Pancreatitis, or inflammation of the pancreas, is a painful and potentially life-threatening condition in dogs. The pancreas, a small organ located near the stomach and small intestine, is responsible for producing digestive enzymes and hormones necessary for normal protein, fat, and carbohydrate digestion. When the pancreas becomes inflamed, these enzymes can activate prematurely, leading to autodigestion of the pancreas itself. In severe cases, pancreatitis can be fatal.
Understanding the Pancreas and Pancreatitis
The pancreas is composed of different cell types that perform specialized functions, including producing and secreting enzymes and hormones. A healthy pancreas is critical for normal protein, fat, and carbohydrate digestion.
Pancreatitis can occur for many reasons, and several dog breeds are genetically predisposed to it, with Miniature Schnauzers being a primary example. Certain diseases, including obesity, diabetes mellitus, or low thyroid function, may also make a pet more likely to develop pancreatitis. Dogs can also develop pancreatitis if they eat foods or materials they shouldn’t eat, or if they eat high-fat or very high-protein foods. Pancreatitis can begin very quickly (acute pancreatitis), or it can be an ongoing problem for a dog that occurs for weeks or months (chronic pancreatitis).
Under normal conditions, several mechanisms protect the pancreas from autodigestion by digestive enzymes. Proteolytic enzymes synthesized within the pancreas are stored as inactive zymogens and are activated only once they have entered the duodenum. Pancreatitis develops because of premature activation of trypsinogen to trypsin within the acinar cells of the pancreas, leading to pancreatic cell destruction. Trypsin activation triggers activation of all other pancreatic zymogens, causing pancreatic autodigestion, inflammation and necrosis, as well as a systemic inflammatory reaction.
Clinical signs of pancreatitis in dogs may range from mild to severe and life-threatening, and can include vomiting, lethargy, anorexia or decreased appetite, diarrhea and abdominal pain. Patients with chronic pancreatitis generally present with low-grade, intermittent clinical signs, although they can present acutely. Dogs may assume the classic “prayer” position with forelimbs extended along the ground and raised hindlimbs. Physical exam findings will vary depending on the severity of disease, but may include abdominal pain, dehydration, fever, and icterus if secondary post-hepatic bile duct obstruction is present.
Read also: Canine Kidney Diet: Ingredient Breakdown
Diagnosing Pancreatitis
Unfortunately, there is not one specific test to diagnosis pancreatitis with 100% confidence. A diagnosis of pancreatitis therefore relies on a combination of factors including recent history, diet history including foods and supplements, and the presence of clinical signs such as abdominal pain, decreased appetite, or vomiting. Blood tests or imaging (x-rays, ultrasound, computed tomography (CT scan) may also be recommended to support a diagnosis of pancreatitis. These tests will also help your veterinarian rule out other possible causes of your dog’s signs including toxins, parasites, or intestinal blockage.
Biochemical and hematologic findings in affected dogs are non-specific and can include elevated liver enzymes, hyperbilirubinemia, azotemia, hypoalbuminemia, hypocalcemia, hypokalemia, anemia, thrombocytopenia, leukocytosis and (less commonly) leukopenia. Previously, elevated serum lipase and amylase were used as markers for pancreatitis, but they are no longer recommended due to their lack of sensitivity and specificity. The canine pancreatic lipase immunoreactivity (cPLI) assay is the most sensitive and specific serum marker currently available for canine pancreatitis. Studies have evaluated the assay for detection of both clinical and histopathological pancreatitis cases, and it is notable that not all patients in the histopathological studies showed clinical signs of pancreatitis. The sensitivity of cPLI has been shown to improve in patients with moderate to severe pancreatitis. Furthermore, the assay loses specificity when a lower cut-off value (200 μg/L) is used for a positive diagnosis. More recently, a new assay for lipase activity has been developed using the substrate 1,2-o-dilauryl-rac-glycero glutaric acid-(6’-methylresorufin) ester (DGGR) and validated in dogs.
