- Intravenous (IV) fluid therapy in severe pancreatitis.
- Vigorous monitoring of a worsening condition.
- Antiemetic medication for vomiting (to prevent dehydration)
- Resting the pancreas (withholding food and water for 24 hours)
Dogs are beloved family members, and as such, we want to ensure they are as healthy as possible. Pancreatitis is a serious condition that, if left untreated, can be life-threatening. It’s important for pet owners to be aware of the signs and symptoms of pancreatitis in order to ensure their dog’s health and safety. In this blog post, we will explore the signs and symptoms of pancreatitis in dogs, as well as treatment options and necessary steps to take if you suspect your dog is suffering from this condition. We will discuss the importance of early diagnosis and management of this condition, as well as potential long-term effects if it is not properly addressed. Finally, we will also provide some tips and advice for caring for a dog with pancreatitis. By understanding the signs, symptoms, and treatment of pancreatitis, pet owners can be better equipped to give their beloved furry family member the best care possible.
What are the clinical signs of pancreatitis?
The most typical clinical symptoms include vomiting, diarrhea, abdominal pain, fever, lethargy, and decreased appetite. Dogs may adopt a praying stance during an attack, with their rear ends raised and their front legs and heads lowered to the ground. Acute shock, severe depression, and even death could happen if the attack is severe.
Laboratory tests typically show an elevated white blood cell count, but in addition to pancreatitis, many other diseases can also cause an elevated white blood cell count. Although elevated blood levels of pancreatic enzymes are likely the most useful indicator of pancreatic disease, some dogs with pancreatitis will have normal enzyme levels. A new pancreatic test that can accurately identify pancreatitis has recently become available (see handout “Pancreatitis in Dogs – Pancreas-Specific Lipase”), even when pancreatic enzymes are normal. Inflammation-related changes may be visible on radiographs, particularly in cases of severe hemorrhagic disease.
The diagnosis of local or pancreatic inflammation brought on by this condition is frequently made using ultrasound studies. Unfortunately, many of these tests will miss some dogs with pancreatitis, especially those with chronic pancreatitis.
Consequently, the diagnosis of pancreatitis may be tentative or presumptive in some cases and based solely on clinical signs and medical history.
Early diagnosis and prompt medical treatment will be essential for pancreatitis management. Treatment for mild, edematous pancreatitis involves resting the pancreas and letting the body heal itself. Dogs who are throwing up should fast until they stop. If necessary, patients can go a few days without eating. When recovering, dogs who are not vomiting may be fed a low-fat, highly digestible diet.
Intravenous fluids will be administered to maintain a normal fluid and electrolyte balance in addition to analgesics to manage the severe pain. In many circumstances, anti-inflammatory drugs or medications to stop vomiting or diarrhea will also be necessary. Antibiotics will be administered if concurrent infection is suspected.
The majority of dogs with pancreatitis are kept in hospitals for two to four days while receiving intravenous fluids, medications, and a gradual reintroduction to food. If the dog is exhibiting symptoms of systemic shock or has severe hemorrhagic pancreatitis, intensive care should be administered using potent intravenous fluid doses and medications to treat shock.
Nutritional Management of Pancreatitis in Dogs
Withholding enteral nutrition during episodes of acute pancreatitis has historically been recommended as a way to “rest” the pancreas and prevent stimulation of the exocrine pancreas and the risk of continuing premature zymogen activation. 3-6 There is little evidence to support this practice, and several studies cast doubt on it. 6 There is growing evidence that early enteral nutrition improves clinical outcomes in patients with systemic illnesses. In particular, it has been demonstrated that early enteral nutrition reduces ileus and inflammation, promotes intestinal mucosal regeneration and mucosal blood flow, reduces protein catabolism, and guards against protein-energy malnutrition. 34 dogs with acute pancreatitis were included in a recent retrospective study, and the results showed that early enteral nutrition (i e. , within 48 hours of hospitalization) improved return to voluntary food intake, was linked to a decrease in gastrointestinal intolerance, and ought to be taken into account as part of medical management. 4.
Given that avoidance of enteral nutrition has been linked to increased gastrointestinal permeability, bacterial or endotoxin translocation, and immunosuppression, imposed anorexia may be detrimental to overall gastrointestinal health. Systemic inflammatory response syndrome (SIRS) may result from increased metabolic demands, protein catabolism, and bacterial translocation linked to pancreatitis itself 3,6,10 10.
Nasoesophageal and nasogastric tubes are frequently used in the management of patients with acute pancreatitis at the author’s hospital. The insertion of a feeding tube is generally painless and inexpensive. Given its practical inability to meet all nutritional needs and the risk of food aversion and aspiration, syringe feeding is not advised. 5.
Ideally, hospitalized dogs should be fed their estimated resting energy requirement (RER) based on either 70 × (body weight in kg)0.75 = RER (kcal/day) or [30 × (body weight in kg)] + 70 = RER (kcal/day). The first formula is the more accurate of the two and is used at the author’s institution for dogs weighing <5 kg or >25 kg, while the second is an approximation of RER for dogs weighing 5 to 25 kg.1,5 In patients that cannot tolerate their full RER as enteral nutrition, providing at least part of the RER via this route will likely provide some benefit in maintaining the absorptive surface area of the intestines.5
There are liquid enteral diets made for veterinary use (TABLE 2). Human enteral diets may be used for short-term feeding, but they are not suitable for long-term use due to their lower fat, protein, and essential nutrient profiles. 5.
