The pancreas is a tiny organ that hugs the duodenum (the first part of the upper intestine) and lies close to the left kidney. Although it’s small, it has important functions for both releasing vital hormones (insulin and glucagon which are necessary for blood sugar regulation) and releasing enzymes important for proper digestion of fat, protein and carbohydrates. Pancreatitis is inflammation of this organ and affects a surprising number of cats.
Pancreatitis predominantly affects cats over the age of 7 but there are no age, sex or breed predispositions recognized in cats. The good news is that most cats have mild forms of pancreatitis and may live for years with chronic pancreatitis. A study of 100 cats showed that 45% of those considered healthy had evidence of pancreatitis. Of those cats, only 6% were diagnosed with acute pancreatitis.
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Incidence of pancreatitis in cats
Pancreatitis used to be considered rare to see in cats. However, current research shows that pancreatitis is actually very common in cats! Of 100 examined cats, the overall prevalence of pancreatitis was 66%, with the majority characterized as having chronic pancreatitis. Only 6% of these cats were diagnosed with acute pancreatitis.
Depending on the degree of inflammation and intensity of the “attack” this illness can cause life threatening complications. Luckily, studies have shown that cats with mild to moderate acute pancreatitis have a good prognosis for full recovery. Data derived from a compilation of 4 studies of cats with acute pancreatitis showed the majority of cats survived a bout of pancreatitis. Mortality varied from 9% of cats up to 41% of cats in these 4 studies.
Triggers for cat pancreatitis and prevention of cat pancreatitis
Known triggers for feline pancreatitis are: hypotension under anesthesia, trauma to the pancreas after road accidents or falling from tall heights. Certain infections and cancers may also trigger pancreatitis. However, in over 95% of cases, an underlying cause is never identified. This is termed idiopathic pancreatitis.
Because the overwhelming number of cats with pancreatitis are deemed “idiopathic”, specific tips for prevention of this disease are difficult. However, we do know that pancreatitis is worse in cats with concurrent diseases and in cats that have delayed veterinary care.
The best way to prevent feline pancreatitis is to keep your cat as healthy as possible by managing their weight and feeding them a nutritious diet designed for their life stage. Immune support supplements may be helpful too. My favorite supplement to promote a cat’s immune system is a probiotic. Probiotics directly support the GI tract where 70% of the immune system lies. The best studied probiotics for cats with proven benefits are :
Purina’s Fortiflora and Proviable DC.
Acute versus chronic pancreatitis in cats: how long do cats live with this disease?
Acute pancreatitis is a sudden onset of inflammation in the pancreas and is characterized by inflammation within the pancreas that is primarily composed of white blood cells called neutrophils. The inflammation from acute pancreatitis can be completely reversible and in mild to moderate cases, and mortality is low. However, acute pancreatitis is more likely to be severe compared to chronic pancreatitis.
The good news about chronic pancreatitis is that the symptoms of chronic pancreatitis are generally mild with low mortality rates too. Cats can live for years with chronic pancreatitis even though chronic pancreatitis creates irreversible changes within the pancreas.
Chronic pancreatitis is characterized by long standing inflammation in the pancreas and needles samples taken from cats with chronic pancreatitis have much fewer cells in these samples because these organs develop a lot of scar tissue from the long term inflammation.
It is not possible to determine if a cat with symptoms of pancreatitis has acute or chronic pancreatitis from symptoms alone. A biopsy of the pancreas is required to discern acute from chronic pancreatitis. Both forms of pancreatitis can have similar clinical signs.
Why some cat have poor outcomes with feline pancreatitis
Several factors have been identified which indicate which cats are less likely to survive pancreatitis. These factors include particular laboratory and physical symptoms of pancreatitis, delayed veterinary attention, persistent inappetence requiring the use of intravenous feedings and the presence of concurrent diseases.
Low blood sugar, low blood pressure, fluid in the chest cavity, elevated kidney values, low ionized calcium
Cats with more severe symptoms and concurrent underlying illnesses are less likely to survive a bout of pancreatitis. Severe pancreatitis in cats will cause abnormal symptoms such as low blood sugar, low blood pressure, fluid in the chest cavity, abnormal kidney values (azotemia) and low ionized calcium levels. Cats with these signs have been correlated to have a poorer outcome. Cats that are delayed treatment at a veterinary hospital once symptoms begin are less likely to survive a bout of pancreatitis than cats that present earlier for treatment.
Delayed veterinary care
Studies of cats that did not survive their bout with pancreatitis were more likely to have presented to the vet over a week after their symptoms began. Cats that were presented for treatment earlier (a median of 4 days after symptoms began) were more likely to survive their bout with pancreatitis.
