Canine pancreatitis
Encyclopedia
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
of the pancreas
Pancreas
The pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as a digestive organ, secreting pancreatic juice containing digestive enzymes that assist...
that can occur in two very different forms. Acute pancreatitis
Acute pancreatitis
Acute pancreatitis or acute pancreatic necrosis is a sudden inflammation of the pancreas. It can have severe complications and high mortality despite treatment...
is sudden while chronic pancreatitis
Chronic pancreatitis
Chronic pancreatitis is a long-standing inflammation of the pancreas that alters its normal structure and functions. It can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption....
is characterized by recurring or persistent form of pancreatic inflammation. Cases of both can be considered mild or severe.
Background
The pancreas is composed of two sections: the smaller endocrineIslets of Langerhans
The islets of Langerhans are the regions of the pancreas that contain its endocrine cells. Discovered in 1869 by German pathological anatomist Paul Langerhans at the age of 22, the islets of Langerhans constitute approximately 1 to 2% of the mass of the pancreas...
portion, which is responsible for producing hormone
Hormone
A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...
s such as insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
, somatostatin
Somatostatin
Somatostatin is a peptide hormone that regulates the endocrine system and affects neurotransmission and cell proliferation via interaction with G-protein-coupled somatostatin receptors and inhibition of the release of numerous secondary hormones.Somatostatin...
, and glucagon
Glucagon
Glucagon, a hormone secreted by the pancreas, raises blood glucose levels. Its effect is opposite that of insulin, which lowers blood glucose levels. The pancreas releases glucagon when blood sugar levels fall too low. Glucagon causes the liver to convert stored glycogen into glucose, which is...
, and the larger, exocrine
Pancreas
The pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as a digestive organ, secreting pancreatic juice containing digestive enzymes that assist...
portion, which produces enzyme
Enzyme
Enzymes are proteins that catalyze chemical reactions. In enzymatic reactions, the molecules at the beginning of the process, called substrates, are converted into different molecules, called products. Almost all chemical reactions in a biological cell need enzymes in order to occur at rates...
s needed for the digestion
Digestion
Digestion is the mechanical and chemical breakdown of food into smaller components that are more easily absorbed into a blood stream, for instance. Digestion is a form of catabolism: a breakdown of large food molecules to smaller ones....
of food. Acinar cells
Acinus
An acinus refers to any cluster of cells that resembles a many-lobed "berry," such as a raspberry...
make up 82% of the total pancreas; these cells are responsible for the production of the digestive enzymes.
Pathophysiology
Pancreatitis is caused by autodigestion of the pancreas thought to begin with a decrease in secretion of pancreatic enzymes in response to a stimulus, which can be anything from table scraps to getting into the garbage to drugs,toxins and trauma. The digestive enzymeDigestive enzyme
'Digestive enzymes' are enzymes that break down polymeric macromolecules into their smaller building blocks, in order to facilitate their absorption by the body. Digestive enzymes are found in the digestive tract of animals where they aid in the digestion of food as well as inside the cells,...
s are released too quickly and begin acting on the pancreas instead of the food they normally digest. Once the process cascades, then inflammatory mediators and free radicals are released and pancreatitis develops, causing amplification of the process.
Clinical Signs
The clinical signs can vary from mild gastrointestinal upset to death, with most dogs presenting with common gastrointestinal signs of upset, such as vomitingVomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
, anorexia, painful abdomen, hunched posture, diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
, fever, dehydration, and lack of energy, with vomiting being the most common symptom. These signs are not specific just for pancreatitis and may be associated with other gastrointestinal diseases and conditions.
Acute pancreatitis can trigger a buildup of fluid, particularly in abdominal and thoractic (chest) areas, acute renal failure
Renal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...
, and cause inflammation in arteries and veins. The inflammation triggers the body's clotting factors
Coagulation
Coagulation is a complex process by which blood forms clots. It is an important part of hemostasis, the cessation of blood loss from a damaged vessel, wherein a damaged blood vessel wall is covered by a platelet and fibrin-containing clot to stop bleeding and begin repair of the damaged vessel...
, possibly depleting them to the point of spontaneous bleeding
Bleeding
Bleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system...
. It is this form which can be fatal in animals and in humans.
Chronic pancreatitis can be present even though there are no clinical signs of the disase.
Pancreatitis can result in exocrine pancreatic insufficiency
Exocrine pancreatic insufficiency
Exocrine pancreatic insufficiency is the inability to properly digest food due to a lack of digestive enzymes made by the pancreas. This disease is found frequently in dogs. EPI is also found in humans afflicted with cystic fibrosis and Shwachman-Diamond Syndrome. EPI is caused by a progressive...