Patients with acute pancreatitis frequently experience vomiting and nausea-related inappetence, and antiemetics are frequently used to treat these symptoms. Circulating emetic agents are likely to play a central role in mediating these symptoms, with ileus, peritonitis, and pancreatic destruction playing a peripheral role. Several antiemetics are frequently used for management and are regarded as useful and effective, though few have undergone extensive testing11; popular options are listed in TABLE 1.
First-line antiemetic Maropitant, an NK1 (neurokinin-1) receptor antagonist, works both centrally (i e. , the vomiting center and chemoreceptor trigger zone) and peripherally (gastrointestinal tract). Maropitant has been found to be more effective than metoclopramide at treating peripherally induced vomiting 1, 3, 12, and 13. Maropitant may inhibit inflammation in addition to having antiemetic properties by blocking NK1 receptors in the pancreas, according to rodent studies. Other antiemetic medications, like serotonergic antagonists (e.g. 12, 14), that have been linked to anti-inflammatory effects g. To reduce nausea and manage emesis, ondansetron can be added as needed. 1.
At the author’s institution, maropitant is the preferred antiemetic. Metoclopramide (1 to 2 mg/kg q24h as a constant-rate infusion) or ondansetron (0 mg/kg q24h) may be used for canines who are resistant to this medication. 1 to 1. Use of 0 mg/kg every six to twelve hours (additional supportive therapy)
Proton pump inhibitors (e. g. , omeprazole, pantoprazole) and histamine type-2 (H2) receptor antagonists (e. g. , famotidine, and ranitidine) are helpful auxiliary drugs that may lessen the risk of esophagitis or gastric or intestinal ulceration (TABLE 1).
Although there is currently no evidence that reducing gastric acidity improves outcomes for dogs with acute pancreatitis or reduces pancreatic exocrine stimulation, it is frequently advised during treatment for acute pancreatitis. However, gastric acid suppression is advised if there is clinical evidence of esophagitis (repeated eructation, regurgitation) or gastric ulceration (hematemesis or melena). 1.
Proton pump inhibitors are superior to H2-antagonists for increasing the intragastric pH when taken twice daily. 1,16,17 Using H2-antagonists and proton pump inhibitors together for a brief period of time has no greater effect than using either drug class separately. 18.
The pathogenesis of acute pancreatitis and the transition from acute, self-limiting to severe, necrotizing pancreatitis are both heavily influenced by disturbances in pancreatic microcirculation. Numerous factors, such as hypovolemia, dehydration, increased capillary permeability, and microthrombi, can disrupt the pancreatic microcirculation 1,3,19. 1,3,19.
The goal of intravenous fluid therapy is to increase blood volume and, consequently, blood flow to the pancreas. Several animal studies have shown that fluid resuscitation improves pancreatic circulation and survival. 20,21 Fluid resuscitation alone does not completely restore pancreatic blood flow and oxygen consumption, though. There isn’t much information about which initial fluid is best, but an isotonic fluid (e.g. g. , lactated Ringer’s solution, 0. 9% sodium chloride) is appropriate. The estimated fluid deficit, any ongoing losses, and the fluid plan should be included in the fluid budget. e. , vomiting, diarrhea), and the ongoing maintenance requirement. Electrolytes should be monitored and supplemented accordingly.
In dogs with severe acute pancreatitis, crystalloid therapy alone might not be sufficient. 3 Compared to crystalloid resuscitation, colloid fluid administration in pancreatitis patients produced better results. 19 There is debate over the current use of colloid solutions in treating pancreatitis in veterinary patients. The use of colloids may increase the risk of renal dysfunction, coagulation/platelet dysfunction, and mortality, according to several human studies and a recent veterinary study. 22-24 More prospective longitudinal studies are required in veterinary medicine to look into the elevated risks (e g. , acute kidney injury) related to the administration of colloid in seriously ill patients
Are Some Dogs Predisposed to Pancreatitis?
Pancreatitis is more likely to develop in some breeds and in dogs who take particular medications.
Due to their propensity to experience issues with high blood triglyceride levels, miniature Schnauzers are regarded as a predisposed breed.
Another example is the English Cocker Spaniel. In general, this breed exhibits higher incidences of immune-mediated diseases, which are brought on by abnormal immune system activity, and pancreas infection is no exception.
Some chemotherapy drugs and some antibiotics are among the medications with a history of causing pancreatic inflammation.
FAQ
How can I treat my dogs pancreatitis at home?
They must provide them with plenty of water when they get home to prevent dehydration. They may need medication for pain, too. Drugs to treat nausea and vomiting may also be given to them. Make sure your dog is eating a low-fat diet when they begin eating again.
Can pancreatitis in dogs heal on its own?
Most dogs recover without any long-term consequences. However, one or more of the following issues could arise from severe or recurrent pancreatitis episodes: If a sizable portion of the cells that produce digestive enzymes are destroyed, inadequate food digestion could result.
What foods trigger pancreatitis in dogs?
After a dog consumes a fatty food, such as pork, beef, or some other human foods, acute pancreatitis may develop. Dogs that get into garbage can develop pancreatitis. Other factors, such as specific medications and some viral or bacterial infections, can also contribute to pancreatitis.
How Long Can dogs live with pancreatitis?
The prognosis for a dog with severe pancreatitis depends on the course of treatment, the level of inflammation caused by the condition, and whether the dog also has other illnesses. In one study, 33% of the 136 dogs with acute pancreatitis who were admitted to a hospital passed away within 30 days (Fabres, 2016).