Persistent inappetence requiring the need for parenteral (intravenous ) nutrition
Cats hospitalized for pancreatitis were not as likely to survive hospitalization if they had persistent inappetence or required parenteral feeding ( feeding with a highly specialized food formulation that is delivered intravenously called total parenteral nutrition:TPN). Cats that require this specialized intravenous feedings are typically cats with chronic vomiting that precludes the ability to provide feedings directly into their stomach via a traditional naso-esophogeal feeding tube.
Concurrent illnesses
Cats with concurrent illnesses such as cholangitis ( infection or inflammation of the biliary tree in the liver), hepatic lipidosis, and diabetes mellitus are at higher risk for more severe clinical courses of pancreatitis.
Interestingly, one study showed that more cats with fevers survived hospitalization for pancreatitis, possibly because they were administered antibiotics.
Symptoms to watch for at home that might indicate pancreatitis in your cat:
- Decreased to no appetite
- Lethargy
- Dehydration
- Weight loss
- Low body temperature
- Fever
- Vomiting
- Diarrhea
- Jaundice
- Abdominal pain
Most cats with pancreatitis had primary symptoms of lethargy and decreased appetite. About 1/3rd or more cats had vomiting and weight loss as symptoms. An even smaller subset suffered from diarrhea or trouble breathing.
| Symptoms of cats with acute pancreatitis | Percent of cats with this symptom in acute pancreatitis |
| Lethargy | 51-100% |
| Partial/complete inappetance | 62-97% |
| Vomiting | 35-47% |
| Weight loss | 30-47% |
| Diarrhea | 11-38% |
| Dyspnea | 6-20% |
Data adapted from: The ACVIM Consensus Statement on Feline Pancreatitis
Lab findings in cats with pancreatitis
Blood work findings in cats with acute pancreatitis can vary. The complete blood count may show anemia (non regenerative), hemoconcentration from dehydration, and increased or decreased total white blood cell counts.
In serum biochemical profiles of cats with acute pancreatitis, one third of cats had no abnormalities on initial evaluation! However, liver enzymes ALT, ALP and bilirubin are elevated in over 50% of cats. Serum cholesterol may be increased in up to 72% of cats. Cats with a low ionized calcium levels have been documented as having poorer outcomes.
The one blood value most recognized as providing supportive evidence of pancreatitis is serum pancreatic lipase (called Spec fPL). The Spec fPL assay has been determined to have a high specificity (a low false positive rate) and high sensitivity (ability to find most of the positive cats) for identifying cats with pancreatitis.
Feeding cats with pancreatitis
Providing nutrition as soon as possible is a very important part of caring for a cat with pancreatitis. The American College of Veterinary Internal Medicine specialists advise initiating feeding in cats with acute pancreatitis early in their treatment course. This can be provided by oral feeding enhanced with the use of appetite stimulants or via a feeding tube placed in the nose to provide a steady drip of a high calorie liquid diet like Clinicare.
A feeding tube is recommended for any car that will not respond to an appetite stimulant within 48 hours, or those cats that have had a longer period of inappetence prior to admission to the hospital. Lack of food in the GI tract leads to impaired GI motility, atrophy of the important villous lining of the GI tract, impaired GI blood flow, and disruption of the healthy GI microbiome.
Unlike dogs with pancreatitis who should avoid diets high in fat, cats with pancreatitis have no such limitation . Cats tolerate higher fat diets well. Rather, a highly digestible, “gastrointestinal “ diet is the preferred diet for cats with pancreatitis. This food should be initiated once the cat is eating reliably so as not to create food aversion. Cats are notorious for developing aversions to foods that they consume during adverse events such as an illness or hospitalization. Therefore, most prescription diets will not be initiated in the hospital setting.
Examples of highly digestible gastrointestinal diets for cats
RC feline Gastrointestinal diet
Hills I/d diet (not the low-fat variety)
Hills w/d diet
Hills GI Biome diet
Diagnosing feline pancreatitis
Feline pancreatitis can be difficult to diagnose. However, a retrospective study of cats with pancreatitis diagnosed pancreatitis in any cat that had appropriate clinical symptoms (decreased or no appetite, lethargy, vomiting, diarrhea, jaundice) and a positive result for one of the following tests:
- A positive SNAP fPL test
- Compatible abdominal ultrasound findings
- Compatible biopsy findings from the pancreas
An abdominal ultrasound is considered by many veterinary practitioners to be part of a “minimum database” for any cat suspected of having pancreatitis. The ultrasound appearance of pancreatitis includes more than 2 of the following findings:
- Enlarged pancreas
- Decreased pancreatic “brightness” on ultrasound or abnormal pancreas texture
- A bright surrounding mesentery (bright fat surrounding the pancreas)
- Fluid surrounding the pancreas
- Mineralization in the pancreas
- An irregular or enlarged appearance to the pancreatic duct
An abdominal ultrasound is useful to also evaluate the other abdominal organs including the gastrointestinal tract and the liver.
