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 levels (below 2.25 mg/dl or 200
µmol/L), yet seems lethargic and far more ill than that mild
level of kidney disease would suggest, ask your vet to consider pancreatitis.
What is Pancreatitis?
The pancreas is a gland located under
the stomach with two main roles:
endocrine (hormonal): it controls
the hormones (insulin and
glucagon) which regulate blood sugar levels.
exocrine: it assists with the digestive process
by producing digestive enzymes.
In cats with
pancreatitis, it is usually 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 further 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 flareups at intervals.
the intestines (in
the form of IBD
or inflammatory bowel disease).
Which tends to
come first is a matter of some debate. One reason triaditis may occur in
cats is because, unlike other species, which have separate bile and
pancreatic ducts, the feline pancreatic duct often merges with the bile duct
before reaching the intestine. Therefore inflammation in any one of these
three body parts can easily spread to all three.
How I treat feline triaditis
(2014) Twedt D Presentation to the World Small Animal Veterinary
Association discusses treatment options.
Triaditis syndrome
(2015) Della Maggiore A & Marks SL Clinician's BriefNov
2015 pp77-83 explains more about the diagnosis and treatment of feline
triaditis.
Causes
Often the cause is never discovered
(Chronic
diarrhoea in cats Gunn-Moore DA Purina Presentation says "While
there are many possible causes of pancreatitis in cats, over 90% are
idiopathic"), but it may be linked to
an autoimmune disease,
inflammation or an infection.
Current approaches to vomiting in cats and puppies
(2013) Gaschen FP, Lee JA, Parnell N, Richter K, Tams TR, Twedt D & Gloyd
K Pfizer Roundtable Discussion
says (Dr Twedt, referring to research from 2011) "we identified bacteria in the
pancreas of about 40% of cats with moderate to severe chronic or acute
pancreatitis."
The following may
also be factors:
cats
who suffer trauma, such as from an accident
e.g. a fall,
appear
to be at risk.
cats with diabetes or
IBDmay
be at increased risk.
cats with CKD who have
uraemiamay
be at increased risk.
many
cats with
hepatic lipidosis go on to develop
pancreatitis, and the prognosis is more guarded for such cats.
Frequency
Pancreatitis appears to be 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 Pathology44
pp39-49 examined deceased cats and found that chronic 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
Unfortunately pancreatitis does not have a clear-cut set
of symptoms unique to the disease, plus the
symptoms you do see may vary, depending upon whether the pancreatitis is
acute or chronic, or an acute flare up in a cat with chronic pancreatitis.
Idexx Laboratories refer to cats with
pancreatitis as ADR cats - cats who "ain't doing right" (which their UK site
describes as "under the weather").
With both acute and chronic pancreatitis, lethargy and loss of appetite are extremely
common: in one study, lethargy was seen in 100% of cats with pancreatitis
and loss of appetite in 97%.
Current approaches to vomiting in cats and puppies
(2013) Gaschen FP, Lee JA, Parnell N, Richter K, Tams TR, Twedt D & Gloyd
K Pfizer Roundtable Discussion
says "Cats with pancreatitis present like cats always present -
with anorexia, vomiting, and lethargy." One of the other participants said
he usually sees reduced appetite, and also weight loss. In cats with chronic
pancreatitis, this may be cyclical.
Cats with acute
pancreatitis may develop fluid build up, such as ascites
(fluid in the abdomen.
Chronic diarrhoea in cats Gunn-Moore DA
Purina Presentation states "Some
will show dyspnoea associated with pleural fluid and/or pulmonary oedema
(resulting from pleural and/or pulmonary inflammation secondary to
circulating inflammatory mediators)."
Whether acute or
chronic, some cats seem to have abdominal pain and some do not.
As you can see, many of the sympoms of pancreatitis are
very similar to those seen in CKD cats.
From what I have seen on Tanya's CKD Support Group, many cats who have relatively low creatinine levels (below 2.25
mg/dl or 200 µmol/L) but who are acting a lot sicker than you
would expect a cat with such low numbers to act, are actually suffering from pancreatitis,
either
in addition to CKD or sometimes without CKD being present. Therefore if your
CKD cat is off colour with no obvious cause shown in standard bloodwork,
consider pancreatitis.
