Acute & Сhronic Pancreatitis in the Cat

The pancreas (pancreas) is both an endocrine (dispensing inwards) and exocrine (distributing outwards) gland. The endocrine part produces vital hormones such as insulin, glucagon, and somatostatin. The exocrine portion stimulates a glandular secretion that breaks down food into usable components. The secretion consists mainly of inactive precursors of the digestive enzymes. These only become active when they reach the intestine. These inactive precursors protect the pancreas from self-digestion.

Pancreatitis develops when this protective mechanism fails. The digestive enzymes are then released prematurely into the pancreatic tissue and lead to inflammation and self-digestion up to the destruction of the pancreas and the surrounding tissue.

We differentiate between acute, chronic, and chronically activated forms of pancreatitis. The latter occurs because cats with pancreatitis usually do not recover completely, ie the inflammation often flares up in waves, so we speak of a chronic disease that has turned into an acute attack with correspondingly dramatic symptoms.

Pancreatitis can present in cats of any age from four weeks to 18 years of age, regardless of breed or gender. According to some studies, Siamese and older cats are affected more often than average.

Although knowledge of this disease has increased significantly in recent years, the origin of pancreatitis has not yet been thoroughly researched. Diagnosis and therapy are still major challenges.

As always, our cats are very special when it comes to this disease. In contrast to humans and dogs, which show clear symptoms of pancreatitis (vomiting, diarrhea, and severe abdominal pain are classic), cats suffer silently and unobtrusively.

In particular, we usually do not notice the main symptom of pancreatitis – very severe pain when pressure is applied to the abdomen. However, even without any clear external signs, we assume that pancreatitis is also very painful for cats, especially since the condition of a sick cat improves significantly very quickly with the administration of painkillers. It is well known that cats are masters at hiding pain.

The range of symptoms is complex and changing. Most cats are only noticed based on non-specific findings such as decreased appetite (advanced stage anorexia), listlessness (lethargy), and weight loss. For this very reason, we cannot clinically distinguish whether the cat is suffering from acute, chronic, or chronically activated pancreatitis.

Despite non-specific subclinical symptoms, the transition to a life-threatening stage associated with cardiovascular shock and/or multi-organ failure can occur at any time. The transition is fluid. In some patients, pancreatitis remains localized, while in others it spreads systemically. Additional accompanying symptoms can be diarrhea, constipation, and jaundice. In severe cases, dehydration and hypothermia also occur. With simultaneous diabetes mellitus, polydipsia (increased thirst) and polyuria (increased urine output) are the main symptoms.

It is not possible to predict when the change to a life-threatening condition will take place. Even if the cat’s condition initially improves with therapy, an unexpected relapse can occur very quickly. Therefore, the prognosis in a cat with pancreatitis should always be cautious. As a rule, the animals are only presented in practice when the disease is already well advanced. Rapid and thorough therapy is therefore always required, even if the diagnosis has not yet been established.

In the case of all non-specific findings such as vomiting, diarrhea, jaundice, abdominal pain, abdominal enlargement, polyuria, and polydipsia, the differential diagnosis of pancreatitis should always be clarified. This is necessary, although the symptoms mentioned can always represent a disease in its own right. However, they can also indicate pancreatitis or, in the worst case, even trigger it. At a certain stage of the disease, cause and effect can no longer be distinguished from one another.

Chronic intestinal inflammation is generally a very high-risk factor for the development of pancreatitis. The background to this connection is that cats suffering from chronic diarrhea usually also suffer from chronic vomitus (vomiting), increased vomitus in turn leads to increased pressure in the intestines. At the point where bile and pancreatic secretion flow into the duodenum, the increased pressure causes bile and pancreatic secretion to be back washed into the pancreas. This reflux is favored by the anatomical peculiarity of the cat, which has a common excretory duct from bile and pancreas into the duodenum. In addition, the upper small intestine of the cat has a significantly more intensive bacterial colonization compared to the dog, which means that a backflow of germs into the duct system of the bile and pancreas promotes inflammation.

If pancreatitis expands into a systemic event, the disease is life-threatening. The cats can die of shock, acute renal failure, septicemia, or endotoxemia. Often there is additional fluid in the chest and abdomen (pleural effusion/ascites).

Unfortunately, the diagnosis of pancreatitis is not easy and requires a large number of examinations. This includes detailed laboratory tests (hematology, serum chemistry, urinalysis, and special tests) and imaging procedures.

X-ray alone is not very helpful, but it is used to rule out further differential diagnoses. We cannot diagnose pancreatitis based on abdominal X-rays alone, but they help us identify associated complications.

Changes in the pancreas can be seen well on ultrasound, but it must be borne in mind that pancreatitis can sometimes be completely unremarkable on ultrasound. However, together with the symptoms, the changed blood values, ​​and the pancreas marker, the diagnosis of pancreatitis can be made. During therapy, this value should change positively.

Correct assessment of the degree of pancreatitis is important. Severe acute pancreatitis is always life-threatening and must be treated very aggressively, often with a long hospital stay. The therapy of pancreatitis has three main goals:

• fighting the cause,
• symptomatic therapy,
• early detection and treatment of possible systemic complications.

It is important to guarantee tissue perfusion, limit the spread of bacteria and inhibit inflammatory mediators and pancreatic enzymes.

Cats need a high protein intake. If cats do not eat food for more than two to three days (anorexia), the liver can become seriously ill (hepatic lipidosis = fatty liver). So it is very important to pay attention to feeding. In anorectic patients, dietary support through enteral feeding can be life-saving.

Cats often eat when they are petted or when food is offered by hand. Here the love and care of the TFA are very much in demand. With a lot of patience, the unappetizing cat can ultimately be persuaded to take food out of your hand, every small start is a big step forward in therapy.

The environment is also very important for the success of the therapy, it should be stress-free and cat-friendly. Cats often eat at home. If their state of health permits, they can be released home at night, where they usually eat in their familiar surroundings. During the day they are brought back to the practice to be given medication.

The most crucial measure is continuous intravenous fluid replacement via an infusion pump.

Since nausea is often the cause of food refusal, the administration of an antiemetic is generally recommended.

The use of antibiotics is controversial because feline pancreatitis is usually a sterile process. However, in cats with evidence of gastrointestinal barrier breakdown, prophylactic administration of broad-spectrum antibiotics is indicated to inhibit bacterial growth.

Since the pain behavior of cats is generally difficult to assess, pain treatment is an important component in the treatment of pancreatitis. Cats often react to pain by withdrawing and refusing to eat, which are the only symptoms that point the way to pancreatitis. Good training and, above all, empathy on the part of the TFA are also required here. Periodically, the TFA should ensure that the cat is no longer in pain. The Glasgow Pain Scale (see below), which helps to assess the patient’s condition based on posture and facial expression, serves as an aid.

The administration of corticosteroids is discussed in various ways. They are part of the treatment plan for cats with traditions. In the meantime, an idiopathic etiology (occurrence from an unknown cause) is also being discussed in cats. In this context, some authors report good results in chronic pancreatitis.