TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

PANCREATITIS

 

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What is Pancreatitis?


Feline Triaditis


Causes


Frequency


Symptoms


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Home > Related Diseases > Pancreatitis

 


Overview


  • Pancreatitis is inflammation of the pancreas, a gland which assists with the digestive process and controls the hormones which regulate blood sugar.

  • CKD cats sometimes also have pancreatitis. To confuse matters, pancreatitis may sometimes cause elevated creatinine levels.

  • If your cat has relatively low creatinine (in the 2s USA, or below 200 international) yet seems lethargic and far more ill than that mild level of kidney failure would suggest, ask your vet to rule out pancreatitis.


What is Pancreatitis?                                                                                           Back to Page Index


 

The pancreas is a gland located under the stomach with two main roles:

  • endocrine (hormonal), i.e. it controls the hormones (insulin and glucagon) which regulate blood sugar levels.

  • exocrine, i.e. it assists with the digestive process by producing digestive enzymes

Usually it is the exocrine function which is affected. The pancreas becomes inflamed, and the enzymes which it would normally release into the intestines are instead released into the pancreas itself, causing pain and inflammation. The liver may also be affected (see below). If the part of the pancreas responsible for endocrine function also becomes damaged, diabetes may develop. During pancreatitis, toxins move throughout the body, and in the worst cases, respiratory failure or brain damage may result, though fortunately such severe effects are uncommon.

 

Pancreatitis can be either acute or chronic. Acute cases often resolve completely, whereas cats with chronic pancreatitis may have flare-ups at intervals.

 

Mar Vista Vet has a very helpful overview of feline pancreatitis.

Idexx Laboratories have a good overview of pancreatitis.

 


Feline Triaditis                                                                                                       Back to Page Index


 

There is also a condition called feline triaditis. A cat with triaditis suffers from the triple whammy of inflammation of the pancreas, the liver (usually in the form of cholangiohepatitis) and the intestines (IBD or inflammatory bowel disease).

 

Purina Pet Health Library explains more about triaditis.

 


Causes of Pancreatitis                                                                                         Back to Page Index


 

Often the cause is never discovered, but cats with CKD who have uraemia or cats with diabetes or IBD may be at increased risk. Cats who suffer trauma, such as from an accident,  are also at risk. Many cats with hepatic lipidosis go on to develop pancreatitis, and the prognosis is more guarded for such cats.

 


Frequency                                                                                                           Back to Page Index


 

It is gradually becoming apparent that pancreatitis is far more prevalent in cats than was previously thought. Prevalence and histopathologic characteristics of pancreatitis in cats (2007) De Cock HEV, Forman MA, Farver TB & Marks SL Veterinary Pathology 44 pp39-49 found that pancreatitis "is common in cats, with an overall study prevalence of 67%, including 45% of apparently healthy cats." They also found that chronic pancreatitis is more likely in older cats. If your cat exhibits the symptoms described below, ask your vet to rule out pancreatitis.

 


Symptoms                                                                                                               Back to Page Index


 

Unfortunately pancreatitis does not have a clear-cut set of symptoms unique to the disease. In one study, 100% of cats exhibited lethargy, and 97% exhibited poor appetite, and these symptoms have also been observed in other studies. Other common symptoms (seen in over 50% of cats with pancreatitis) include rapid breathing, low temperature and jaundice. Some cats may appear to be in pain, and/or may not want to be touched. Others may vomit, or develop ascites (fluid in the abdomen).

 

I have found that some CKD cats who have relatively low creatinine levels (in the low 2s USA, or below 200 in international values) but who act a lot sicker than you would expect a cat with such low numbers to act actually have pancreatitis in addition to CKD. Idexx refers to cats with pancreatitis as ADR cats - cats who "ain't doing right" (which their UK site describes as "under the weather"). If your cat is off colour with no obvious cause shown in standard bloodwork, consider pancreatitis.

 

Can we diagnose feline pancreatitis and do we need to? (2008) Mansfield C Presentation to the 33rd World Small Animal Veterinary Association World Congress has a table of symptoms which may be seen.  

 


Diagnosis                                                                                                                Back to Page Index


Ultrasound


 

Ultrasound is often used initially to see if there are any changes in the pancreas. If so, the vet may order further tests. However, it can be hard to detect the pancreas on ultrasound, and ultrasound may not detect pancreatitis in every cat with the disease.

 

Biopsy


This is the only definitive way to diagnose pancreatitis, but it is invasive, and is usually no longer  necessary in most cases since the development of the spec fPL test.

 

Blood Chemistry


There is now a special blood test for pancreatitis in cats (see below) but your vet may initially suspect pancreatitis from your cat's symptoms and certain results in general bloodwork (known as blood chemistry). Up to 50% of cats with pancreatitis have low calcium levels (hypocalcaemia). BUN and creatinine may be elevated because of pre-renal azotaemia. White blood cells are usually high. ALT and AST, both liver enzymes, are often elevated, and the cat may be anaemic.