Diagnosis
Diagnosing pancreatitis in cats is unfortunately not simple. A biopsy
is the most definitive way to do so,
but it is invasive, and therefore most vets
no longer perform biopsies for suspected
pancreatitis.
Instead, a combination of other diagnostic methods are
used.
Canine and feline pancreatic lipase immunoreactivity
(2012) Xenoulis PG & Steiner JM Veterinary Clinical Pathology41(3) pp312-24.states "As there is currently no gold standard for antemortem diagnosis of
pancreatitis in dogs and cats, the combination of a complete history and
physical examination, measurement of pancreatic lipase immunoreactivity,
and ultrasonographic examination of the pancreas is the best approach
for an accurate noninvasive diagnosis of pancreatitis.”
Ultrasound
may be
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, even when performed by a skilled operator.
Feline pancreatitis
(2012) Reichle JK & Felumlee AE NAVC Clinician's BriefJun
2012 discusses the use of ultrasound in diagnosing pancreatitis but
states "the sensitivity of ultrasonography for feline pancreatitis is low
and has been reported as only 10% to 35% when performed by a board
-certified ultrasonographer."
An ultrasound may not show pancreatitis even in cats who are known to have
it.
Feline acute pancreatitis: current concepts in
diagnosis and therapy (2015) Armstrong PJ & Crain S Today's
Veterinary Practice5(1) pp22-32 states "some cats with
biopsy-confirmed acute pancreatitis have no detectable sonographic
abnormalities." It does add "However, the sensitivity of
ultrasonography increases with increasing severity of pancreatitis" and says
"Abnormal sonographic findings are highly specific for pancreatitis—a cat
with compatible clinical signs and visible changes in the pancreas is very
likely to be correctly diagnosed with pancreatitis."
Blood Chemistry
Special blood test for pancreatitis in cats are available (see
below) but your vet may
initially suspect pancreatitis from your cat's symptoms and certain results
in general bloodwork (known as blood chemistry).
Low Calcium Levels (Hypocalcaemia)
Up to 50% of cats with pancreatitis have low
calcium levels (hypocalcaemia).
Current approaches to vomiting in cats and puppies
(2013) Gaschen FP, Lee JA, Parnell N, Richter K, Tams TR, Twedt D & Gloyd
K Pfizer Roundtable Discussion says "if a cat is hypocalcemic and has an inflammatory
leukogram, I think about acute pancreatitis. I usually make a clinical
diagnosis with imaging (ultrasound) and feline pancreatic lipase
immunoreactivity (fPLI) test results, along with ruling out other
etiologies."
ALT
and AST, both liver enzymes, are often elevated.
The cat may be anaemic.
Amylase and Lipase
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
says "Serum lipase and amylase
activities have been shown to be of no clinical usefulness for the diagnosis
of pancreatitis in cats. Current evidence suggests that when values of these
enzymes in feline serum are increased, the underlying disease is not present
in the pancreas. Many such cats have chronic small intestinal disease and/or
gastritis."
Testing amylase and lipase is therefore of no benefit in
cats.
Current approaches to vomiting in cats and puppies
(2013) Gaschen FP, Lee JA, Parnell N, Richter K, Tams TR, Twedt D & Gloyd
K Pfizer Roundtable Discussion says "We do not include these
on our panels anymore."
Specialised Tests
There are a number of specialised tests available and your vet will probably
use one of these.
(2012) Forman MA has a table comparing the accuracy of the various tests
available.
Spec fPL Test
This test was developed by IDEXX Laboratories in conjunction with Texas A&M
University (TAMU) and measures pancreatic lipase immunoreactivity (PLI).
This test superseded another test also
developed by TAMU called the fPLI test (see
below). The Spec fPL test
appears to be slightly less accurate than the original PLI test, but the
test is available from IDEXX laboratories around the world (the PLI test
sample had to be sent to
Texas A&M University), so it is a much more widely available
test.
Results are usually available quickly, within
a day. When a member of
Tanya's CKD Support Group
had it done in 2015, it cost US$160, but price will vary depending upon
where you live.
