The Wretched Disease called Pancreatitis
Stephen Sheldon, D.V.M.

I hope everyone got the pun in my title. If you know me by reading my articles, you know I like to make light of many situations. Unfortunately, pancreatitis is not a light subject. It is a truly awful disease. It is a painful disease where true compassion and empathy are elicited. Never have I felt sorrier for my patients than those with pancreatitis.
Pancreatitis is a very serious life-threatening illness. This is hard for many people to understand. They know their dog is vomiting and not feeling well, but dogs are not supposed to die from an "itis." From the Greek, the suffix "itis" means inflammation. Dogs die from things like a "sarcoma" (tumor) and "osis" (cirrhosis or endocardiosis), but not usually an "itis" (bronchitis or tendonitis).
So, what happens in pancreatitis that makes it so deadly and painful? Basically, the enzymes in the pancreas that are supposed to digest food become released into the pancreas itself and the gland begins to auto-digest itself. The intense inflammation occurring inside the pancreas then spreads to the stomach and the small and large intestines. The by products of all this inflammation get into the bloodstream and spread to organs like the liver, kidneys, and lungs. As if this weren't bad enough, these inflammatory by products can initiate a cascade of events leading to disseminated intravascular coagulopathy, or D.I.C. Doctors refer to D.I.C. as "Death Is Coming."
Pancreatitis typically occurs in middle-aged or older dogs. Most of these dogs are overweight and have a history of recently having eaten a fatty meal. Unlike in people, alcohol plays only a small role in pancreatitis in dogs. No one really knows the exact cause of pancreatitis, besides obesity and high fat meals. Some of the other suspicions are abdominal trauma, some drugs used in chemotherapy, and some infections, such as toxoplasmosis.
The most common sign of pancreatitis is intense vomiting, although symptoms are often vague and can be those of lethargy and just not wanting to eat. Bloody diarrhea, shock and death often accompany these signs. There is intense abdominal pain and many owners' first complaint is that their pet doesn't want to walk or resents being picked up.
Pancreatitis requires a full battery of tests to in order to be diagnosed because it can closely resemble other gastrointestinal disease (enteritis, GI foreign body, poisoning, peritonitis) and uterine infection. We start the work-up by running complete cell counts, blood chemistries, blood amylase and lipases, urinalysis, and abdominal radiographs. X-rays are often inconclusive, so an ultrasound may also be recommended. If all else fails and a diagnosis cannot be obtained, an exploratory surgery may be necessary to get a sample or biopsy of the pancreas.
If your dog has been diagnosed with pancreatitis, he or she will most definitely be hospitalized. Now is the time to get aggressive in treatment. What we've got to do is simply rehydrate the patient and shut down any further pancreatic secretions. We do this by withholding food and water for at least 48 to 72 hours (2 to 3 days) and provide support via intravenous fluids. We may need to withhold food for up to a week! It is so important that we do not let patients even smell or see any food as this alone can trigger pancreatic secretions. We also need to use strong medications to control the vomiting and, equally as important, the pain. Like I said earlier, it is tough to watch these dogs and not feel for them; the pain is intense. Antibiotics are also used because a diseased pancreas is a welcome place for bacteria. There are some controversial treatment options, such as transfusions of plasma (provides anti-protease-type products to control destruction), heparin (to discourage clotting problems that can lead to D.I.C.), and cortisone (to control inflammation, used initially to combat shock).
Laboratory data will need to be checked daily. Once the labs start to approach normal and nausea subsides, we can start with small amounts of liquid. If vomiting starts again we are back to square one: withholding food and restarting the IVs. Complications can occur during this period and can include renal or kidney failure, diabetes, cardiac arrhythmias, and sepsis (blood infections).
So, you can see acute pancreatitis is a serious problem. Death rates can approach 5o percent from acute pancreatitis. I have painted a bleak picture, but, fortunately, mild cases of pancreatitis can occur also. So can chronic pancreatitis, which is a low-grade, persistent pancreatic problem. But it always amazes me how ugly acute pancreatitis can be; if you've ever seen a necropsy or autopsy of a dog who died from it, it would break your heart.