Breaking down acute canine pancreatitis

An animal’s pancreas is designed to protect itself with built-in safeguards. When the pancreas is damaged, the body tries to minimize damage by localizing inflammation, according to Christopher G. Byers, DVM, DACVECC, DACVIM(SAIM), CVJ. However, sometimes those local safeguards become overwhelmed, leading to more aggressive pancreatitis and systemic inflammation that can lead to secondary opportunistic bacterial infections, multiple organ dysfunction, and potentially death.

Byers addressed this serious condition in canines during his lecture at the 2022 Fetch dvm360® Conference in San Diego, California. He offered insight on signs, risk factors, and diagnostic measures to maximize the potential for successful treatment.¹

Risk factors

One risk factor for pancreatitis is breed. Byers noted, “Schnauzers are the poster children for this [disease] because of their genetic predisposition.” Specifically, these dogs tend to have hypertriglyceridemia, and “when you have lots of lipids in your blood, your blood becomes like sludge, and the pancreatic microcirculation doesn't like sludging…setting up the predisposition for inflammation.”

Comorbid conditions, such as diabetes, may contribute to pancreatic inflammation as well. “The way I explained this to owners is, well if one part of the pancreas is messed up, eventually the other part is going to become messed up.” Some other conditions that are risk factors for pancreatitis include chronic kidney disease, various neoplasia, congestive heart failure, autoimmune disorders, and chronic enteropathies. Certain drugs, particularly those used for autoimmune diseases, may also increase a patient’s risk.

Signs

According to Byers, there is unfortunately nothing pathognomonic that may be noted during a physical examination. Clinical signs, including dehydration, anorexia, nausea, vomiting, fever, lethargy, abdominal pain, and diarrhea may mimic those of many other conditions.² “Now if [dogs] do have diarrhea, it could be large bowel, it could be small bowel. Why? Because that boomerang, which is what I call the pancreas, it lies next to the small intestine [and] it lies next to the large intestine. So, depending on what area is ‘angry’ and how that adjacent segment of intestines respond, you could have a wholly different type of diarrhea depending on which section is involved.”

Another sign to ask clients of is if their dog has done the “praying position,” with their rear end up in the air while their front legs and head are lowered to the floor, as this indicates a pancreatic attack.²

Diagnostics

As pancreatitis may be difficult to detect during a physical exam, Byers advised to use other diagnostic measures, including abdominal ultrasonography and pancreatic serology. With pancreatic serology, there are many options, including the SNAP cPL, Spec cPL, VetScan cPL, and Precision PSL. Though the different tests’ sensitivities tend to be equivalent, the specificities aren't ideal. Byers said, “Here's the way to interpret these tests. If it is normal, the dog doesn’t have pancreatitis, move on, look for something else. Is there a possibility of a false normal? Yes, but it's not very high.” In contrast, if there is a positive result, there’s a good chance the patient has pancreatitis, and you can pursue therapies for this condition. However, Byers added ideally after an in-house positive test, the results should be confirmed by a reference laboratory.

References

1. Byers CG. Practicalmanagementofacutepancreatitisindogs. Presented at: Fetch dvm360® Conference; San Diego, California. December 2-4, 2022.
2. Ward E, Panning A. Pancreatitis in dogs. VCA Animal Hospitals. Accessed December 21, 2022. https://vcahospitals.com/know-your-pet/pancreatitis-in-dogs