The pancreas is a pale pink organ nestled just below the stomach. It has two main functions: the production of hormones (insulin and glucagon which regulate blood sugar) and the production of digestive enzymes, which are secreted through a special duct into the intestine to digest food. There are other hormonal products from the pancreas that assist in the regulation of digestion and movement of our food but the above description should present a basic picture of what the pancreas is there to do.
Pancreatitis (inflammation of the pancreas) is a metabolic disaster.
The digestive enzymes are potentially dangerous things they will indiscriminately destroy material to which they are exposed. The normal pancreas has a number of safeguards in place to keep these hazardous products stored safely and delivered safely to their worksite in the intestine.
When the pancreas gets inflamed, as it does in pancreatitis, the enzymes escape and begin digesting the pancreas itself. The living tissue becomes further inflamed and the tissue damage can involve the adjacent liver and stomach. Toxins released from this orgy of tissue destruction are released into the circulation and can cause a body-wide inflammatory response. If the pancreas is affected so as to disrupt its ability to produce insulin, diabetes can result.
Special disasters include the disruption of surfactants in the lung tissue that normally keep the tiny air-filled alveoli from collapsing after each exhaled breath. Without surfactants, the alveoli close up and respiratory failure results.
Pancreatitis is one of the chief risk factors for the development of what is called disseminated intravascular coagulation, or DIC, which is basically a massive uncoupling of normal blood clotting and clot dissolving mechanisms. This leads to abnormal simultaneous bleeding and clotting of blood throughout the body.
Pancreatic encephalopathy (brain damage) can occur if the fats protecting the central nervous system become digested.
Fortunately, total disasters such as the above are rare but one should be aware that the potential for such disasters exists should the pancreatic inflammation get out of hand.
Most of the time the disease is confined to the area of the liver and pancreas.
Pancreatitis can be acute or chronic (acute cases can reverse completely)
Pancreatitis can be mild or severe (acute cases tend to be more severe).
What causes pancreatitis? 90% of the time we never find out. There are risk factors in dogs that will increase the chances of getting pancreatitis. These risk factors include obesity, chronic kidney disease, cancer, diabetes, and Cushing's disease.
There may be an association with pancreatitis and nutritional factors. Episodes of pancreatitis may be triggered by medications that slow stomach and intestinal motility, reflux of material from the small intestine back up into the stomach, some infectious diseases, and trauma.
It is prudent to avoid drugs that have been associated with pancreatic inflammation in a patients with history of pancreatitis. Such drugs included: azathioprine (an immune suppressive agent), thiazide diuretics, furosemide (Lasix), tetracycline (an antibiotic), valproic acid (a seizure control agent), and procainamide (a heart medicine).
Chances are the cause for a given case will never be revealed.
In the dog (and human) this condition is associated with a lot of nausea and abdominal pain. Lethargy and appetite loss are consistent signs, but none of these signs are specific for pancreatitis. Ingestion of garbage can cause identical signs, as can metabolic diseases like kidney failure.
One of the first steps in evaluating a sick dog is a metabolic database (a blood panel and urinalysis). There are two pancreatic enzymes commonly checked on this panel (amylase and lipase). Elevations in these enzymes are indicators of pancreatic inflammation in dogs, but the degree of elevation is not consistent with the degree of inflammation in the pancreas. It seems a bit counter-intuitive, but a dog with very high pancreas enzymes can have mild pancreatitis, and a dog with low pancreas enzymes in the blood can have very severe pancreatitis. There is a test for canine pancreas-specific lipase (CPL) that is more accurate at diagnosing pancreatitis.
Supportive treatment is necessary in all but the very mild cases of pancreatitis. When anything (food or water) enters the stomach, the pancreas is stimulated to secrete large amounts of enzymes in anticipation of needing to digest a meal. When a pet has pancreatitis, the enzymes are released within the pancreas itself instead of into the intestine. The pancreas tries to digest itself, causing pain and even more inflammation.
Obviously the first thing to do is to prevent anything from entering the stomach, including water and oral medications. We need to withhold food and water for a short period of time in order to allow the pancreas to rest.
This almost always means that a pet needs to be hospitalized and put in IV fluids in order to maintain hydration and give medication. Most of these dogs are vomiting or have diarrhea, and so need fluids to replace what they are losing. Medications are used to stop the vomiting and diarrhea and to control the abdominal pain that comes with pancreatitis.
Plasma transfusions can be helpful in some dogs as the plasma replaces the clotting factors needed to prevent DIC as well as natural blood factors to deactivate pancreatic enzymes.