Pancreatitis may be suspected but not definitively diagnosed, based on abdominal radiographs. Radiographic findings in affected dogs have been reported to include loss of detail or increased radio-opacity in the right cranial abdomen, displacement of the duodenum to the right or pyloric antrum to the left, and gas in the descending duodenum or transverse colon. However, in this study radiographic abnormalities suggestive of acute pancreatitis were present in only 24% of dogs with fatal acute pancreatitis. The most commonly used diagnostic imaging tool for examining the canine pancreas is abdominal ultrasound. Changes seen ultrasonographically with acute pancreatitis include an enlarged, hypoechoic pancreas, often with hyperechoic peri-pancreatic mesentery. Additional abnormalities such as pancreatic pseudocysts, abscesses or masses, and peritoneal effusion may also be present. Hyperechoic areas within the pancreas may be seen, which could represent fibrosis. Computed tomography (CT) is the most valuable imaging modality for diagnosing pancreatitis in people, but has been evaluated less in dogs. CT angiography findings in dogs with acute pancreatitis in a recent pilot study included an enlarged, homogeneously to heterogeneously attenuating and contrast-enhancing pancreas, with illdefined borders in all dogs.
Treatment Options and Nutritional Management
Treatment of pancreatitis focuses on supportive care and managing clinical signs. Supportive care may include medications to treat pain or nausea. Dogs can become dehydrated in severe cases and may need to be hospitalized for IV fluids and more intensive supportive care. Nutritional management of pancreatitis can be started as soon as the dog’s pain and nausea are controlled. Nutritional goals include providing food that is complete and balanced (including all essential vitamins and minerals), low in fat, and easy to digest. Low fat and moderate protein are recommended to meet the dog’s nutritional needs without contributing to excessive pancreas stimulation, which could worsen pancreatitis. Feeding multiple, smaller meals (rather than 1 or 2 larger meals), may also help prevent nausea or vomiting and can help owners evaluate if the new food is acceptable and tolerated (good appetite, no vomiting or diarrhea) by the dog.
Because there is no specific cure, treatment is limited to supportive measures. The main complications of moderate to severe acute pancreatitis to be managed are anorexia, vomiting, abdominal pain, dehydration, electrolyte imbalances, and sometimes systemic inflammatory response syndrome (SIRS). Continuous intravenous fluids are necessary for all but the mildest cases. Most dogs have a history of inappetence or vomiting, and fluids are required to restore hydration and replace electrolytes, with Lactated Ringer’s (Hartmann’s) solution the initial fluid of choice. Potassium supplementation may also be required. Vomiting causes significant morbidity and worsening of dehydration and acid-base/electrolyte imbalance. Abdominal pain may be difficult to recognize in affected dogs, so analgesics should be provided for most cases. Opioids (mu agonists) are typically the most effective drugs at relieving abdominal pain. While corticosteroids have historically been regarded as a risk factor for pancreatitis, more recent evidence suggests they are not a cause and may in fact be beneficial in treatment.
Read also: Managing Canine Lymphoma with Diet
Traditional recommendations for the management of acute pancreatitis in dogs included fasting to “rest the pancreas”. It was thought that recommending nil per os (NPO) for 48-72 hours (or up to 5 days of anorexia) would reduce pancreatic stimulation and excessive release of enzymes. However, the pathogenesis most likely involves intracellular activation of proteolytic enzymes rather than excessive pancreatic stimulation, and there are numerous adverse consequences with prolonged NPO therapy. Protein malnutrition can lead to a catabolic state and hypoproteinemia. The gastrointestinal barrier may be compromised due to a combination of decreased intestinal blood flow, villus atrophy and decreased local immunoglobulin production, which is a risk factor for bacterial translocation and SIRS. Several studies have demonstrated the safety and efficacy of providing assisted enteral nutrition to dogs with experimental or naturally occurring pancreatitis. Total parenteral nutrition (TPN) has also been recommended, especially in cases of severe or refractory vomiting, although it can be associated with a higher rate of complications. Feeding tubes are available in various sizes and materials. For cases of acute pancreatitis, the most common types are nasogastric (NG) tubes and esophagostomy (E) tubes. NG-tubes are easy to insert without the need for sedation and can remain in place for up to 7 days, which is usually long enough to allow recovery and resumption of voluntary intake. Only liquid diets can be fed through NG-tubes, which limits the choice of products. E-tube placement requires general anesthesia and a surgical approach, and critical patients should be stabilized before being anesthetized.
