Contributors: Phil Nicholls, Kenneth Simpson, Julien Bazelle

 Species: Feline   |   Classification: Diseases

Introduction Pathogenesis Diagnosis Treatment Outcomes Further Reading


  • Signs: often vague (lethargy, anorexia); vomiting, abdominal pain, diarrhea or asymptomatic.
  • Diagnosis: elevated feline pancreatic lipase, ultrasonography, histopathology.
  • Treatment: intravenous fluid support, dietary modification, enteral/parenteral nutrition, pain relief, anti-nauseous medications.
  • Prognosis: variable.
    Print off the owner factsheet on Pancreatitis Pancreatitis to give to your client.

Presenting Signs

  • May be no clinical signs.

Acute Presentation

Geographic Incidence

  • Worldwide distribution.

Age Predisposition

  • Young to middle aged adult (mean age //www.vetlexicon.com5 years).

Breed Predisposition

  • +/- higher incidence in Siamese Siamese.



Predisposing Factors


  • Hyperstimulation of pancreas.
  • Blocked pancreatic ducts.


  • Hyperstimulation of pancreas or blocked pancreatic duct  →  fusion of zymogen granules and lysozymes  →  activation of intrapancreatic trypsin and pancreatic autodigestion.
  • Oxygen-derived free radicals  →  damage to cell membranes  →  increased capillary permeability  →  edema.
  • Increased levels of proteases and phospholipase in pancreas and blood stream  →  necrosis  →  multisystem involvement including pulmonary edema and vasculitis. Trypsin activates coagulation cascade and fibrinolytic system can  →  disseminated intravascular coagulation.
  • Serum antiproteases and alpha-2 macroglobulin bind trypsin and are removed from circulation. Manifestations of pancreatitis are only seen when compensatory mechanisms are overwhelmed.
  • Pancreatitis is often found concurrently with other diseases, such as cholangiohepatitis Liver: cholangitis, and inflammatory bowel disease Inflammatory bowel disease: overview. The concurrent occurrence of these three disorders in cats is termed "triaditis". Chronic pancreatitis can also be associated with exocrine pancreatic insufficiency Exocrine pancreatic insufficiency and diabetes mellitus Diabetes mellitus


  • Acute progression: 24-48 hours, but many cats appear to have chronic relapsing pancreatitis.


Presenting Problems

  • Anorexia Anorexia.
  • Weight loss Weight loss.
  • Vomiting Vomiting in 35-90% of cases.
  • Diarrhea in 11-57%. 
  • Icterus in 31-37%.
  • Abdominal pain in 19-29%. 
  • Fever in 19-25%. 

Client History

  • May be no clinical signs.
  • Anorexia.
  • Lethargy.
  • Vomiting or signs of nausea (35% cases).
  • Dyspnea.
  • Diarrhea.

Clinical Signs

  • Some cases subclinical.
  • Dehydration.
  • Thin/poorly muscled.
  • Cranial abdominal pain in 25% cases (more often associated with experimental disease).
  • Hypothermia (although some cases may be pyrexic).
  • Palpable abdominal mass.
  • Occasionally dyspnea.

Diagnostic Investigation

2-D Ultrasonography  

  • Is supportive of pancreatic abnormalities in acute pancreatitis Ultrasonography: pancreas (but the sensitivity of ultrasonography compared with histology only 24-84%).
  • Small amount of free peritoneal fluid can be visible Abdomen: ascites - DV ultrasound .
  • Hyperechoic mesentery Pancreas: pancreatitis - ultrasound is the most sensitive single ultrasonographic findings.
  • Pancreas is often very difficult to image but may be seen as hypoechoic or heterogenous mass.
  • May detect concomitant liver and GI disease.
  • Sensitivity increased with disease severity.
  • Recently endosonography has been trialed for diagnosis but was not shown to be any better than ultrasonography except perhaps in obese cats where standard ultrasounds are difficult.



  • Thrombocytopenia (8-33%)  Hematology: platelet count may contribute to coagulopathy.
  • Anemia (non-regenerative>regenerative) may be present in 20-55% of cases, or in 13% of cases increased PCV Hematology: packed cell volume due to dehydration.
  • Neutrophilia often not marked, and 5-13% cases show leukopenia.
  • Coagulation abnormalities are very common, prothrombin time Hematology: activated partial thromboplastin time  and thromboplastin time are frequently prolonged.
  • Vitamin K deficiency is common in cats with pancreatitis, inflammatory bowel disease or liver disease.


  • Rarely specific or diagnostic.
  • Help ruling out other conditions.
  • Poor abdominal contrast due to localized peritonitis or fluid accumulation on lateral and dorsoventral abdominal radiographs.
  • Hepatomegaly is a common finding Liver: hepatomegaly - radiograph lateral  .

Computed tomography

  • The normal pancreas is readily identified using CT Computed tomography: abdomen - it is homogenous with smooth margins.
  • The value of CT in identifying pancreatitis is low with a sensitivity of 20%.