 

In dogs with pancreatitis, amylase and lipase (pancreatic enzymes) are often elevated, but unfortunately these will not necessarily be elevated in cats with pancreatitis, so normal levels do not rule out pancreatitis.

 

Pancreatitis in cats (2004) Williams D Presentation to the World Small Animal Veterinary Association World Congress explains that amylase and lipase are not useful in diagnosing pancreatitis in cats.

 

Spec fPL Test


This test was developed by Idexx Laboratories in conjunction with Texas A&M University (TAMU) (TAMU developed the original test for pancreatitis in cats). Although this test is slightly less accurate than the PLI test (see below), since it is available from Idexx laboratories around the world, it is probably easier for most people to have this test done. Results are usually available quickly, within a day. When a member of Tanya's CKD Support Group had it done in March 2011, it cost US$54.

 

In theory cats should be fasted for this test, but it is not essential. Results are interpreted as follows:

  • If the level is below 3.5, the cat probably does not have pancreatitis and other causes should be considered.

  • If it is between 3.6 and 5.3, the cat may have pancreatitis, and the test should be re-run in two weeks.

  • If it is over 5.3, the cat probably does have pancreatitis.

Idexx has more information about the test.

 

There is also a less precise type of test called the Snap fPL test. This basically tells you if your cat has a level above or below 3.5, i.e. whether pancreatitis is likely to be present or not. The advantage of this test is that it can be run in the vet's office with results within a few minutes. However, since it is slightly less accurate, it is wise to have the Spec fPL test run as well if you suspect pancreatitis.,

 

Idexx has information about the Snap fPL test.

 

Idexx has detailed information about the comparative accuracy of the two tests.

 

PLI Test


The Pancreatic Lipase Immunoreactivity (PLI) test was the forerunner to the spec fPL test. It was patented by Texas A&M University (TAMU) and could therefore only be run by them. This test was slightly more accurate than the spec fPL test at confirming pancreatitis in cats, but the cat needed to fast for 12 hours before having blood drawn for the test, and the results could take up to a week (although when we had it done for Harpsie, it took a dreadful 17 days!). Texas A&M no longer offers this test but instead use the spec fPL test.

 

TLI Test


The trypsin-like immunoreactivity (TLI) test is another older test, also devised by Texas A&M University, which has also been superseded by the spec fPL test. This test measures two enzymes, trypsinogen and trypsin, which are only produced by the pancreas. A cat needs to fast for 12 hours before having blood drawn for this test. TLI is not always elevated in cats with pancreatitis, so a normal TLI test does not rule out pancreatitis. If you have the spec fPL test run at TAMU, however, they may ask that you have this test done together with a folate test.

 

Cobalamin (Vitamin B12) and Folate Test


Up to 50% of cats with pancreatitis have below normal levels of folate, particularly if they are also suffering from IBD. Texas A&M University can measure levels of cobalamin and folate, and explains why they are important.

 


Treatments                                                                                                              Back to Page Index


 

It is difficult to treat pancreatitis in the sense of curing it, so the goal of treatment is to keep the cat as comfortable as possible by treating whichever symptoms are present. Fluid therapy, diet and pain control are the main focus.

 

Treatment recommendations for feline pancreatitis (2011) is a paper by Idexx.

Treating feline pancreatitis (2009) is a helpful article by Dr J Robertson DX Consult Winter 2009 pp12-13 on how to manage pancreatitis and common concurrent conditions such as IBD or diabetes.

 

Fluid Therapy


Since cats with pancreatitis are often dehydrated, fluid therapy is often used to rehydrate them and make them feel better. Intravenous fluids (IV or "a drip") at the vet's office may be used initially, and thereafter you may need to give sub-cutaneous fluids at home.

 

Diet


A common part of treatment for pancreatitis in humans and dogs is fasting However, fasting does not seem to be particularly effective for cats, who have a physiological need to eat relatively frequently, and can be problematic for CKD cats in particular because the lack of food may permit levels of stomach acid to rise. Feeding little and often is usually more effective, unless the cat cannot stop vomiting, in which case the vet may wish to treat the cat in hospital.

 

It is often recommended that humans and dogs with pancreatitis should reduce their fat intake.There is no evidence that reducing fat intake is essential for cats, but some people do find that feeding a lower fat diet does seem to help their cat.

 

Your vet may prescribe a prescription food such as Hill's i/d to help manage the condition. The phosphorus level is a little high for a CKD cat at 0.86%, and it is not low fat at 24.1%, but if your cat will eat it and can tolerate it, it could be a good choice to help your cat through the crisis.

 

Treating feline pancreatitis (2009) is a helpful article by Dr J Robertson DX Consult Winter 2009 pp12-13 which explains why fasting is not recommended.

