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Pancreatitis in Cats

The pancreas is an important organ in the body. It produces digestive enzymes that pass into the small intestine to aid in digestion of food. The pancreas also produces insulin, which is needed by the body for metabolizing normal glucose (a type of sugar). Sometimes the pancreas becomes inflamed, causing pancreatitis (pancreatitis simply means inflammation of the pancreas). When this occurs, a cat may have difficulty digesting food, start vomiting, become painful, lose weight or refuse to eat. Long-term pancreatitis may cause diabetes as the insulin-producing cells of the pancreas are damaged or destroyed. In addition, if enough pancreatic cells are destroyed with pancreatitis, a cat may not be able to produce normal amounts of digestive enzymes, leading to a condition known as exocrine pancreatic insufficiency, or EPI. Consequently, we want to diagnose and treat pancreatitis as quickly and effectively as possible.

In cats, pancreatitis varies from being low-grade with only occasional mild symptoms to a much more severe necrotizing pancreatitis (total destruction or death of pancreatic tissue) that can be fatal.

Pancreatitis is thought to be caused in some cases by bacteria migrating up the pancreatic duct from the intestinal tract. Pancreatitis also can be caused by some parasitic infections, such as toxoplasmosis and pancreatic flukes, although this is unlikely in our indoor-dwelling city cats. Swelling and damage to the pancreatic duct from inflammation in the small intestine (inflammatory bowel disease) can cause the digestive enzymes to back up in the pancreas causing swelling and inflammation of the pancreas and even surrounding tissues. Inflammation in the liver and bile ducts (cholangiohepatitis) can cause a sterile pancreatitis as well. In fact, pancreatitis occurs so frequently with inflammation in the liver and inflammatory bowel disease that we have a name for this combination of problems: triaditis. Unfortunately, however, in the majority of cases of feline pancreatitis, its cause remains unknown.

Pancreatitis is most commonly diagnosed with a combination of blood tests and an abdominal ultrasound. In some cases, a surgical biopsy is needed to confirm the diagnosis. Most cats with pancreatitis will have increased levels of the enzyme called pancreatic lipase (PLI) in their blood. We have a test that we run in the Cat Hospital laboratory that looks for increased levels of PLI in the blood. This screening test is most commonly run for cats that have become acutely (suddenly) ill with vomiting or a lack of appetite at home (along with other tests that tell us about disease in other organ systems that may cause symptoms similar to those of pancreatitis).

With cats that have a history of chronic or long-term weight loss or vomiting, we usually need to obtain additional information. We often will have a reference lab perform a fasted gastrointestinal panel. This panel, which is conducted after a cat fasts for a period of time, measures two pancreatic enzymes and the ability of the intestinal tract to absorb B vitamins. If these B vitamin levels are low, and the PLI is increased, we know that there is a strong likelihood that not only are pancreatic issues involved, but we likely also have intestinal disease as well. We want to make sure we do not miss inflammatory bowel disease or triaditis when present as a cat will do much better if we treat all of the areas of inflammation. Radiographic images (X-rays) or an abdominal ultrasound may be needed to help confirm a diagnosis of pancreatitis and determine if other problems are occurring, especially if signs are sudden and severe or have been present for some time. Rarely, surgery may be performed if a mass in the pancreas is found or an abscess or tumor is present.

Since the cause of pancreatitis is unknown in most cases, treatment is basically supportive, i.e., aimed at keeping kitties comfortable and alleviating the symptoms. Supportive care is critical. Cats with pancreatitis will need fluid therapy to maintain adequate hydration. This may be given either subcutaneously (under the skin by injection) in the hospital or by the owner at home, or intravenously in the hospital, depending on how severely the individual patient is affected. In addition, pain medication is critical because a cat in pain will not eat, and the cat needs to maintain caloric intake to help with healing as well as to prevent serious fatty liver changes that can occur as a result of inadequate calorie intake. We may use buprenorphine or other prescription pain medications to help reduce pain. Never use human over-the-counter pain medications, such as Tylenol or ibuprofen, in cats as these are poisonous and very dangerous for them.

Many cats with pancreatitis require prescription anti-vomiting medications. They also may benefit from prescription appetite stimulants once their nausea has been controlled. If bacterial infections are likely, antibiotics are needed, though historically it has been thought that most cases of feline pancreatitis do not require antibiotics. Recent research is reassessing that belief. Anti-inflammatory medications are frequently needed especially when inflammatory bowel disease is present or pancreatitis is severe. If liver inflammation is present, bile thinners and/or liver antioxidants may be needed. Cats with low levels of B vitamins are supplemented with weekly injections of B12 (usually given at home by owners) and/or oral folate supplementation.

Many cats with pancreatitis do well and recover completely. Some cats, however, require long-term maintenance treatment, especially when triaditis is present. In kitties with chronic (long-term) pancreatitis, the symptoms often will wax and wane, meaning that patients may need more aggressive treatment (often at home) during flare-ups, and less or no medication at all when they are doing well. Stress often can cause pancreatitis to flare up, so we often will increase or restart medications during stressful events (stress as defined by the cat!), such as holidays, vacations or moves, household changes, such as the arrival of a new baby, etc.

Please let us know if you have any questions or concerns about your kitty or about pancreatitis in general. Because we often cannot identify a true cause for pancreatitis in most patients affected, its course can understandably be frustrating and worrisome to many owners. Cats with chronic pancreatitis (with or without concurrent intestinal disease), especially when flare-ups are severe, or whose good days aren't great, will require much more care on the part of owners at home to assess if and when appropriate supportive medication is necessary, and to properly administer it when it is needed. Our goal is to help you keep your cat as healthy and happy as possible, and assure that the pet/owner (pet parent) bond is well maintained. We always are open to helping owners make the best decision for their cat based on how the cat is doing at home, how well the cat is tolerating medications, how easy or difficult it may be for owners to administer medications, and other factors that may play a role in our patients' well being.

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