids can also be used in some severe or chronic cases, or in cases thought to be due to another inflammatory disorder such as inflammatory bowel disease. Low fat diets can be utilized to decrease the likelihood of a recurrent bout of pancreatitis in dogs with severe disease. This is not helpful in cats. Treating non-symptomatic/subclinical pancreatitis diagnosed via a random blood test is not usually recommended since there are no symptoms to guide therapy or to determine success.

The prognosis is good for uncomplicated or mild to moderate cases. In some instances, chronic pancreatitis can develop, however, more often than not, there is another disease such as gastrointestinal disease that may be driving recurrent cases.

Pancreatitis is not a fun experience for people or pets. One of my previous dogs had two bouts, and one of the bouts required multiple days of hospitalization. The other bout lead to the diagnosis of inflammatory bowel disease.

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