The ideal diet for supporting dogs with pancreatitis has not yet been determined. In most cases, a highly digestible fat-restricted diet is the most appropriate choice as high-fat diets are a potential risk for both pancreatitis and hyperlipidemia. A commonly accepted recommendation is to select commercial canine diets that do not exceed 20 grams of fat per 1,000 kcal (approximately 7% fat on a dry matter basis). Several veterinary therapeutic diets are available that are formulated for gastrointestinal disease and are also fat-restricted. However, diets that are intended for management of obesity or fiber-responsive conditions may not be appropriate, as they are not highly digestible and require larger volumes of food to meet energy requirements. Commercially available liquid diets may not be fat-restricted but can be used in NG-tubes as long as careful monitoring is done to assess for post-feeding nausea, vomiting, abdominal discomfort, or other unwanted signs. A starting point for assisted feeding (NG- or E-tube) is to calculate the resting energy requirement, the daily amount in kilocalories appropriate for a dog recovering from illness. Dogs with mild pancreatitis often start eating voluntarily within three days of the onset of anorexia, and in such cases feeding tubes are not necessary, but a gradual return to full feeding can be achieved using these guidelines. In dogs with moderate to severe pancreatitis, enteral nutrition (placement of a feeding tube) is recommended if anorexia has persisted for three days or longer and voluntary intake is not occurring.
After recovery and discharge from the hospital, home care of patients with acute or chronic pancreatitis often includes medication and ongoing feeding of therapeutic diets. If the dog has hyperlipidemia or is at high risk of relapse, then food should be limited to highly digestible fat-restricted diets as noted previously.
Dietary Recommendations for Dogs with Pancreatitis
The cornerstone of managing pancreatitis in dogs is a carefully controlled diet. The primary goal is to reduce pancreatic stimulation and prevent further inflammation. Here's a detailed look at dietary recommendations:
Low-Fat Diet
High-fat foods are a major trigger for pancreatitis. Therefore, a low-fat diet is crucial. The general recommendation is to choose foods with less than 20 grams of fat per 1,000 kcal, which is approximately 7% fat on a dry matter basis. This helps minimize pancreatic enzyme release and reduces the risk of further inflammation.
Read also: Diet for Seizures in Dogs
Highly Digestible Foods
Easy-to-digest foods help reduce the workload on the pancreas. Opt for diets that contain easily digestible carbohydrates and proteins.
Moderate Protein
While low fat is critical, moderate protein levels are important to meet the dog’s nutritional needs without overstimulating the pancreas.
Small, Frequent Meals
Feeding multiple smaller meals throughout the day, rather than one or two large meals, can also help prevent nausea and vomiting. It allows owners to assess how well the dog is tolerating the new food.
Commercial vs. Homemade Diets
- Commercial Diets: Several veterinary therapeutic diets are specifically formulated for gastrointestinal issues and are low in fat. Brands like Royal Canin, Hill’s Science Diet, and Purina Pro Plan offer prescription diets that meet these requirements. Ensure the diet is also highly digestible.
- Homemade Diets: If considering a homemade diet, consult with a veterinary nutritionist to ensure it is complete and balanced. Lean proteins like boiled chicken or turkey and simple carbohydrates such as rice or sweet potatoes are common ingredients. Avoid fatty meats like pork, lamb, and certain cuts of beef.
Ingredients to Include
- Lean Proteins: Boiled chicken, turkey, or fish are easier for dogs to digest.
- Easily Digestible Carbohydrates: White rice or sweet potatoes are gentle on the digestive system. Boiled pumpkin or oatmeal can also be beneficial.
Foods to Avoid
- High-Fat Foods: Fatty meats (pork, lamb, fatty beef cuts), fried foods, and table scraps.
- Dairy Products: Due to their fat content, dairy products should be avoided.