In theory cats should be fasted for this test, but it is not essential
(results might vary by around 10% if the cat is not fasted, but this is
unlikely to make much difference unless your cat has a very borderline
result).
Results are interpreted as follows:
Level
Interpretation
Below 3.5
Probably does not have pancreatitis. Consider other causes.
Between 3.5 and 5.3
May have pancreatitis. Re-run the test in two weeks.
Current approaches to vomiting in cats and puppies
(2013) Gaschen FP, Lee JA, Parnell N, Richter K, Tams TR, Twedt D & Gloyd
K Pfizer Roundtable Discussion says "Veterinarians sometimes get a positive fPLI result and stop right there,
assuming that the
positive test definitively means pancreatitis ... which is a big mistake."
This is because the test is not 100% accurate in every case, particularly
in less severe cases.
Texas A&M University, which helped
develop the test, states "In cats, Spec fPL correctly identified
patients with pancreatitis with a sensitivity between 54% (subclinical to
mild disease) to 100% (moderate to severe disease)."
Feline pancreatitis and fPLI - making sense of
sensitivity and specificity Lewis
J Greendale Veterinary Diagnostics explains more about this and
states "Disappointingly, studies released so far are not overly convincing
for fPLI having a reliable role in the detection of the most common form
of feline pancreatitis - chronic, low-grade pancreatitis. The studies
currently available suggest that in a sample of 13 cats with known
chronic, low-grade pancreatitis on histopathology, the fPLI test only
showed ~50/50 chance of providing a correct diagnosis. Based on these
figures, in practice this means that when using fPLI in mild pancreatitis,
for every cat you correctly diagnose, you miss another altogether."
Another problem for people with CKD cats is that the result may be influenced by CKD. As mentioned above,
many cats with pancreatitis have mildly elevated BUN and creatinine levels,
and in some cases, it may be thought that these cats have CKD when actually
they have pancreatitis. The reverse may also occur, i.e. cats with CKD may have elevated
pancreatic enzymes even though they do not have pancreatitis.
The effect of naturally occurring renal insufficiency
on serum pancreatic-specific lipase in cats
(2013) Jaensh S Comparative Clinical Pathology22(5)
p801-803 looked at the effect of CKD on the Spec fPL test and found "Cats with azotaemia and cats with renal insufficiency had
significantly higher mean SPEC fPL than cats without azotaemia or cats with
pre-renal azotaemia... Cats with renal insufficiency had an elevated SPEC
fPL in 50 % of cases, with 14% marginally elevated and 36% consistent with
pancreatitis." The study
concludes "This paper reveals increased pancreatic-specific lipase in
cats with renal insufficiency, but not pre-renal azotaemia, and suggests a
significant effect of renal insufficiency on serum pancreatic-specific
lipase concentrations."
Therefore the test may not be as reliable in CKD cats, and mild elevations
in fPLI in a CKD cat do not necessarily mean the cat has pancreatitis.
However, the study does indicate that an fPL result of around 8 or above is
suggestive of pancreatitis.
Diagnosing and managing feline pancreatitis, a
roundtable discussion
(2008)
Robertson J, Forman M, Steiner J, Twedt D & Williams D IDEXX Laboratories
does state "If a cat has an elevated serum fPLI concentration, you can
assume pancreatitis exists. We don’t know of anything, such as dehydration
or other diseases, which falsely increases fPLI concentrations."
Therefore, particularly if symptoms are also present, your vet might well decide to treat for pancreatitis and see if your cat improves.
Since pancreatitis can be very painful, this is usually a wise approach.
Snap fPL Test
IDEXX offers another test called the Snap fPL test. This basically tells you
if your cat has a level above or below 3.5 µg/dl, i.e. whether the level is above
the point at which pancreatitis becomes a possibility.
The advantage of this test is that it can be run in the vet's office with
results within a few minutes.
Diagnosis of feline pancreatitis with SNAP fPL and
Spec fPL (2019) Schnauß, Hanisch F & Burgener IA Journal of
Feline Medicine and Surgery21(8) pp700-707 performed both SNAP
fPL and Spec fPL tests on 111 cats admitted to a hospital over a year.