, if the organ's acinar cells are permanently damaged; the pancreatic enzymes then need replacement with pancrelipase
Pancrelipase
Pancrelipase is a form of enzyme therapy for the treatment of various digestive disorders, primarily exocrine pancreatic insufficiency. It is a mixture of three digestive enzymes, amylase, trypsin, and lipase, which are normally produced by the pancreas...
or similar products. The damage can also extend into the endocrine portion of the pancreas, resulting in diabetes mellitus. Whether the diabetes is transient (temporary) or permanent depends on the severity of the damage to the endocrine pancreas beta cell
Beta cell
Beta cells are a type of cell in the pancreas located in the so-called islets of Langerhans. They make up 65-80% of the cells in the islets.-Function:...
s.
Risk factors
Although there can be various causes of dog pancreatitis, such as drugs, fatty diet, trauma, etc., the pathophysiology is very complex. Pancreatitis can be idiopathicIdiopathic
Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease...
; no real causation factor can be found. Obese animals as well as animals fed a diet high in fat may be more prone to developing acute and chronic pancreatitis. Certain breeds of dogs are considered predisposed to developing pancreatitis including miniature schnauzer
Miniature Schnauzer
The Miniature Schnauzer is a breed of small dog of the Schnauzer type that originated in Germany in the mid-to-late 19th century. Miniature Schnauzers developed from crosses between the Standard Schnauzer and one or more smaller breeds such as the Poodle and Affenpinscher.The breed remains one of...
s, Cocker Spaniels, and some terrier
Terrier
A terrier is a dog of any one of many breeds or landraces of terrier type, which are typically small, wiry, very active and fearless dogs. Terrier breeds vary greatly in size from just a couple of pounds to over 70 pounds and are usually categorized by size or function...
breeds. Miniature Schnauzers as a breed tend toward developing hyperlipidemia
Hyperlipidemia
Hyperlipidemia, hyperlipoproteinemia, or hyperlipidaemia is the condition of abnormally elevated levels of any or all lipids and/or lipoproteins in the blood...
, an excess of circulating fats in the blood. The breed which appears to be at risk for the acute form of pancreatitis is the Yorkshire Terrier
Yorkshire Terrier
The Yorkshire Terrier is a small dog breed of terrier type, developed in the 19th century in the county of Yorkshire, England to catch rats in clothing mills. The defining features of the breed are its size, to , and its silky blue and tan coat...
, while Labrador Retriever
Labrador Retriever
The Labrador Retriever is one of several kinds of retriever, a type of gun dog. A breed characteristic is webbed paws for swimming, useful for the breed's original purpose of retrieving fishing nets. The Labrador is the most popular breed of dog by registered ownership in Canada, the United...
s and miniature Poodles
Poodle
The Poodle is a breed of dog. The poodle breed is found officially in toy, miniature, and standard sizes, with many coat colors. Originally bred as a type of water dog, the poodle is highly intelligent and skillful in many dog sports, including agility, obedience, tracking, and even herding...
seem to have a decreased risk for the acute form of the disease. It is suggested that genetics may play a part in the risk factor. Dogs suffering from diabetes mellitus
Diabetes in dogs
Diabetes mellitus is a disease in which the beta cells of the endocrine pancreas either stop producing insulin or can no longer produce it in enough quantity for the body's needs. The condition is commonly divided into two types, depending on the origin of the condition: Type 1 diabetes, sometimes...
, Cushing's disease (hyperadrenocorticism), hypothyroidism and epilepsy are at increased risk for pancreatitis. Diabetes and hypothyroidism are also associated with hyperlipidemia. Those with other types of gastrointestinal conditions and dogs who have had previous pancreatitis attacks are also at increased risk for the disorder.
Treatment
There are no approved treatments for canine pancreatitis. Treatment for this disease is supportive, and may require hospitialization to attend to the dog's nutritional and fluid needs, pain management, and addressing any other disease processes (infection, diabetes, etc.) while letting the pancreas heal on its own. Treatment often involves "resting" the pancreas for a short period of time by nil per osNil per os
Nil per os is a medical instruction meaning to withhold oral food and fluids from a patient for various reasons. It is a Latin phrase which translates as "nothing through the mouth". In the United Kingdom it is translated as nil by mouth .Typical reasons for NPO instructions are the prevention...
/nothing per os (NPO)/nil by mouth (NBM), in which the patient receives no food or fluids by mouth, but is fed and hydrated by intravenous fluids and a feeding tube. Dehydration is also managed by the use of fluid therapy.
Canine pancreatitis is complex, often limiting the ability to approach the disease.