Dr. med. vet. Gabriele Rummel
The pancreas is both an endocrine (inward secreting) and exocrine (outward secreting) gland. The endocrine part produces vital hormones such as insulin, glucagon and somatostatin. The exocrine part produces a glandular secretion that breaks down food into digestible components. The secretion consists mainly of inactive precursors of digestive enzymes. These become active only when they enter the intestine. These inactive precursors protect the pancreas from self-digestion.
Pancreatitis develops when this protective mechanism fails. Digestive enzymes are then released prematurely into the pancreatic tie, leading to inflammation and self-digestion, and even destruction of the pancreas and surrounding tie.
We distinguish the acute, the chronic and the chronic-activated form of pancreatitis. The latter occurs because cats with pancreatitis usually do not fully recover, d. h. there is often a wave-like flare-up of the inflammation, so that we speak of a chronic disease, which has changed into an acute attack with correspondingly dramatic symptoms.
Which cats get sick?
Pancreatitis can present in cats, regardless of breed or sex, at any age from four weeks to 18 years of age. Siamese and older cats are affected more often than average according to some studies.
Although knowledge of this disease has increased significantly in recent years, the origin of pancreatitis is not yet fully understood. Diagnosis and also therapy are still a great challenge.
Our cats are – as always – very special in this disease as well. In contrast to humans and dogs, which show clear symptoms in pancreatitis (classic are vomiting, diarrhea and great abdominal pain), cats suffer silently and inconspicuously.
Especially the Leading symptom of pancreatitis – very great pain when prere is applied to the abdomen – we do not notice our cats as a rule. However, even without clear external signs, we ame that pancreatitis is also very painful for cats, especially since the condition of a sick cat improves very quickly with the administration of painkillers. It is well known that cats are true masters in hiding pain.
The range of symptoms is complex and variable. Most cats are noticed only because of nonspecific findings such as decreased appetite (anorexia in the continued stage), listlessness (lethargy), and weight loss. For this very reason, we are unable to distinguish clinically whether the cat is suffering from acute, chronic or chronic-activated pancreatitis.
Despite nonspecific subclinical symptoms, the change to a life-threatening stage associated with cardiovascular shock and/or multiple organ failure can occur at any time. The transition is fluent. In some patients the pancreatitis remains localized, in others there is a systemic spread. Additional accompanying symptoms may be diarrhea, constipation and jaundice. In severe cases, dehydration and hypothermia also occur. In the presence of concomitant diabetes mellitus, polydipsia (increased thirst) and polyuria (increased urine excretion) Leading symptoms.
When the change into the life-threatening state occurs is not predictable. Even if the cat's condition initially improves with therapy, an unexpected relapse can occur very quickly. Therefore, the prognosis of a cat with pancreatitis should always be cautious. As a rule, the animals are presented to the practice only when the disease is already far advanced. Therefore, rapid and thorough therapy is always required, even if the diagnosis has not yet been clearly established.
When to think of pancreatitis?
In all non-specific findings such as vomiting, diarrhea, icterus, abdominal pain, abdominal girth enlargement, polyuria and polydipsia, the differential diagnosis of pancreatitis should always also be clarified. This is necessary even though the symptoms mentioned can always represent a disease in their own right. However, they can also indicate pancreatitis or, in the worst case, even cause it. From a certain stage of the disease, cause. consequence simply cannot be distinguished from each other.
A chronic intestinal inflammation is basically a very high risk factor for the development of pancreatitis. The background for this connection is that cats suffering from chronic diarrhea i. d. R. also suffer from chronic vomiting, increased vomiting in turn leads to increased prere in the intestine. At the point where bile and pancreatic secretions enter the duodenum, increased prere causes bile and pancreatic secretions to back up into the pancreas. This reflux is favored by the anatomical peculiarity of the cat, the one common excretory duct of bile and pancreas into the duodenum has. In addition, the upper small intestine of the cat has a significantly more intensive bacterial colonization compared to the dog, which means that a backflow of germs into the ductal system of bile and pancreas promotes inflammation.
If the pancreatitis develops into a systemic disease, the disease is life-threatening. The cats may die of shock, acute renal failure, septicemia or endotoxemia. Often there is additional fluid in the chest cavity. abdomen (pleural effusion/ascitis). Unfortunately, the diagnosis of pancreatitis is not simple. A large number of examinations are required. This includes extensive laboratory testing (hematology, serum chemistry, urinalysis, and special tests) and imaging procedures.