Magnetic resonance imaging

  • Magnetic resonance cholangiopancreatography has been recently suggested as a useful diagnostic tool but remains to be evaluated in a clinical setting.

Gross Autopsy Findings

  • Check for other concurrent disease, eg enteropathy, liver disease.
  • Do not confuse nodular pancreatic hyperplasia (common incidental finding) with lesion.
  • Examine promptly and handle pancreatic tissue gently.

Histopathology Findings

  • Variable infiltration of pancreatic tissues with neutrophils/lymphocytes.
  • Mild to severe pancreatic edema, hyperemia, necrosis and hemorrhage.
  • +/- peripancreatic fat necrosis.
  • Variable degree of fibrosis depending on chronicity.
  • The lesions can have a patchy distribution, and multiple biopsies are recommended.
  • Recently developed histological classification scheme (De Cock et al, 2007), but the clinical significance of a low level of lymphocytic infiltration (<10%) remains uncertain.
  • Cholangiohepatitis and IBD are commonly seen in association with pancreatitis.
  • Thromboembolic complications including pulmonary thrombi.

Differential Diagnosis


Initial Symptomatic Treatment

  • Remove inciting cause if possible.
  • Intravenous fluid therapy Fluid therapy: overview to replace losses and for maintenance. Plasma 10-20 mg/kg if reduced protein or non-responsive to electrolyte therapy.
  • Correction of electrolyte abnormalities, eg hypokalemia Hypokalemia.
  • No evidence that starvation improves prognosis in cats as most have been anorectic >1 week prior to diagnosis.
  • No evidence that low fat diet is beneficial in cats with pancreatitis. Current recommendations: diet low in carbohydrate, high in proteins and with moderate amount of fat to avoid the development of malnutrition and hepatic lipidosis Nutrition: disease modulation. In cats with pancreatitis or hepatic lipidosis, oral nutrition is often inadequate and aggressive enteral nutrition via gastrotomy tubes or enterostomy tubes Gastrostomy: percutaneous tube (endoscopic) has been recommended. Parenteral nutrition if enteral nutrition is not tolerated.
  • Anti-emetics should be considered in all cats with suspicion of pancreatitis, given the difficulty to recognize nausea in cats. NK-1 receptor antagonist (maropitant Maropitant citrate.) or 5-HT3 antagonists (ondansetron Ondansetron, dolasetron) more efficient than metoclopramide Metoclopramide.
  • Maropitant is not only a strong anti-emetic drug but may also decrease visceral pain.
  • Re-introduce or feed a diet with low carbohydrate, high protein and moderate fat composition.
  • Control DIC Disseminated intravascular coagulation - plasma/heparin.
  • The use of antibiotics is controversial.
  • Amoxicillin Amoxicillin may be used but no proven beneficial effect.
  • The importance of analgesia is easily overlooked as evidence of abdominal pain is not easy to detect in cats.
  • Treat other conditions such as inflammatory bowel disease or liver disease.
  • Cobalamin injection if documented hypocobalaminemia Blood biochemistry: vitamin B12.

Standard Treatment

  • Butorphanol Butorphanol tartrate 0.1-0.4 mg/kg SC QID for pain relief or oxymorphone   Oxymorphone 0.05-0.1 mg/kg SC q6h.
    Do not use morphine as this may stimulate closure of the sphincter of Oddi, thus preventing pancreatic flow.


  • Hydration: adjust fluid rate for maintenance.
  • Bleeding tendency: may signal disseminated intravascular coagulopathy.
  • Test for and treat vitamin K deficiency.
  • Blood [glucose] Blood biochemistry: glucose for monitoring transient or permanent diabetes mellitus.

Subsequent Management


  • If progress poor (and evidence of anemia or coagulopathy), consider blood Blood transfusion or plasma transfusion to supply serum antiproteases.



  • Prognosis very variable - related to extent of pancreatic necrosis and presence of complications.
  • Very poor prognosis for suppurative pancreatitis.
  • Poor prognosis if associated with concurrent disease (survival rate probably <50%).
  • Other negative prognostic factors: hypocalcemia, hypokalemia, hepatic lipidosis.

Expected Response to Treatment

  • Appetite returns and improvement in general demeanor in 3-4 days.

Reasons for Treatment Failure

  • Severe necrotizing pancreatitis overwhelming compensatory mechanisms.
  • Development of disseminated intravascular coagulation.
  • Development of pancreatic pseudocyst   →   sterile necrosis and pancreatic abscess   →   poor prognosis.
  • Development of renal failure.
  • Long-term complications: diabetes mellitus Diabetes mellitus, exocrine pancreatic insufficiency Exocrine pancreatic insufficiency.