Results were the same for 89% of the cats, but the tests gave different
results for 11% of the cats. However, only one cat had a normal SNAP result
but abnormal Spec fPL result. The study concludes "SNAP fPL and Spec fPL
have a good agreement, especially when Spec fPL is ≤3.5 or ≥5.4 µg/dl."
However, if the result comes back over 3.5 µg/dl, I would suggest then also
having the Spec fPL test run so you know exactly what you are dealing with
and to rule out the very low possibility of a false negative.
The Pancreatic Lipase Immunoreactivity (PLI) test
was the forerunner to the spec fPL test. It was
patented by
Texas A&M University 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
University no longer offers this test but instead uses the
spec fPL test.
Variants of this test are gradually being offered by a number of different
laboratories, including Antech Laboratories, which apparently offers it as part
of the standard Antech blood chemistry tests at no additional charge.
However,
I can find no information about it at all on Antech's website, so I am
wondering if they are still offering it.
Biovet
in Canada is offering the DGGR-Lipase test in all its laboratories
(including possibly the USA). There is more information
here.
Vetpath in
Australia has been offering the test since 2015.
You probably
will not be surprised to hear that
Texas A&M University does not believe
this test is as good as their fPLI test, and explains why in the link.
TLI Test
The trypsin-like immunoreactivity (TLI) test
is an older test devised by
Texas A&M University which measures two enzymes,
trypsinogen and trypsin, which are only produced
bythe 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 outpancreatitis.
This test has been largely superseded by the spec fPL test.
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.
Cats with pancreatitis are often dehydrated,
sofluid therapy is
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 will usually be needed for several days or
longer for cases of acute pancreatitis. Your vet should monitor your cat
carefully for
overhydration and
hypokalaemia
(low potassium levels).
Thereafter you may need to give subcutaneous fluids at
home.
Cats with pancreatitis may need subcutaneous fluids even if their kidney
function is not reduced enough to warrant them in a normal CKD cat.
Diet
The most important thing is that your cat takes in food. Cats with
pancreatitis are at high risk of
hepatic lipidosis so food is essential and should be given as soon as
the cat is rehydrated, usually after the first 12-24 hours on IV fluids.
Once your cat is home, you must continue to ensure your cat eats, preferably
little and often.
Your vet may prescribe a
therapeutic diet
such as
Hill's i/d to help manage the condition.
The phosphorus level is a little high for a CKD cat at around 0.80-0.90%
(DMA basis), and it
is not low fat at around 24%, but if your cat will eat it and can tolerate it, it
could be a good choice to help your cat through the crisis.
Whether hospitalised or at home, some cats will require a
feeding tube.
Fasting
Fasting has historically been
part of the treatment
plan
for pancreatitis in humans and dogs. However,
fasting
does not seem to be particularly effective for cats, who
have a physiological need to eat relatively frequently (and has
fallen out of favour for dogs too).
Managing pancreatitis and concurrent conditions
(2009) Robertson
J DX ConsultWinter 2009
pp12-13 states
"The historical recommendation of nothing per os (NPO) for animals with
pancreatitis is no longer accepted."
Fasting 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
will need to treat the cat in hospital.
Reduce Fat Intake
It is often recommended that humans and dogs with pancreatitis should
reduce their fat intake,
but there is no evidence that reducing fat intake is essential for cats.
To feed or not to feed. Controversies in the
nutritional management of pancreatitis (2016) Shmalberg J Today's Veterinary PracticeNov/Dec 2016
pp45-51 says "There is no evidence that dietary fat restriction is warranted
in feline pancreatitis, whether acute or chronic. Therefore, higher fat
recovery diets can be fed if palatable and available."
However, some people do find that feeding a lower fat diet does seem to help
their cat, especially if their cat has IBD or diabetes, or if the
pancreatitis is chronic.
Essential Fatty Acids
I've heard from a number of people who felt essential
fatty acids did not agree with their cats with pancreatitis, causing
problems such as diarrhoea.