X-ray examination alone is not very helpful, but it is used to rule out other differential diagnoses. We cannot make a diagnosis of pancreatitis based on abdominal radiographs alone, but it helps us to identify concomitant complications (z. B. ascitis). A CT scan is diagnostically uninteresting.
Changes in the pancreas can be easily detected on ultrasound, but it must be remembered that pancreatitis is sometimes completely inconspicuous on ultrasound. However, together with the symptoms, altered blood counts, and pancreatic marker (fPLI test), the diagnosis of pancreatitis can be made. the fPLI is a sensitive marker. It is additionally suitable to follow the course of pancreatitis. Under therapy, this value should change positively.
It is important to correctly assess the degree of pancreatitis. High-grade acute pancreatitis is always life-threatening and must be treated immediately with very aggressive therapy, often involving a long hospital stay. The therapy of pancreatitis has three main objectives:
Fighting the cause,
early detection and treatment of possible systemic complications.
Basically, it is important to guarantee tie perfusion, limit bacterial spread and inhibit inflammatory mediators and pancreatic enzymes.
Cats need a high protein intake. If cats do not eat food for more than two to three days (anorexia), the liver can become severely diseased (hepatic lipidosis = fatty liver). Thus, strict attention must be paid to feed intake. In anorectic patients, dietary support through enteral nutrition can be life-saving.
Cats often ingest food when they are petted or food is offered by hand. Here is the love. Attention of the TFA very much in demand. With a lot of patience the inappetent cat can be persuaded to take food from the hand, every small beginning is a big progress in the therapy.
The environment is also very crucial for the success of the therapy, it should be absolutely stress-free and cat-friendly. Frequently cats eat at home. If their health permits, they can be discharged home at night, where they will mostly guzzle in familiar home surroundings. During the day, they are brought back to the practice to be medicated.
Intravenous fluid administration
The most important measure is continuous intravenous fluid substitution via an infusion pump.
Since nausea is often the cause of feed refusal, the administration of an antiemetic is generally recommended.
The use of antibiotics is controversial, as feline pancreatitis is usually a sterile process. However, in cats with evidence of gastrointestinal barrier breakdown, prophylactic administration of broad-spectrum antibiotics is indicated to inhibit bacterial spread.
Since the pain behavior of cats is generally difficult to assess, pain management is an important component in the treatment of pancreatitis. Cats often respond to pain with withdrawal and refusal to eat, the only symptoms that are also directional in pancreatitis. Here, too, the good training. Above all empathy of the TFA is required. At regular intervals, the TFA should ensure that the cat is no longer in pain. As an aid, the Glasgow Pain Scale (s. u.), which helps to assess the patient's condition by body posture and facial expression.
The administration of corticosteroids is discussed diversely. They are definitely part of the treatment plan in cats with triaditis. In the meantime, an idiopathic etiology (development from an unknown cause) is also being discussed in cats. In this context, some authors report good successes with the chronic pancreatitis.
If glucocorticoids are used, the success should be checked in any case after two weeks by means of the concentration of fine pancreas-specific lipase (Spec fPL ® test). If the values have not improved, the glucocorticoid must be discontinued. Basically, the prognosis in pancreatitis is cautious. Very dependent on the accompanying systemic complications. Cats with high-grade pancreatitis and frequent acute episodes or complex comorbidities have a poor prognosis. For cats with a mild course, even if they get sick more often, the prognosis is favorable.
In any case, regular future checks (laboratory/ultrasound) are advisable to detect a flare-up in time and to contain the risk of systemic derailment.
A PDF of the Glasgow Pain Scale can be found here.
Three different clinical pictures often occur together; experts then speak of triaditis:
Cholangiohepatitis (inflammation of the bile ducts and liver tie)
IBD (Inflammatory Bowel Disease; chronic intestinal inflammation)
Ultrasound and pancreatic markers
If pancreatitis is suspected, an ultrasound examination in combination with the determination of pancreatic markers (fPLI = feline pancreatic lipase ) is most suitable for clarification. These two examinations are indispensable and directional.
About the author
Dr. met. vet. Gabriele Rummel, veterinarian in private practice in Nidderau, Germany. She is particularly interested in diseases of the cat. She is a founding and board member of the Working Group on Feline Medicine of the DGK-DVG and the German Group on Feline Medicine as well as a member of the International Society of Feline Medicine (ISFM). Your practice is certified as "cat friendly practice" by the ISFM.