Treats
Treats should be low in fat and should not provide more than 10% of the daily calorie intake. Several commercially available low-fat treats are available. Alternatively, non-toxic fruits and vegetables may provide low fat and moderate protein amounts and could also be considered after a discussion with your veterinarian. Instead of feeding random food scraps, use part of your dog’s primary diet as treats. Set aside part of each meal to use for training and random snacks. Another option is to use healthy, low-calorie items as treats.
Importance of Gradual Diet Changes
If you need to change your dog’s diet, do it gradually. Start by feeding 75% of the old diet mixed with 25% of the new diet. The next day, feed 50% of each diet, then on the third day feed 25% old and 75% new. If you end up doing a sudden diet change, your dog may have some diarrhea because they aren’t used to the new diet yet. This is usually temporary and will resolve without treatment, but can be unpleasant for both of you.
Nutritional Support: When and How
While dietary changes form the foundation of pancreatitis management, some dogs may require additional nutritional support, especially during acute episodes:
Assisted Feeding
- Enteral Nutrition: If a dog is not eating voluntarily, enteral nutrition (feeding through a tube) is recommended. Nasogastric (NG) tubes and esophagostomy (E) tubes are common options. NG-tubes are suitable for short-term use (up to 7 days) and require liquid diets. E-tubes require general anesthesia for placement but allow for a wider range of food options.
- Parenteral Nutrition: In severe cases with persistent vomiting, total parenteral nutrition (TPN) may be necessary. TPN involves intravenous administration of nutrients and should be used when enteral feeding is not possible due to the risk of complications.
Pancreatic Enzyme Supplements
In more severe or chronic cases of pancreatitis, you may also need to include pancreatic enzyme supplements to aid in digestion. These supplements help break down food, making it easier for the pancreas to manage the digestive process without becoming inflamed.
Outcome After Treatment and Long-Term Management
Treatment outcome and nutritional needs after recovery of pancreatitis is extremely individualized. There is no single feeding recommendation for fat or protein for dogs with a history of pancreatitis, and some dogs will tolerate higher amounts of fat or protein than others. In cases of acute pancreatitis in which a cause of pancreatitis is found, such as history of eating a very high fat meal, the dog may eventually be able to be transitioned back to their previous food with no further issues. In cases of chronic pancreatitis, a lower fat diet may need to be fed for weeks, months, or even the remainder of the pet’s life dependent on the presence of other disease(s) and pancreatitis severity.
After recovery and discharge from the hospital, home care of patients with acute or chronic pancreatitis often includes medication and ongoing feeding of therapeutic diets. If the dog has hyperlipidemia or is at high risk of relapse, then food should be limited to highly digestible fat-restricted diets as noted previously.
Monitoring and Adjustments
Regular veterinary check-ups are essential to monitor the dog’s progress and adjust the diet as needed. Factors to consider include:
- Weight management: Maintaining an ideal body weight is crucial, as obesity is a risk factor for pancreatitis.
- Bloodwork: Regular blood tests can help monitor pancreatic enzyme levels and overall health.
- Clinical signs: Watch for any recurring symptoms of pancreatitis, such as vomiting, diarrhea, or abdominal pain.
Case-Specific Considerations and Additional Factors
Underlying Conditions
Pancreatitis can be associated with other health issues, such as diabetes mellitus, hyperlipidemia, and exocrine pancreatic insufficiency (EPI). Addressing these conditions is an integral part of managing pancreatitis.
Breed Predisposition
Certain breeds, like Miniature Schnauzers, Cocker Spaniels, and Yorkshire Terriers, are more prone to pancreatitis. These dogs may require more stringent dietary management and monitoring.
The Role of Fats
The type of fat consumed may influence a dog’s response to a particular diet. Dietary fat may be saturated or unsaturated and have different lengths of fatty acid chains. Oxidized or rancid fats should be avoided.
Importance of Veterinary Guidance
Any nutritional intervention in the treatment of pancreatitis is predicated on the veterinarian distinguishing acute or chronic pancreatitis from other causes of gastrointestinal signs. In the absence of evidence specific to canine pancreatitis, practitioners should evaluate the risks of enteral feeding in the context of the patient’s overall clinical picture.
tags: #canine #pancreatitis #diet #recommendations