Potential adverse effects of Omega-3 fatty acids in
dogs and cats (2013) Lenox CE &
Bauer JE Journal of Veterinary Internal Medicine27(2)
states "Pancreatitis also is a concern when feeding high fat diets or high
doses of fatty acid supplementation, especially in dogs with a known risk
of pancreatitis. However, there are no reports of omega-3 fatty acid or
fish oil supplements causing pancreatitis in dogs, cats, or humans.
Theoretically, omega-3 fatty acids could prevent pancreatitis because of
decreased blood triglyceride concentrations. An extremely high dosage of
omega-3 fatty acids or a fish oil supplement in addition to a very high
fat diet would likely be required to induce pancreatitis." It goes on to
say "Clinical patients that develop diarrhea or other adverse
gastrointestinal effects may need a decreased dosage of omega-3 fatty
acids as well as other dietary modification."
An increased level of essential fatty acids compared to
standard cat foods is one of the features of therapeutic kidney diets. If
you have a cat with CKD and pancreatitis, ask your vet if a therapeutic
kidney diet and/or additional essential fatty acids
are appropriate for your cat.
Pain Medications
Pancreatitis can be very painful, though this may not be true in every case.
Unfortunately cats often hide the fact that they are in pain (possible signs
of pain in cats are discussed
here), so it is
usually safer to assume your cat is in pain until proven otherwise.
Managing pancreatitis and concurrent conditions
(2009) Robertson
J DX ConsultWinter 2009
pp12-13 states "Abdominal
pain is rarely recognized in
cats with pancreatitis. Nonetheless, many
cats will show clinical improvement if
provided analgesic therapy; therefore pain
management should be provided to all
cats with acute pancreatitis."
Current approaches to vomiting in cats and puppies
(2013) Gaschen FP, Lee JA, Parnell N, Richter K, Tams TR, Twedt D & Gloyd
K Pfizer Roundtable Discussion says "If I diagnose an animal
with acute pancreatitis, even if the patient does not show signs of pain, I
begin pain management. I have been surprised by how many patients improve
clinically with the only difference being pain management."
Cats with chronic pancreatitis may also feel and act better
with pain medication.
Managing pancreatitis and concurrent conditions
(2009) Robertson
J DX ConsultWinter 2009 pp12-13 goes on to say "Cats
with chronic
pancreatitis may also benefit from pain
management, and options for outpatient
treatment include a fentanyl patch,
sublingual buprenorphine, and oral
butorphanol or tramadol." Discuss
the provision of painkillers with your vet.
If you find your cat seems brighter after being given them, chances are s/he
was in pain.
Buprenorphine (Buprenex or Vetergesic) is
a painkiller which appears safe to use in CKD cats when necessary,
and which most people seem to find effective. You can read more about it
here
Vitamin B12
(Methylcobalamin)
Pancreatitis may cause malabsorption of vitamin B12,
particularly in cats who also have IBD, so supplements should
be provided.
Cats with a condition called exocrine
pancreatic insufficiency (EPI) require vitamin B12 supplements.
Feline exocrine pancreatic insufficiency: a
retrospective study of 150 cases (2016) Xenoulis PG, Zoran DL,
Fosgate GT, Suchodolski
JS & Steiner JM Journal of Feline
Internal Medicine30(6) pp1790-1797 states "those receiving
cobalamin therapy were 3.0 times more likely to have a positive clinical
response, whether or not they were hypocobalaminemic prior to treatment."
The study concludes "Cobalamin should be supplemented in all feline EPI
patients, even those whose test results demonstrate normocobalaminemia,
because tissue cobalamin is depleted before hypocobalaminemia develops."
Most people with CKD cats find their cats do better if they are taking
vitamin B12, so your cat with pancreatitis is probably already taking it, but if not, talk to your vet about starting it
in the form of methylcobalamin.
Antibiotics have not been a routine treatment for cats with pancreatitis.
Diagnosing and managing feline pancreatitis, a
roundtable discussion
(2009) Robertson
J DX ConsultWinter 2009
pp12-13 says "Pancreatitis is usually a sterile
process in cats and antibiotics are rarely indicated."