Further Reading


Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Forman M A, Steiner J M,  Armstrong P J, Camus M S, Gaschen L,  Hill S L, Mansfield C S, Steiger K (2021) ACVIM consensus statement on pancreatitis in cats. JVIM 35(2), 703-723 PubMed
  • Marolf A J, Kraft S L, Dunphy T R et al (2013) Magnetic resonance (MR) imaging and MR cholangiopancreatography findings in cats with cholangitis and pancreatitis. J Feline Med Surg 15 (4), 285-294 PubMed.
  • Oppliger S, Hartnack S, Riond B et al (2013) Agreement of the serum Spec fPL" and 1,2 -omega-dilauryl-rac-glycero-3-glutaric acid-(5'-methylresorufin) ester lipase assay for the determination of serum lipase in cats with suspicion of pancreatitis. JVIM 27 (5), 1077-1082 PubMed.
  • Boscan P, Monnet E, Mama K et al (2011) Effect of maropitant, a neurokinin 1 receptor antagonist, on anesthetic requirements during noxious visceral stimulation of the ovary in dogs. Am J Vet Res 72 (12), 1576-1579 PubMed.
  • Giorano T, Steagall P V, Ferreira T H et al (2010) Postoperative analgesic effects of intravenous, intramuscular, subcutaneous or oral transmucosal buprenorphine administered to cats undergoing ovariohysterectomy. Vet Anaesth Analg 37 (4), 357-366 PubMed.
  • Trepanier L (2010) Acute vomiting in cats: rational treatment selection. J Feline Med Surg 12 (3), 225-230 PubMed.
  • Chan D L (2009) The inappetent hospitalized cat: clinical approach to maximising nutritional support. J Feline Med Surg 11 (11), 925-933 PubMed.
  • Schweighauser A, Gaschen F, Steiner J et al (2009) Evaluation of endosonography as a new diagnostic tool for feline pancreatitis. J Fel Med Surg 11 (6), 492-498 PubMed.
  • De Cock H E, Forman M A, Farver T B et al (2007) Prevalence and histopathologic characteristics of pancreatitis in cats. Vet Pathol 44 (1), 39-49 PubMed.
  • Forman M A, Marks S L, De Cock H E et al (2004) Evaluation of serum feline pancreatic lipase immunoreactivity and helical computed tomography versus conventional testing for the diagnosis of feline pancreatitis. JVIM 18 (6), 807-815 PubMed.
  • Steiner J M (2003) Diagnosis of pancreatitis. Vet Clin North Am Small Anim Pract 33 (5), 1181-1195 PubMed.
  • Simpson K W (2002) Feline pancreatitis. J Feline Med Surg (3), 183-184 PubMed.
  • Mansfield C S & Jones B R (2001) Review of feline pancreatitis part 1 - the normal feline pancreas, the pathophysiology, classification, prevalence and aetiologies of pancreatitis. J Feline Med Surg​ (3), 117-124 PubMed.
  • Mansfield C S & Jones B R (2001) Review of feline pancreatitis part 2 - clinical signs, diagnosis and treatment. J Feline Med Surg (3), 125-132 PubMed.
  • Gerhardt A, Steiner J M, Williams D A et al (2001) Comparison of the sensitivity of different diagnostic tests for pancreatitis in cats. JVIM 15 (4), 329-333 PubMed.
  • Simpson K W (2001) The emergence of feline pancreatitis. JVIM 15 (4), 327-328 PubMed.
  • Washabau R J (2001) Feline acute pancreatitis - important species differences. J Feline Med Surg (2), 95-98 PubMed.
  • Swift N C, Marks S L, MacLachlan N J et al (2000) Evaluation of serum feline trypsin-like immunoreactivity for the diagnosis of pancreatitis in cats. JAVMA 217 (1), 37-42 PubMed.
  • Zhao P, Tu J, Martens A et al (1998) Radiologic investigations and pathologic results of experimental chronic pancreatitis in cats. Acad Radiol (12), 850-856 PubMed.
  • Bruner J M, Steiner J M, Williams D A et al (1997) High feline trypsin-like immunoreactivity in a cat with pancreatitis and hepatic lipidosis. JAVMA 210 (12), 1757-1760 PubMed.
  • Steiner J M & Williams D A (1997) Feline pancreatitis. Cont Educ Pract Vet 19, 590-602.
  • Hines B L, Salisbury S K, Jakovljevic S et al (1996) Pancreatic pseudocyst associated with chronic-active necrotising pancreatitis in a cat. JAAHA 32 (2), 147-152 PubMed.
  • Weiss D J, Gagne J M & Armstrong P J (1996) Relationship between inflammatory hepatic disease and inflammatory bowel disease, pancreatitis and nephritis in cats. JAVMA 209 (6), 1114-1116 PubMed.
  • Akol K G, Washabau R J, Saunders H M et al (1993) Acute pancreatitis in cats with hepatic lipidosis. J Vet Intern Med (4), 205-209 PubMed.
  • Hill R C & Van Winkle T J (1992) Acute necrotising pancreatitis and acute suppurative pancreatitis in the cat; a retrospective study of 40 cases (1976-1989). JVIM (1), 25-33 PubMed.

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