Contributors: James Simpson, Kenneth Simpson, Julien Bazelle
Species: Canine | Classification: Diseases
- Chronic pancreatitis in the dog is not commonly diagnosed antemortem.
- It may develop as a sequelae to acute pancreatitis Pancreatitis: acute.
- Cause: usually unresolved acute pancreatitis.
- Signs: episodic signs of abdominal pain/vomiting or subclinical condition manifest as/resulting in diabetes mellitus or exocrine pancreatic insufficiency.
- Diagnosis: laboratory tests, ultrasonography, histopathology.
- Treatment: acute episodes as for acute pancreatitis; dietary modification, pancreatic enzyme supplementation.
- Prognosis: guarded unless underlying etiology identified and controlled.
Print off the owner factsheet on Pancreatitis Pancreatitis to give to your client.
Follow the management tree for vomiting/anorexia Vomiting in suspected pancreatitis vomiting/anorexia in suspected pancreatitis.
- Vomiting (intermittent).
- Weight loss.
- Recurrent episodes of acute pancreatitis Pancreatitis: acute.
- Sequelae of unresolved acute pancreatitis Pancreatitis: acute.
- Months to years.
- Abdominal pain/acute abdomen Investigation of Acute Abdomen.
- Intermittent vomiting.
- Weight loss.
- Diarrhea Diarrhea: chronic.
- Anterior (cranial) abdominal pain (in acute recurrent pancreatitis, absent in sub-clinical).
- Jaundice (if inflammation causes swelling and obstruction of bile duct).
- In acute phase changes as for acute pancreatitis, eg raised canine pancreatic lipase Canine pancreatic lipase immunoreactivity (cPLI) test , amylase Blood biochemistry: amylase and lipase Blood biochemistry: lipase.
- Trypsin like immunoreactivity Blood biochemistry: trypsin-like immunoreactivity may be low in chronic cases with EPI and normal, high or low in acute cases.
- Hypocobalaminemia Blood biochemistry: vitamin B12 is frequent with chronic pancreatitis, especially in case of EPI.
- Hyperglycemia Blood biochemistry: glucose if insulin deficient due to islet cell destruction.
- Recurrent hypercholesterolemia Blood biochemistry: cholesterol and/or hyperbilirubinemia Blood biochemistry: direct bilirubin when acute-on-chronic-episodes.
- Measurement of an elevated canine pancreatic lipase concentration in serum (cPLI test Canine pancreatic lipase immunoreactivity (cPLI) test , available from Idexx Reference Laboratories or the Gastrointestinal Laboratory at Texas A&M University).
A negative cPLI does not exclude chronic pancreatitis, as cPLI indicates active acute inflammation and may not be elevated when inflammation is mild and/or chronic.
- Increased fibrous tissue.
- Possibility of acinar architecture +/- inflammatory infiltrate.
- Signs correlated to the degree of pancreatic necrosis and pancreatic fat necrosis.
- Evidence of auto-immune disease in certain breeds (eg English Cocker spaniel).
- Other causes of vomiting Vomiting.
- Other causes of EPI.
- Pancreatic neoplasia Pancreas: neoplasia.
- Other causes of:
- Abdominal pain.
- Chronic diarrhea.
- Reduced weight.
- Jaundice if present.
- Manage acute episodes as for acute pancreatitis Pancreatitis: acute.
- Dietary manipulation with low fat, high carbohydrate feeding.
- Pain relief, eg tramadol Tramadol , gabapentin Gabapentin , maropitant Maropitant citrate.
- Pancreatic enzymes supplements have been shown to decrease the frequency and severity of acute episodes in human patients with chronic pancreatitis. This remains unproven in dogs.
- There is not enough evidence to support the use of immunosuppressive drugs in cases of auto-immune chronic pancreatitis in dogs (although this is the treatment of choice in human patients) and their effects may be limited in end-stage disease where fibrotic tissue replaces normal pancreatitic parenchyma.
- Fair if underlying cause identified and managed.
- Relapses still likely in spite of all efforts.
- Risk of development of diabetes mellitus and EPI. These were not associated with worse prognosis or poorer response to therapy.
Expected Response to Treatment
- Cessation of vomiting on therapy.
- Improving demeanor, appetite and weight gain.
- Diabetes and EPI are unlikely to resolve once established.
Reasons for Treatment Failure
- Underlying disease not addressed.
- Severity of pancreatic damage → diabetes mellitus or EPI.
- Recent references from PubMed and VetMedResource.
- Bostrom B M, Xenoulis P G, Newman S J, Pool R R, Fosgate G T & Steiner J M (2013) Chronic pancreatitis in dogs: a retrospective study of clinical, clinicopathological, and histopathological findings in 61 cases. Vet J 195 (1), 73-79 PubMed.
- Watson P J, Roulois A, Scase T, Holloway A & Herrtage M E (2011) Characterisation of chronic pancreatitis in English Cocker Spaniels. JVIM 25 (4), 797-804 PubMed.
- Watson P J, Archer J, Roulois A J, Scase T J & Herrtage M E (2010) Observational study of 14 cases of chronic pancreatitis in dogs. Vet Rec 167 (25), 968-976 PubMed.
- Watson P J, Roulois A J, Scase T, Johnston P E, Thompson H & Herrtage M (2007) Prevalence and breed distribution of chronic pancreatitis at post-mortem examination in first-opinion dogs. JSAP 48 (11), 609-618 PubMed.
- Mansfield C S & Jones B R (2000) Plasma and urinary trypsinogen activation peptide in healthy dogs, dogs with pancreatitis and dogs with other systemic diseases. Aust Vet J 78 (6), 416-422 PubMed.