However,
Current approaches to vomiting in cats and puppies
(2013) Gaschen FP, Lee JA, Parnell N, Richter K, Tams TR, Twedt D & Gloyd
K Pfizer Roundtable Discussion states "we identified bacteria
in the pancreas of about 40% of cats with moderate to severe chronic or
acute pancreatitis. Currently, my approach to a cat with chronic
pancreatitis is cultures and histopathology. I usually start with antibiotic
therapy because bacteria may play a role."
An antibiotic called
metronidazole (Flagyl)may be
prescribed because it has anti-inflammatory properties.It tastes utterly
foul, so if your vet prescribes this, try to give it in a gelcap.
Cats with pancreatitis do not always vomit, but may be suffering from
nausea. It is therefore often recommended that anti nausea medication should
be given, and as with painkillers, many people find that their cats seem to
do better when they are receiving these medications.
One commonly used anti nausea medication
which is very effective is
ondansetron (Zofran).
You may also be offered
dolasetron.
You may be
offered
metoclopramide (Reglan), which works by regulating stomach contractions,
and therefore may be
helpful for nausea caused by a lack of motility in the stomach;
but since it can cross the blood/brain barrier, it can also act on the
brain to control feelings of nausea. However, it appears that it is not
actually particularly effective in cats.
Current approaches to vomiting in cats and puppies
(2013) Gaschen FP, Lee JA, Parnell N, Richter K, Tams TR, Twedt D & Gloyd
K Pfizer Roundtable Discussion states "I
don’t use metoclopramide in cats anymore. I am not completely convinced it
is that effective as an antiemetic
in cats. Evidence suggests that cats don’t have dopamine receptors in the
chemoreceptor trigger zone, which
is metoclopramide’s site of action." It also has possible adverse
side effects which can be very serious, so I would avoid using it if
possible.
Current approaches to vomiting in cats and puppies
(2013) Gaschen FP, Lee JA, Parnell N, Richter K, Tams TR, Twedt D & Gloyd
K Pfizer Roundtable Discussion
has some information on how to treat vomiting in cats.
Some people do find these medications help their cat with pancreatitis. Be
guided by your vet.
There is more
information about these treatments
here.
Steroids
Since there is often inflammation present in cases of
pancreatitis,
corticosteroids may be prescribed to help dampen down the
inflammation.
Diagnosing and managing feline pancreatitis, a
roundtable discussion (2008)
Robertson J, Forman M, Steiner J, Twedt D & Williams D IDEXX Laboratories
discusses the use of steroids in pancreatitis andsays "It
is important that practitioners don't just give corticosteroids as a
knee-jerk reaction. I only give corticosteroids while monitoring Spec fPL
results. I want to have a Spec fPL result before I start therapy and 10 days
later. If the cat is clinically improved and the Spec fPL decreases, I'll
certainly continue. If the cat is better but the Spec fPL doesn't decrease,
I reconsider. Similarly, if the Spec fPL decreases but the cat doesn't feel
better, I think twice about corticosteroid use. If the Spec fPL increases
and the cat doesn't feel better, I certainly stop corticosteroid use."
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.
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 Dermatology15 (s1), pp 10 supports this view.
Some people with pancreatitis but without EPI have reported that they
experience less pain when given pancreatic enzyme supplements,
though others have apparently felt worse. It is not known if the same
applies to cats, but some vets do recommend trying them.
Feline acute pancreatitis: current concepts in
diagnosis and therapy
(2015) Armstrong PJ & Crain S Today's
Veterinary Practice5(1) pp22-32 states "Pancreatic
enzyme supplements are used in some humans with chronic pancreatitis with
normal exocrine pancreatic function because they are associated with
decreased frequency and intensity of episodes of abdominal pain. This has not been
investigated in cats, but there are anecdotal reports that this therapy
improves appetite and gastrointestinal signs in cats with chronic
pancreatitis."
If your vet does think you should try pancreatic enzyme supplements,
Chronic diarrhoea in cats Gunn-Moore DA
Purina Presentation recommends supplementation as follows for cats with
chronic pancreatitis: "Replace pancreatic enzymes by adding pancreatic
enzyme replacement to food (~ half a teaspoonful of powder per meal, or to
effect, ideally incubating it with the food for 30 minutes before feeding to
reduce the risk of lip irritation), or add fresh-frozen then defrosted pig
pancreas (~20-40g per meal, or to effect)."