Chronic pancreatitis is often associated with inflammation of the small intestine and liver: Feline Triaditis
Most cats with pancreatitis suffer from chronic pancreatitis. Cats that form inflammation in one organ often form inflammation in one or two other places, namely the small intestine and/or the liver. The chronic pancreatitis inflammation they experience that can also affect their GI tract and liver, is a condition called “triaditis”. The reason cats are predisposed to inflammation in more than one of these organs is because of their close proximity. The duodenum of the cat (the upper small bowel) contains 100 times more bacteria than in the dog. If there is inflammation of the upper small bowel that leads to vomiting, then bacteria-rich fluid can be pushed from the upper small bowel into the ducts that lead to the liver and the pancreas. This can cause inflammation and possible infection of these organs.
Cats with pancreatitis sometimes turn yellow (jaundice)
Over half of cats with pancreatitis develop jaundice, which is a yellow discoloration to their skin. It can be seen most easily inside their ears where there is not much hair or by examining the whites of your cat’s eyes.
Cats with pancreatitis are more prone to jaundice because the pancreatic duct joins the bile duct close to the pancreas. If there is enough swelling of the pancreas, it can squeeze the bile duct closed and cause a buildup of bilirubin. Bilirubin excesses can be measured in the blood and noted as yellow discoloration to the tissues.
Adapted from : The ACVIM Consensus Statement on Feline Pancreatitis: you can see the bile duct and pancreatic ducts join close to the upper intestine and just outside the pancreas.
How to treat cat pancreatitis
Management of acute pancreatitis will often require a trip to the veterinary hospital. Unfortunately, there are no direct treatments for pancreatitis. Treatment for feline pancreatitis revolve around supportive care to help encourage appetite, reduce /stop vomiting, improve hydration and treat possible pain. In the rare case that an inciting cause is identified, that cause should be treated . For example, if an infectious cause is identified such as Toxoplasmosis gondii, then the appropriate antibiotic would be prescribed. Because over 95% of cases of feline pancreatitis are due to unknown causes, the treatments are focused on supportive care until the inflammation in the pancreas subsides. The average hospital stay for a cat with acute pancreatitis is between 2-5 days.
Fluid therapy
Fluid therapy is one of the most important treatments provided. A balanced electrolyte fluid is given to correct dehydration, correct electrolyte derangements and support proper blood pressure. Inappetence, vomiting and diarrhea can all worsen your cat’s hydration. If there are low blood sugar levels or elevated kidney values, these can be improved with the proper fluid therapy plan.
Antinausea medication
Antinausea medication and medications to help stimulate motility of the Gi tract are also very helpful.
Treat abdominal pain
Abdominal pain in cats is much less frequently encountered compared to dogs. However, because we know pancreatitis can be a painful condition in multiple species, it is a good idea to provide a pain control medication to ensure your cat is as comfortable as possible.
Start feeding cats with pancreatitis right away
Once vomiting is controlled, then encouraging eating without the need for a feeding tube is tantamount to a more rapid discharge from the hospital. Once a cat with pancreatitis can eat and keep food down, then they are more likely able to be sent home to continue recuperating there with oral medications as needed.
Appetite stimulants are used frequently for this purpose in cats. If a cat goes for 48 hours or longer without eating, we generally recommend placing a feeding tube. Providing early nutrition helps tremendously in recovery.
Antibiotic and steroid use in cat pancreatitis
Antibiotics and steroids are two supportive care treatments that are sometimes recommended for our feline patients with pancreatitis. Many cases of pancreatitis are considered sterile inflammation. However, cats who are suspected to have possible compounding liver infections (cholangiohepatitis) or inflammatory bowel disease may benefit from antibiotics. Additionally, cats who present with fevers are often provided antibiotic courses. Studies of cats with pancreatitis show that 35% of cats with moderate to severe pancreatitis have evidence of bacterial infection in their pancreas.
Steroids are another treatment that is not always utilized but can sometimes provide a tremendous ebenefit. There are not enough studies to date to routinely recommend steroids in the treatment of cats with acute pancreatitis. However, they play a role in treatment of other inflammatory diseases in cats that can occur concurrently with pancreatitis: inflammatory bowel disease and cholangiohepatitis (liver inflammation/infection). Diabetic cats who suffer from pancreatitis can have significant alterations in their diabetes regulation with the use of a steroid, so this is generally not recommended for theise cats.
Conclusion for feline pancreatitis
A surprising number of cats develop pancreatitis in their lifetime. Many are mild, chronic forms of this disease with few obvious symptoms. Cats that develop acute pancreatitis are more likely to have severe forms of the disease. Their most common symptoms are : lethargy, inappetence and vomiting. Although there is no absolute prevention or cure for feline pancreatitis, cats who have more prompt medical attention fare better than those who have delay seeking veterinary care.
Of interest for further reading:
