Contributors: James Simpson, Kenneth Simpson, Julien Bazelle

 Species: Canine   |   Classification: Diseases

Introduction Pathogenesis Diagnosis Treatment Outcomes Further Reading

Introduction

  • 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.

Presenting Signs

  • Subclinical.
  • Vomiting (intermittent).
  • Anorexia.
  • Weight loss.

Acute Presentation

Pathogenesis

Etiology

Predisposing Factors

General

Pathophysiology

Timecourse

  • Months to years.

Diagnosis

Presenting Problems

Client History

  • Intermittent vomiting.
  • Weight loss.
  • Anorexia.

Clinical Signs

  • Anterior (cranial) abdominal pain (in acute recurrent pancreatitis, absent in sub-clinical).
  • Jaundice (if inflammation causes swelling and obstruction of bile duct).

Diagnostic Investigation


Biochemistry
2-D Ultrasonography
  • Pancreas may appear small and irregular or, in case of acute-on-chronic pancreatitis, swollen with mottled echogenicity Abdomen pancreatitis - ultrasound Ultrasonography: pancreas. Distinguish from pancreatic cancer Pancreas: neoplasia.
  • Biliary obstruction.

Histopathology Findings

  • 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).

Differential Diagnosis

  • Other causes of vomiting Vomiting.
  • Other causes of EPI.
  • Pancreatic neoplasia Pancreas: neoplasia.
  • Other causes of:
    • Abdominal pain.
    • Chronic diarrhea.
    • Reduced weight.
    • Polyuria/polydipsia.
    • Jaundice if present.

Treatment

Standard Treatment

  • Manage acute episodes as for acute pancreatitis Pancreatitis: acute.
  • Dietary manipulation with low fat, high carbohydrate feeding.

Subsequent Management

Treatment

  • 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.

Outcomes

Prognosis

  • 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.

Further Reading

Publications

Refereed papers

  • 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.

Other Sources of Information