PetCoach
explains more about how pancreatic enzyme supplements are sourced.
Viokase is one commonly used brand.
Obviously, if you feel the
pancreatic enzyme supplements are making your cat worse,
you should speak to the vet about stopping them.
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 Lancet371(9613)
pp651-659, found that using probiotics more than doubled the risk of
death.
The findings of this study have been debated and disputed.
Use of probiotics in the treatment of severe acute
pancreatitis: a systematic review and meta-analysis of randomized controlled
trials (2014) Gou S, Yang Z, Liu T, Wu H, & Wang C Critical
Care18(2) R57 refers to the above trial, stating that the
trial "showed that probiotics had harmful effects, which deterred the
initiation of other trials on probiotics. In recent years, however, two
other RCTs have been completed, with no negative consequences were in
patients treated with probiotics. We therefore consider that the results of
the PROPATRIA trial are questionable and that further meta-analyses of the
more recent RCTs is required. To this end, we performed this meta-analysis
on six select RCTs in order to determine the effects of probiotics on the
rate of pancreatic and total infection, operation rate, length of hospital
stay and mortality. In addition, we tried to determine the reason for the
heterogeneous results across the different trials."
The study concludes "Probiotics showed neither beneficial
nor adverse effects on the clinical outcomes of patients with predicted SAP.
However, significant heterogeneity was noted between the trials reviewed
with regard to the type, dose and treatment duration of probiotics, which
may have contributed to the heterogeneity of the clinical outcomes. The
current data are not sufficient to draw a conclusion regarding the effects
of probiotics on patients with predicted SAP.'
These studies related to humans with acute pancreatitis, and may well not be
applicable to cats, particularly cats with chronic pancreatitis.
If you are using probiotics, talk to your vet about whether to continue
with them.
Some cats with
chronic pancreatitis may develop a condition called exocrine pancreatic
insufficiency (EPI). This means that the pancreas is not producing enough
pancreatic enzymes, which are necessary to process protein, fat and
carbohydrates in the diet. It was previously thought that this condition was
rare in cats but recent research indicates that it may be less rare than was
previously thought (it may also develop in cats without pancreatitis), as
discussed by
Exocrine pancreatic insufficiency in cats: more common
than veterinarians think (2013) Carr
AP DVM360 Magazine.
Feline exocrine pancreatic insufficiency: a
retrospective study of 150 cases (2016) Xenoulis PG, Zoran DL,
Fosgate GT, Suchodolski
JS & Steiner JM Journal of Feline
Internal Medicine30(6) pp1790-1797 looked at 150 cats with EPI
and found that the most common symptom (91% of cats in the study) was weight
loss; you may also see loose stools or poor coat condition. Equal numbers of
cats (42%) in the study had either a poor appetite or an increased appetite.
The best way to
diagnose EPI is via the fTLI test.
The usual
treatment is to supplement pancreatic enzymes orally. The above study also
found that it is important to give
cobalamin (vitamin B12) because cats who
received this as well as enzyme replacement did better, stating "those
receiving cobalamin therapy were 3.0 times more likely to have a positive
clinical response, whether or not they were hypocobalaminemic prior to
treatment." The study concludes "Cobalamin should be supplemented in all
feline EPI patients, even those whose test results demonstrate
normocobalaminemia, because tissue cobalamin is depleted before
hypocobalaminemia develops. The authors speculate that those cats with
partial or poor response to ERT [enzyme replacement therapy] may have not
been concurrently supplemented with cobalamin."
TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE
EXTREMELY DANGEROUS.
I have
tried very hard to ensure that the information provided in this website is
accurate, but I am NOT a vet, just an ordinary person who has lived
through CKD with three cats. This website is for educational purposes
only, and is not intended to be used to diagnose or treat any cat. Before
trying any of the treatments described herein, you MUST consult a
qualified veterinarian and obtain professional advice on the correct
regimen for your cat and his or her particular requirements; and you
should only use any treatments described here with the full knowledge and
approval of your vet. No responsibility can be accepted.
If your cat
appears to be in pain or distress, do not waste time on the internet,
contact your vet immediately.
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