Feline GI pearls (2001) is a presentation by Dr M Scherk to the World Small Animal Veterinary Association World Congress 2001, which explains why fasting and reducing fat is of little benefit to cats with pancreatitis.

 

Pain Medications


Some cats cope better with pancreatitis if they are given pain medications. Buprenorphine (Buprenex or Vetergesic) is commonly used in cats with pancreatitis. If your cat appears dull, or is tender in the abdominal area, discuss this possibility with your vet.

 

Vitamin B12


Pancreatitis may cause malabsorption of Vitamin B12, particularly in cats who also have IBD. Texas A&M University provides a treatment protocol if required, which calls for Vitamin B12 injections because oral supplementation is unlikely to be effective in cats with pancreatitis.

 

Antibiotics


Sometimes cats with pancreatitis are given antibiotics. Metronidazole (Flagyl) is commonly prescribed because it has anti-inflammatory properties. It tastes utterly foul, so if your vet prescribes this, try to give it in a gelcap.

 

Mar Vista Vet has more information about metronidazole.

 

Anti Nausea Medications


One commonly used anti nausea medication which is very effective is ondansetron (Zofran).

 

You may also be offered metoclopramide (Reglan), which works by regulating stomach contractions, and therefore is helpful for nausea caused by a lack of motility in the stomach; but since it can cross the blood/brain barrier, it also acts on the brain to control feelings of nausea, which can be helpful to cats with pancreatitis.

 

Please read the Nausea, Vomiting and Excess Stomach Acid page for more information on these medications.

 

Acid Blockers


There are several medications which can be most effective in controlling stomach acid, thus reducing vomiting and nausea, and increasing appetite, which can be helpful for cats with pancreatitis. There is more information about these treatments here.

 

Digestive Enzymes


Humans with pancreatitis have reported that they experience less pain when given digestive enzymes, though others have apparently felt worse. It is not known if the same applies to cats, but some vets do recommend trying them. Viokase is one commonly used brand. Obviously, if you feel the digestive enzymes are making your cat worse, you should speak to the vet about stopping them.

 

Steroids


Since there is often inflammation present in cases of pancreatitis, corticosteroids may be prescribed to help dampen down the inflammation. A commonly used corticosteroid in cats is pred (prednisone or prednisolone). Cats metabolise prednisolone better than prednisone (they have to convert prednisone into prednisolone in their bodies anyway before they can use it) so it is usually better to give prednisolone in the first place. Bioavailability and activity of prednisone and prednisolone in the feline patient (2004) Graham-Mize CA &  Rosser EJ Veterinary Dermatology 15 (s1), pp 10 supports this view.

 

Your vet may want to start at a higher dose to reduce the inflammation, then reduce to a maintenance dose. If your cat can eventually come off the steroids, they should not be stopped suddenly, but rather the dose must be tapered. This is because using corticosteroids may suppress the adrenal glands' ability to produce cortisone naturally; so tapering the dose minimises the risk of adrenal insufficiency occurring as a result.

 

The Treatments section has more information about steroids.

 

Caution: Probiotics


One study into humans with severe acute pancreatitis, Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised double-blind placebo-controlled trial (2008) Besselink MGH, van Santvoort HC, Buskens E, Boermeester MA, van Goor H, Timmerman HM, Nieuwenhuijs VB, Bollen TL, van Ramshorst B, Witteman BJM, Rosman C, Ploeg RJ, Brink MA, Schaapherder AFM, Dejong CHC, Wahab PJ, van Laarhoven CJHM, van der Harst E, van Eijck CHJ, Cuesta MA, Akkermans LMA, Gooszen HG The Lancet 371(9613) pp651 - 659, found that using probiotics more than doubled the risk of death. The same may not apply to cats but I would not take the risk. If you are using probiotics, therefore, I would speak urgently to your vet about stopping them.

 


Links                                                                                                                         Back to Page Index


 

Mar Vista Vet has a very helpful overview of feline pancreatitis.

Chronic feline pancreatitis: cats are not small dogs (2011) is a presentation by Dr S Little to the 36th World Small Animal Veterinary Association World Congress.

Chronic pancreatitis in dogs and cats (2008) Xenoulis PG, Suchodolski JS & Steiner JM Compendium provides detailed about pancreatitis.

Feline pancreatitis - species specific diagnostic and therapeutic approach (2007) is a presentation by C Mansfield to the World Small Animal Veterinary Association World Congress 2007.

Update on the diagnosis and management of feline pancreatic disease (2003) Marks SL is a presentation to the Waltham Feline Medicine Symposium 2003.

Pancreatitis in cats (2004) Williams D Presentation to the World Small Animal Veterinary Association World Congress has a detailed overview of pancreatitis.

Feline Pancreatitis Group is a support group for people dealing with pancreatitis in their cat. This group has open archives, i.e. if you post a message, it is visible to anyone online.

 

 

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This page last updated: 12 October 2012

 

Links on this page last checked: 03 April 2012