Does your dog vomit occasionally for no apparent reason? Reject your favorite meal unexpectedly? Do you have gas, diarrhea or stomach pain after eating? If so, it could be due to an often overlooked diagnosis: chronic pancreatitis.
Most dog lovers have heard of pancreatitis. The typical story is about a dog that is overfed with a large meal of “human food”, throws it in the trash after a festive meal or somehow eats too much fatty food. The resulting deluge of vomiting, diarrhea (often bloody) and severe abdominal pain is indelibly worrying. If you’ve ever seen a dog with acute pancreatitis you won’t forget it. Acute pancreatitis is so traumatizing to both the dog and the dog’s parents that any sudden, severe case of vomiting and diarrhea counts as “pancreatitis” until proven otherwise.
We are only just beginning to realize that in dogs, just like humans, a more subtle, chronic form of pancreatitis exists and may be more common than we know. What is Chronic Pancreatitis? What causes it And can we treat it or prevent it?
Let’s start with the pancreas
The pancreas is a slender, pink-colored organ that is attached to the bottom of the stomach and the beginning of the small intestine. This location is critical to its primary function: secreting enzymes that aid in the digestion of food, also known as its “exocrine function”. Its “endocrine function” is responsible for regulating blood sugar through the production of insulin and glucagon and other essential hormones.
The digestive enzymes are responsible for pancreatitis. Pancreatitis occurs when these enzymes start to digest the pancreas, just as they break down fats, carbohydrates, and proteins. The classic case of acute pancreatitis follows a high-fat meal that triggers an increase in pancreatic enzyme secretion, resulting in damage to the pancreas and liver. These enzymes overflow into the entire pancreas, flush back into the pancreatic duct or erode the stomach and intestinal walls and dissolve sensitive tissue.
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Who will get it
Miniature Schnauzers are predisposed to pancreatitis due to their genetic alteration in lipid metabolism (hyperlipidemia), which causes the pancreas to secrete excessive fat digestive enzymes, leading to injury. Other causes of pancreatitis include obesity and abnormal lipid metabolism, pancreatic trauma or tumors, and certain medications, including sulfa-containing antibiotics, chemotherapy, and potassium bromide. Diabetes, hypothyroidism, and hypercalcemia are also documented causes of pancreatitis in dogs. Genetic research in the UK is looking at whether certain lines of English Cocker Spaniels could have an inherited form of chronic autoimmune pancreatitis.
What it looks like
Dogs with chronic pancreatitis most commonly have mild, intermittent symptoms that make diagnosis difficult. Anorexia or unexplained food refusal, mild attacks of colitis and diarrhea, occasional vomiting, increased borborygmi (“stomach gargling”), and abdominal discomfort, especially after a meal, can be the only signs for months to years. In other words, most dogs show some clinical signs of chronic pancreatitis at times. How can you find out?
Most dogs are not diagnosed until a mild chronic case becomes seriously severe and acute. Others find out after developing diabetes mellitus or pancreatic exocrine insufficiency (EPI). In both cases, these final episodes are the result of a long, subclinical progression that has caused significant pancreatic damage.
Let your veterinarian know if your dog has had these symptoms in the past as they may be at a higher risk of developing diabetes, EPIs, or both. When I diagnose a middle to elderly dog with EPIs or a healthy dog with diabetes, I look for chronic pancreatitis as the culprit. I also came across a diagnosis after putting a patient on a therapeutic low fat diet and the owner reports that the dog is more playful, less picky and energetic. The bottom line: don’t ignore those persistent, vague cycles of upset stomach and pain. In this case, trust your gut instinct.
The classic case of acute pancreatitis follows a high fat meal which causes an increase in pancreatic enzyme secretion, cause damage to the pancreas and liver.
The challenge of diagnosis
Unfortunately, there is no specific test for chronic pancreatitis. The diagnosis is usually made using a combination of symptoms, pancreatic laboratory tests (especially SPEC cPL or specific canine pancreatic lipase), liver enzymes, blood lipids, and abdominal ultrasound. The final diagnosis is based on a pancreatic biopsy, although it is rarely done in dogs.
Since chronic pancreatitis is a diagnosis of exclusion where everything else is excluded, this can be a frustrating journey. More and more veterinarians are realizing that chronic pancreatitis is a real problem in many dogs and diagnosing it earlier. The therapeutic goal is to prevent further damage to the pancreas, maintain function and avoid debilitating diseases such as diabetes and EPIs.
The 7 symptoms of chronic pancreatitis
In contrast to acute (sudden) pancreatitis, dogs with chronic pancreatitis show symptoms for months to years. Look out for these symptoms, which appear continually over time:
- anorexia
- Inexplicable refusal to eat
- Mild attacks of colitis (inflammation of the colon or colon causing loose stools or diarrhea with mucus or fresh blood)
- Mild diarrhea (watery or loose stools)
- Occasional vomiting
- Increased belly gargle (borborygmi)
- Abdominal discomfort or pain after a meal
Low fat diet is key
In cases that progress to acute pancreatitis, the veterinarian must be aggressive in treatment to reduce pancreatic tissue destruction and future complications. Treatment for chronic pancreatitis typically involves finding a low-fat to extremely low-fat diet that the dog can tolerate.
Eat a diet that contains less than 7% fat based on dry matter. For example, if a canned feed says raw fat is 4% on the label, the actual fat content is around 16% on a dry matter basis, far too high (76% moisture, 24% dry matter, 4/24 = 16%). For dry feed with a proportion of 14% raw fat, this also corresponds to around 16% real fat (10% moisture, 90% dry matter, 14/90 – 15.6%). Examples of low-fat to extremely low-fat dog foods are Royal Canin Gastrointestinal Low Fat, Hill’s Prescription Diet i / d low fat and Purina Pro Plan Veterinary Diets DE Gastroenteric Low Fat Canine Formula – available as wet or dry food from your veterinarian.
(Editor’s tip: After our chronic pancreatitis dog Justice came home from a week in the hospital, he refused to eat. The vet told us to make small meatballs out of Royal Canin Gastrointestinal Low Fat Wet Food. Hospital gave us and bake them in the oven for a few minutes so they are a little crispy on the outside. I tried it and he ate it!)
Dogs suffering from chronic pancreatitis must also be fed low-fat and low-calorie treats. I have seen too many dogs develop acute pancreatitis after a well-intentioned friend, dog sitter, or family member “showed a little too much love”.
Baby carrots, sliced cucumbers and zucchini, and other crunchy vegetables are my favorite treats for my chronic pancreatitis patients. In addition, being overweight increases a dog’s risk, so keeping your dog lean and healthy is always good preventative medicine.
Chronic pancreatitis in dogs is serious and probably more common than previously thought. No dog should endure abdominal torment for a lifetime. The sooner you can help, the better your dog’s chances of a long, healthy, pain-free life.
Low Fat Products: Hill’s Prescription Diet i / d Low Fat, Purina Pro Plan Veterinary Diets DE Gastroenteric Low Fat Canine Formula, Royal Canin Gastrointestinal Low Fat.
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