CANINE PANCREATITIS
Case Report by Dr. Kim Robertson

As the holidays approach, I think about Randi and her owner, Mr. Jackson, both of whom ended up in the hospital after Thanksgiving several years ago. It seems Mrs. Jackson served her spouse and her schnauzer, Randi, large helpings of turkey covered in homemade gravy for Thanksgiving dinner. The next day, both Randi and Mr. Jackson became violently ill.

After taking her husband to the hospital, the owner's wife brought Randi to see me. Randi was a nine-year old, overweight female Schnauzer. She was vomiting, passing diarrhea and was very lethargic. On physical exam, her temperature was elevated, she was dehydrated, and her cranial abdomen was tense and painful. Knowing she had just enjoyed a turkey dinner with all the fixings, I suspected pancreatitis.

The pancreas is a V-shaped organ that lies in the right cranial (upper) abdomen next to the stomach and duodenum (the entrance to the small intestine from the stomach). The pancreas secretes many important enzymes that aid in digestion of the food we consume. These enzymes are secreted when food enters the stomach. The cells in the pancreas that manufacture these enzymes are resistant to the enzymes' digestive nature. Under certain conditions, however, the membranes of these cells lose their integrity and the enzymes are unleashed into the pancreatic tissues themselves causing edema (water retention), hemorrhage and necrosis (cell death). This is pancreatitis.

There are three common causes of pancreatitis in pets. The first is consumption of a fatty meal. The second is the reflux of bile acids and bacteria from the duodenum into the pancreas. The third cause may be the ingestion of certain drugs, such as furosemide and L-asparaginase. (Certain medications such as these are suspect; there is no proof that they cause pancreatitis).

The pancreas itself is highly responsive to dietary changes, and pancreatitis is more prevalent in overweight animals. Lean, well exercised dogs rarely develop pancreatitis.

To confirm my suspicions, I sent Randi's blood to our lab for a complete blood count, a chemistry panel and amylase and lipase levels. Because the pancreas is the only organ to secrete lipase, pancreatitis consistently causes a large rise in this enzyme. It also commonly increases amylase, an enzyme secreted by the pancreas, liver and small intestine. Randi's amylase and lipase levels were more than four times higher than normal. I took abdominal radiographs which showed a loss of detail in the cranial abdomen due to the localized edema and inflammation of Randi's pancreas.

When treating acute pancreatitis, my aim is to decrease the synthesis and secretion of the pancreatic enzymes and to replace fluid losses. I placed an I.V. catheter in Randi's leg and started her on a balanced electrolyte solution. This not only replaces the fluids lost in the vomiting and diarrhea, but it also helps pancreatic blood circulation. I also put Randi on a "nothing by mouth" diet because drinking even small amounts of water or eating anything would stimulate her pancreas to secrete enzymes.

I gave Randi all her medications parenterally, meaning "other than by mouth." The alternative to giving a medication orally is to give it intravenously, intramuscularly, or subcutaneously (into the fat under the skin). I gave Randi antibiotics to prevent abscesses from forming in the pancreas and to treat possible bacterial infection. I also gave her antiemetics to control the vomiting and pain medication for comfort. She was on this regimen for five days to allow her pancreas time to heal.

Randi was a sick pup for three days. I continued her I.V. fluids throughout her hospitalization, making adjustments for changes in her blood sugar or electrolytes. Because the pancreas is also the site for insulin secretion, I had to monitor Randi's blood sugar carefully to make sure she didn't become hyperglycemic. Some patients with acute, severe pancreatitis have decreased insulin production and thus become transiently diabetic.

While Randi was on fluids, I also monitored her plasma proteins, which could have become profoundly low because of protein losses from diarrhea. I had a plasma transfusion ready to give her, if necessary, that would supply proteins.

After four days in the hospital, Randi's amylase and lipase levels were almost back to normal. After she had gone 24 hours without vomiting, I offered her water to drink. She kept the water down, so I offered her a low-fat, highly digestible diet of cottage cheese and white rice. Once she was eating and drinking, I weaned her off the I.V. fluids and sent her home with her owner. I recommended that Randi eat a low-fat diet and avoid snacks. I was pleased to hear that Mr. Jackson had recovered from his own bout of pancreatitis.

Pets who are overweight are more susceptible to having pancreatitis. Dogs that develop the condition are usually adult to middle-aged, with spayed females slightly more at risk. It is important to monitor your pet's nutritional status year-round and to maintain a healthy body weight. Be especially careful during the holidays. It's easy to "treat" your pet to a meal or snack that just might put her in the hospital!