The pancreas is an organ located near the stomach and alongside the small intestine. It is responsible for producing digestive enzymes and hormones (such as insulin) that regulate blood glucose. In cats, pancreatitis is a serious condition in which the pancreas becomes inflamed leading to poor appetite, listlessness, dehydration and vomiting. It is also commonly diagnosed together with other diseases and can have life-threatening and severe long-term effects. In this article we will discuss the causes, symptoms, diagnosis, treatment and prevention of pancreatitis.

Pancreatitis has been found to be very prevalent in cats world-wide and is often not diagnosed. This may be because the symptoms are vague and there is no single test to accurately identify it.

Pancreatitis is classified as either acute or chronic, based on the changes present in the tissues of the pancreas when examined microscopically. In dogs this is important, but in cats the distinction between these two processes is very unclear and not helpful in the treatment of these patients.

What causes pancreatitis in cats?

The development of pancreatitis is considered idiopathic, which means that we do not know exactly what causes it. It is often found in association with other inflammatory diseases, most notably cholangiohepatitis (inflammation of the liver and biliary system) and IBD (inflammatory bowel disease). This disease complex is referred to as feline inflammatory disease or ‘triaditis’. Distinguishing these separate diseases is often not possible or useful, and patients suspected of having any one of these are often managed as having all three. Other diseases that are commonly associated with pancreatitis in cats are diabetes mellitus and hepatic lipidosis (fatty liver syndrome).

How does pancreatitis develop?

During acute pancreatitis the pancreas becomes inflamed when digestive enzymes are activated inside the pancreas instead of in the intestine, there is an accumulation of cellular waste products, and a decrease in blood flow. If this inflammation is very severe it can lead to multiple organ failure and death.

Chronic pancreatitis occurs as a long-standing inflammation of the pancreas that may not be detected. It can also develop after a bout of acute pancreatitis is resolved. This ongoing inflammation damages the cells leading to fibrosis and an inability of the pancreas to perform its function.

As previously mentioned, both acute and chronic pancreatitis can have complications and associated diseases that are potentially life-threatening, making distinguishing between them irrelevant in cats.

What are the symptoms of pancreatitis?

The symptoms of pancreatitis in cats are vague and include poor appetite, listlessness, dehydration and vomiting. Unlike dogs, cats do not often show signs of abdominal pain. Pancreatitis should be considered a possible cause of illness in any cat exhibiting these symptoms.

Other symptoms may be due to associated diseases rather than directly as a result of pancreatitis. Patients with IBD may have diarrhoea and weight loss. Diabetic patients will show weight loss or weight gain and typically drink large amounts of water. Patients with cholangiohepatitis and/or hepatic lipidosis may be icteric, i.e., having yellow mucus membranes (for example, of the gums and eyes).

How is pancreatitis in cats diagnosed?

Unfortunately, no single test can accurately identify pancreatitis in cats. Multiple tests will need to be performed. A full panel of blood and urine tests should be run on all cats presenting with symptoms suggestive of pancreatitis. This is important as it is often found together with other diseases. These tests will also help the vet to gauge the severity of the illness and know which treatments need to be added.

An abdominal ultrasound is a key part of the diagnostic process. Although the changes associated with this disease may not be detected on the ultrasound, it is useful for evaluating comorbidities and other possible causes for the symptoms. Referral for a specialist ultrasound may be needed in cases with subtle changes. A specific blood test called feline pancreatic lipase immunoreactivity (fPLi) is also helpful in diagnosing the disease and monitoring the cat’s response to treatment. The presence of the associated diseases (cholangiohepatitis, IBD and diabetes mellitus) will also strongly point towards a diagnosis of pancreatitis.

How is pancreatitis treated?

Aggressive in-hospital treatment is indicated for cats who are collapsed and dehydrated, as this disease can rapidly progress to full organ failure and death. The cat will need to be put on a drip, and given medications for pain and nausea. Hospital stays for this condition can range from three to 10 days or even longer if the cat is severely ill. Feeding these patients is key to their recovery, but since they will often feel too ill to eat, they will need to have a feeding tube placed. Feeding them early on in treatment is especially vital in overweight cats, as they can develop fatty liver syndrome (hepatic lipidosis), which is a life-threatening complication in itself.

Patients that are not as ill can be treated on an outpatient basis. Medications for pain and nausea will be given as necessary. Pancreatitis is often associated with cholangiohepatitis, which can occur as a result of a bacterial infection in the gallbladder and liver. Therefore, these patients may be treated with antibiotics.

Any of the associated diseases (diabetes mellitus, cholangiohepatitis, IBD and hepatic lipidosis) may also require specific treatments over and above the treatment for pancreatitis.

How is pancreatitis managed?

All patients that have pancreatitis need a permanent diet change. A hypoallergenic diet is recommended and various prescription diets are available that have been specifically formulated for this reason. It is very important that these diets be strictly adhered to, which means no additional treats or toppings to their meals. Unlike dogs, fat-restriction for cats with pancreatitis is not indicated and can lead to deficiencies in essential fatty acids.

If a diet change alone is inadequate in controlling the symptoms, most other patients will respond to an immunosuppressive drug such as cortisone.

Repeat blood tests are necessary to monitor the recovering cat’s response to treatment.

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