Pancreatitis in Cats

What is pancreatitis?

Pancreatitis is a disease caused by inflammation of the pancreas. The pancreas is a small, vital organ on the right side of the abdomen, between the stomach and the small intestine. It produces enzymes that help with food digestion, and hormones that regulate blood sugar, such as insulin. The digestive enzymes are secreted into the small intestine, and the hormones enter the bloodstream.

Pancreatitis occurs occasionally in cats, and it may be acute (sudden) or chronic (recurring). Acute pancreatitis can range from mild inflammation, causing swelling and edema, to severe hemorrhagic or necrotizing pancreatitis, leading to bleeding and tissue death.

The inflammation associated with pancreatitis allows digestive enzymes from the pancreas to spill into the abdominal cavity, often resulting in inflammation of the liver and intestine. This multi-organ inflammatory process is sometimes referred to as "triaditis." Some cats that recover from an acute episode of pancreatitis may continue to have recurrent bouts of pancreatitis, which is then called chronic or relapsing pancreatitis.

What causes pancreatitis?

Normally, pancreatic enzymes are inactive when they are produced. They travel through the pancreatic duct to the duodenum, which is part of the small intestine, and once there, they are activated and begin digestion. With pancreatitis, these enzymes are activated prematurely in the pancreas instead of later in the small intestine.

Think of this as a time-release capsule that suddenly bursts before it reaches its intended target. In this case, the pancreatic enzymes begin to digest before they should, which results in the digestion of the pancreas itself. The clinical signs of pancreatitis are often variable, and the intensity of the disease will depend on the extent of organ involvement.

In cats, there is no age, sex, or breed predisposition for pancreatitis, and pancreatitis typically occurs spontaneously, without any identified trigger or inciting cause. Pancreatitis may also occur secondary to or concurrently with underlying causes, such as inflammatory bowel disease, cholangiohepatitis, or diabetes mellitus. Cats may be at additional risk if they have fatty liver (hepatic lipidosis), kidney disease, heart disease, abdominal trauma, or certain infectious diseases such as feline infectious peritonitis.

What are the clinical signs of pancreatitis?

Common clinical signs include:

• Decreased appetite
• Nausea, vomiting
• Lethargy
• Diarrhea
• Weight loss
• Abdominal pain

If the attack is severe, acute shock or death may occur. In many cats however, clinical signs may be vague, making diagnosis challenging.

How is pancreatitis diagnosed?

Pancreatitis is usually diagnosed with laboratory testing. Tests may reveal elevations in white blood cells or pancreatic enzymes. The specific feline pancreatic lipase immunoreactivity (SPECFPLI) test can be run in the clinic quickly, providing a positive or negative result. Ultrasound studies can show inflammation in the pancreas and surrounding area.

Unfortunately, many cats with pancreatitis will escape detection with any of these tests. For that reason, the diagnosis of pancreatitis may be tentative or presumptive in many cases and based solely on clinical signs and medical history.

How is pancreatitis treated?

Successful pancreatitis management depends on early diagnosis and prompt medical therapy. With acute pancreatitis, treatment is supportive. It involves treating pain and nausea and feeding small amounts of a low-fat, easy-to-digest diet.

In severe cases, additional analgesics will be given to control the intense pain, along with supportive care. Intravenous fluids may also be required to restore and maintain a normal fluid and electrolyte balance. Additional diagnostics and treatments may be needed depending on your cat’s condition.

Most cats with severe pancreatitis are hospitalized for two to four days while intravenous fluids and medications are administered, and food is gradually re-introduced. Antibiotics will be administered if a concurrent infection is suspected.  If your cat is not eating for a prolonged period, your veterinarian may recommend placement of a feeding tube.

With severe necrotizing pancreatitis, or in cases where the cat shows signs of systemic shock, intensive care will be necessary, with aggressive doses of intravenous fluids and medications to counteract shock. If your veterinarian suspects that the underlying cause may be related to inflammatory bowel disease, your cat may need to remain on a diet suitable for dietary sensitivities. Additionally, further treatment may be warranted if your cat is found to have diabetes mellitus.

What is the prognosis for a cat diagnosed with pancreatitis?

The prognosis depends on the severity of the disease and the response to initial therapy. Cats that show shock and depression have a very guarded (uncertain) prognosis. Most mild forms of acute pancreatitis have a good prognosis with early intervention and treatment.

Will there be any long-term problems?

Most cats recover without any long-term consequences. However, with severe or repeated episodes of pancreatitis, one or more of the following problems may develop:

• Improper digestion of food. If a significant number of cells that produce digestive enzymes are destroyed, it may result in a lack of proper food digestion. This condition is known as exocrine pancreatic insufficiency (EPI) and can be treated with daily administration of an enzyme replacement powder. This complication is rare in cats.
• Diabetes mellitus. If a significant number of cells that produce insulin are destroyed, diabetes mellitus can result. This can usually be treated with daily injections of insulin or newer oral treatments.

Management of these conditions is a significant factor in treatment success.