Production of Hormones, Including Insulin

PANCREATITIS

The pancreas is a pale pink, glandular organ nestled just under the stomach. It has two main functions:  Production of hormones, including insulin  Production of digestive enzymes

The normal pancreas has a number of protective mechanisms to keep its stored digestive enzymes from damaging body tissues, including the pancreas itself. However, with pancreatitis, these protective mechanisms are overcome, causing profound inflammation. If this inflammatory process progresses, other tissues and/or organs may become inflamed as well, most notably the liver and gastrointestinal tract. Furthermore, toxins released from the inflammation are released into the body’s circulation, potentially causing a body-wide inflammatory response. If pancreatic damage disrupts its ability to produce insulin (a hormone involved in the body’s regulation of sugar), diabetes mellitus may result.

What causes pancreatitis in animals? Unfortunately, 90% of the time, a definitive cause is never discovered. However, we have some idea of possible risk factors. These include:

 Genetic predisposition o Schnauzer dogs have been repeatedly documented as a breed over-represented for developing pancreatitis  Other underlying diseases o A variety of other systemic diseases may predispose a pet to develop pancreatitis, including hyperadrenocorticism (Cushing’s Disease), hyperlipidemia, obesity, and diabetes mellitus  Dietary indiscretion o Fatty/spicy meals, and “garbage raids” are both thought to predispose animals to developing pancreatitis  Trauma o Being hit by a vehicle or falling from a great height may damage the pancreas, predisposing to pancreatic inflammation  Use of certain medications o Various medications currently used in veterinary medicine have been shown to predispose human patients to pancreatitis, including thiazide diuretics, furosemide, estrogens, azathioprine, ranitidine (Zantac™), acetominophen (Tylenol™), sulfonamides, tetracyclines, L-asparaginase, metronidazole, procainamide, and nitrofurantoin. o Corticosteroids do not appear to induce pancreatitis, although these medications do potentially cause alterations in levels of pancreatic enzymes

Clinical signs associated with pancreatitis are variable, and often include: A. Vomiting B. Loss of appetite (especially in cats) C. Lethargy (especially in cats) D. Diarrhea E. Abdominal discomfort F. Fluid accumulation in the abdominal and/or chest cavities

These symptoms may range from very mild to severe  they may recur over months to years, or an animal may be presented to a veterinarian in severe shock. Additionally, various complications may occur secondary to pancreatitis, including diabetes mellitus, dietary maldigestion, and bile duct obstruction.

Pancreatitis may be difficult to diagnose. Obtaining an accurate patient history is invaluable to help eliminate potential predisposing factors. Thorough diagnostic evaluation is essential, and includes blood/urine tests, fecal tests, abdominal radiography and/or ultrasonography. Occasionally, surgery is needed (i.e.: to correct a bile duct obstruction), and allows the surgeon to biopsy adjacent organs to rule out additional problems, such as inflammatory bowel disease.

There are three key elements to treatment of pancreatitis. They are:

 Removing the cause of the pancreatitis (if possible)  Monitoring and instituting protection against potential complications listed above  Providing supportive care and symptomatic relief, including pain medications, gastroprotectant medications, anti-nausea medications, nutritional support

Fluid therapy is used to support the vasculature (blood supply) and correct dehydration from vomiting and/or diarrhea. Plasma transfusions may be helpful in dogs, as these fluids help to replace important clotting proteins and enzymes to help fight inflammation. Food and water are withheld for a variable period of time to help reduce inflammation, and often a temporary supplemental feeding tube may be used to ensure an animal receives adequate nutritional support at an appropriate time. Specific treatment of pancreatitis is very variable, and is tailored to the unique needs of each patient.

The risk of recurrence of pancreatitis is very difficult to predict. However, appropriate treatment of any predisposing conditions, avoidance of sudden dietary changes, and feeding a low fat diet may help to reduce the likelihood of recurrence.