Pancreatitis: a Pain in the Gut

Kelly Wang, DVM, MS
Diplomate American College of Veterinary Internal Medicine
Nashville Veterinary Specialists

Pancreatitis can range from mild to severe.  In the severe form, cellular necrosis is present, and morbidity and mortality significantly increases.  The treatment of pancreatitis has shifted from early surgical debridement to more aggressive intensive medical care.  Due to the advances in radiology and biochemical analysis, we are able to diagnose pancreatitis and institute treatment earlier since the PLI (pancreatic lipase immune reactivity test) is much more sensitive and specific compared to amylase and lipase.  Amylase and lipase are even more unreliable in cats.

The presentation signs of pancreatitis in dogs and cats vary depending on severity.  Mild cases are often subclinical.  Clinical signs include anorexia, vomiting, abdominal pain and/or diarrhea.  About 33% of dogs, however, don’t vomit and cats rarely vomit with pancreatitis.

The mainstays of therapy are intravenous fluid, support to help maintain adequate circulating volume and sometimes antibiotics.  This area can be a little controversial since most pancreatitis cases are considered an inflammatory process, rather than an infectious disease.  Fresh-frozen plasma is often used as a supplemental form of alpha-macroglobulin and as therapy for DIC, which is frequently seen with severe cases.  Delayed aggressive fluid support can worsen the prognosis with moderate to severe pancreatitis.

Pain management is an important treatment since abdominal discomfort is often associated with this disease.  Common drugs used include butorphanol, buprenorphine, morphine and fentanyl given parenterally.  Antiemetics (such as Cerenia) are used to help relieve nausea, and promotility agents (such as metoclopramide – ideally in CRI form since this drug has a very short half-life orally) can also help animals feel more comfortable.