The pancreas ? A mixed gland
Pancreatitis is inflammation of the pancreas. The pancreas is an annex gland of the digestive system located in the anterior part of the abdomen, in the loop of the duodenum, not far from the stomach. Pancreatitis in dogs is also common disease.
It is said to be a mixed gland since it has an exocrine part (the most important) and an endocrine part.
The exocrine pancreas participates in the digestion of food by secreting various enzymes (amylase, lipase, trypsin, etc.). There are protective mechanisms to fight against the self-digestion of the gland.
The endocrine part, for its part, allows, via the production of hormones (insulin, glucagon), to store or transform the nutrients absorbed for future use as a source of energy.
When it gets out of hand …
In some circumstances, the protection mechanisms fail. Pancreatic enzymes are then activated and released within the gland itself, leading to tissue self-digestion and causing inflammation of the pancreas, called pancreatitis. Sometimes a local spread follows, with the release of enzymes and inflammation mediators into the circulation, explaining the tissue and systemic repercussions, well beyond the pancreas.
Pancreatitis can be acute, that is to say of sudden onset, with more dramatic consequences or evolve in a chronic, crude, or even asymptomatic manner.
It is estimated that more than 1% of healthy dogs present, at autopsy, lesions of the pancreas, without having shown symptoms during their lifetime. It is therefore an underestimated disease. The overwhelming forms being rarer, the diagnosis of this pathology is difficult for the clinician.
Predispositions and risk factors
There is a predisposition for certain breeds: the miniature schnauzer, the miniature poodle, terriers… Severe pancreatitis mainly occurs in middle-aged to advanced subjects.
The exact cause of the disease is often unknown, but several risk factors can be cited. Among these we find: a diet too rich in fat, overweight, trauma (road accidents, pancreatic surgery, etc.), taking certain drugs (corticosteroids, potassium bromide, azathioprine, etc.), certain agents infectious diseases such as toxoplasmosis or concomitant diseases (diabetes, hypothyroidism, Cushing’s disease, gastrointestinal diseases, etc.).
What are the symptoms of pancreatitis?
Pancreatitis can go unnoticed. This is the case with chronic pancreatitis, which manifests as recurrent episodes of inflammation with ambiguous symptoms.
More impressive, acute pancreatitis presents a high risk of mortality and co-morbidity.
The symptoms observed are diverse and may reflect the extension to neighboring structures. We note among them are anorexia, vomiting, more or less marked dehydration. Other symptoms are weakness, diarrhea (with blood or not), a sharp abdominal pain. It makes the dog adopt a posture of relief known as “ dog in prayer ”, bleeding disorders, a state of shock…
Subsequently, complications may arise: necrotic foci, pancreatic abscesses, pseudo-cysts, etc.
How to diagnose pancreatitis?
The diagnosis of pancreatitis is difficult and requires various additional examinations.
The abdominal x-ray lacks sensitivity, and the imaging test of choice remains the abdominal ultrasound. This will reveal the change in the volume of the gland, the presence of liquid around it or the presence of nodules.
A blood test can also do in order to carry out various analyzes. A blood-biochemistry but above all a dosage of canine specific lipase (cPLI). It constitutes the reference blood test for the diagnosis of acute pancreatitis (false positives or false negatives nevertheless possible) will thus carry out.
A pancreatic biopsy can also perform, this will essential when diagnosing pancreatic tumors.
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Act quickly to optimize the chances of success
Treatment for acute pancreatitis should start as early as possible to increase the chances of success.
The treatment will aim to calm the pain, decrease pancreatic activity. But, it also aim to prevent and / or fight against shock and infection.
It is therefore based on the establishment of an infusion and antiemetic and painkiller therapy. An appropriate diet (hyperdigestible and low in fat) must put in place quickly because prolonged fasting decreases the chances of survival. Antibiotic therapy is usually used to prevent sepsis.
The prognosis, meanwhile, will depend on the severity of the inflammation and whether or not complications arise. In mild to moderate pancreatitis, the prognosis is favorable. In severe cases, the prognosis is much more reserved and hospitalization in intensive care is often necessary.