Pancreatitis in dogs as a cause of gastrointestinal problems

Aetiology of pancreatitis in dogs

• Pharmacological causes: azathioprine, oestrogens, tetracyclines or alcohol present in human medicines.
• Vasculitis: an immune-mediated aetiology.
• Nutritional causes: high-fat diets reduce the resistance of acinar cells to trypsin and increase the release of pancreatic enzymes, which promotes pancreatic cell destruction.
• Metabolic causes: such as hyperlipidaemia due to reduced pancreatic microcirculation and subsequently ischaemia.
• Shock/trauma: due to pancreatic ischaemia and necrosis which release zymogens and trypsin, causing further damage.

All these causes bring about a decline in the mechanisms that the pancreas uses to protect itself from self-digestion.

Clinical signs

Acute pancreatitis results in depression, vomiting, diarrhoea, fever, abdominal pain, anorexia and dehydration. In severe cases dyspnoea, pleural effusion, arrhythmias, DIC, sepsis and shock may also occur.

Treatment

The treatment of pancreatitis in dogs is symptomatic. It consists of fasting, fluid therapy and early treatment of any complications that arise.

• Nutrition: Nutritional management forms an important part of the patient’s treatment.  Based on scientific evidence from veterinary medicine, treatment should begin directly with enteral nutrition.  Compared to parenteral nutrition, enteral nutrition is known to provide benefits in terms of the patient’s evolution.  Parenteral nutrition alone or combined with enteral feeding is indicated as a temporary measure in malnourished patients who cannot tolerate exclusively enteral nutrition.  Immunonutrition is currently receiving a lot of research attention because of its positive contribution to the regulation of pancreatitis. 
• Fluid therapy: Maintenance needs must be met and any dehydration and electrolyte imbalances corrected. Patients can be given low-molecular-weight colloids and dextrans.
• Plasma: contains trypsin inhibitors.
• Insulin: in the event of diabetes mellitus due to endocrine insufficiency.
• Corticosteroids: provide well-documented anti-inflammatory effects and may help stabilise membranes; however, their use remains controversial.
• Analgesics: meperidine is the agent of choice.
• Broad-spectrum antibiotic therapy: such as first-generation cephalosporins to prevent sepsis.
• Peritoneal lavage: The aim is to remove harmful substances released into the abdomen, which are responsible for many organic complications. 30 mL/kg of saline at 37 °C are injected, then withdrawn 0.5 to 2 hours later.
• Surgery: in case of intestinal perforation, pancreatic abscesses or bile duct obstruction.

Prognosis

Pancreatitis in dogs may lead to several serious complications, so the prognosis of acute pancreatitis is guarded. Regarding chronic pancreatitis, it tends to be self-limiting, but complete recovery is very difficult given the persistence of mechanisms that damage pancreatic tissue.

Temporary fasting is recommended for most gastrointestinal disorders associated with pancreatitis. Fasting is intended to reduce the amount of unabsorbed food, which worsens the clinical picture by causing osmotic diarrhoea and diminishing the intestinal flora.

Fasting is usually applied for 24–36 hours. Food should then be reintroduce gradually using small, frequent portions.