Pancreatitis
The pancreas is a tricky organ to keep tabs on. Because of its position in both humans and animals (just under
the stomach), it’s very difficult to diagnose any problems and often disguises any inflammation viewed through x-
rays, endoscopic surgery or ultrasound. Its two main functions include the production of metabolic hormones
(insulin and glucagon which regulate blood sugar) and the production of digestive enzymes. Those enzymes are
secreted through a special duct into the intestine to digest our food. In cats, the pancreatic duct joins with the
common bile duct from the liver, so both bile and pancreatic fluid, which is rich in digestive enzymes enter the
intestine from the same location.

X-rays can be inconclusive in diagnosis as the pancreas is located behind the stomach and hard to see with X-
rays. Ultrasound is a better tool and often shows an enlarged pancreas surrounded by fluid, which confirms the
diagnosis. When doing ultrasound, make sure to have a board certified, licensed and experienced
ultrasonographer performing the tests. They’ll know what to look for and how to spot any inconsistencies in the
size and texture of the pancreas.

I highly recommend getting both an ultrasound and a Spec PLI (pancreatic lipase) run. Lipase is one of the
pancreatic digestive enzymes with small traces that are normally present in the circulation. These levels jump
dramatically in pancreatitis, giving a clear diagnosis without invasive tests. Alex’s two ultrasounds showed no
inflammation in the pancreas, only the liver. But months later, her PLI showed a positive result and a bacterial
overgrowth. Another cat was the opposite. His PLI showed no disease yet when his parent insisted on running
an ultrasound, the results were positive and he was hospitalized, which saved his life. That insistence was due
in part to the sudden downturn and death of my Alex and sparked many to get their cats tested again and with
both tests run. Although I lost my girl, thankfully because of her, some lives were saved. I also recommend re-
testing every two to three months and staying hyper vigilant in regards to this issue.

Because Alex was found to have bacterial overgrowth with the results of her PLI serum tests, her vet has stated
that she most likely died of a massive viral infection. The theory is that these bacteria are able to crawl up the
pancreatic duct and cause infection in the pancreas. When the pancreas gets inflamed, the enzymes escape and
begin digesting the pancreas itself. The living tissue becomes further inflamed and the tissue damage quickly
involves the adjacent liver. Toxins released from this tissue destruction are released into the circulation and can
cause a body-wide inflammatory response resulting in infection. For this reason, digestive enzymes should only
be given under the care of a veterinarian and closely monitored as it can quite frequently exacerbate the
digestive process. Even the vet won’t know for sure how it will affect your cat’s pancreas, but they can monitor
your kitty closely and know which changes warrant either continuing the enzymes or halting their use.

Pancreatitis is a chief risk factors for developing what’s called disseminated intravascular coagulation or DIC.
DIC is a massive uncoupling of normal blood clotting and clot dissolving mechanisms. This leads to simultaneous
bleeding and clotting of blood throughout the body, which can eventually lead to heart failure. After speaking with
several vets, we think this may be what caused Purr Panther’s (located in the Tributes section of this site)
untimely passing. Again, its just guesswork but many vets have seen this before and can make an educated
guess about the circumstances. Plasma transfusions can sometimes be helpful to replace the clotting factors
needed to prevent DIC as well as natural blood factors to deactivate pancreatic enzymes.

Pancreatitis can be acute or chronic. Acute cases can reverse completely but tend to be much more severe than
chronic. Lethargy, depression, appetite loss, abdominal pain, nausea and vomiting are consistent signs.
Crouching in a meatloaf position is indicative of abdominal pain and lip smacking almost always suggests severe
nausea and that the cat will vomit shortly thereafter. Pancreatitis is painful and your vet should prescribe pain
medications for you to administer at home along with subcutaneous fluids to avoid dehydration. Here are some
examples of the meatloaf positions. The first two are normal meatloafs, the second two are signs of illness.

































Approximately 40% of cats with hepatic lipidosis have pancreatitis as the underlying cause. Hepatic lipidosis,
(fatty liver disease), is liver failure that develops from appetite loss/inadequate calorie intake and complicates
pancreatitis tremendously. The old recommendations that involve withholding food for 48 hours to rest the
pancreas no longer apply, as there is too much risk of fatty liver disease, liver failure, infection and even death.
It's also been shown that the pancreas needs as much nutrition to heal as the liver does.

Exocrine pancreatic insufficiency is the insufficient secretion of digestive enzymes, usually due to loss of the
exocrine tissue from idiopathic atrophy (unknown cause of muscle mass). It can lead to acute or chronic
inflammation and causes maldigestion and malabsorption with diarrhea, steatorrhea and weight loss.
Steatorrhea is excess fat in the feces due to malabsorption caused by disease of the intestines. The feces are
bulky, greasy, foul smelling and pale in color. It was never diagnosed, but I now know this is what Alex had in the
last week or two of her life. I thought she was going to the bathroom very well, because she never had diarrhea
or constipation. But her stools became more and more pale and large, which means that she wasn’t absorbing
any nutrients at all.

Alex’s case was extreme as she suffered from triaditis; IBD, liver disease and pancreatitis. The occurrence of
these conditions is becoming more common unfortunately as when one organ is overworked, the other organs
try to compensate and it's a vicious cycle. This is why it's incredibly important to get the inflammation down as
soon as you spot trouble. I'll repeat what I said on the IBD Guidelines page, please do not wait to take your cat to
the vet for an exam should they become lethargic, have chronic vomiting, inappetance, weight loss, etc. You will
be taking control of the disease and doing what's necessary to try and stop the progression. There are no
guarantees that will happen but you need to at least try.

Learning the signs of distress from your cat can help to facilitate that early treatment. Pacing around the room,
crying, huddling and rapid breathing. Putting what’s called their third eyelid up, the coated film on their eyes
beginning to close. Those are signs of extreme pain and disorientation. Fever, accompanied by a quick
temperature drop are usually a sign that organ failure has started and the body is shutting down. Get your cat to
a vet or an ER immediately if they exhibit any of these signs. Cats are the smartest animals at hiding their
illnesses and are notorious for not showing any symptoms at all, even if they’re very sick. Learning to recognize
different behavior patterns and any changes in their diet, stools, coloring, etc. is the best way to tell if they need
to be seen by a vet. Please see Alex's medical history page for more information:
http://ibdkitties.net/Alexmedicalhistory.html.

Some materials used in this article were written and provided by:
Dr. Wendy C. Brooks, DVM, DipABVP
www.marvistavet.com/html/pancreatitis.html
www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=577

Although this website is based on information about pancreatitis for humans, it’s got an enormous amount of
information on just how the pancreas works, what exactly each enzyme does, different levels of enzymes, etc.
www.medical-dictionary.thefreedictionary.com/pancreatic+hypertrophy

Here are some links on feline pancreatitis, some are from medical journals and veterinary articles:
www.vetinfo.com/cpancrea
www.manhattancats.com/Articles/pancreatitis_test
www.idexx.com/pubwebresources/pdf/en_us/smallanimal/education/dx-consult/managing-pancreatitis-and-
concurrent-conditions.pdf
www.idexx.com/animalhealth/laboratory/specfpl/0969115.pdf
www.vetcentric.com/reference/encycEntry.cfm
www.veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=313764&pageID=1&sk=&date=
www.ncbi.nlm.nih.gov/pmc/articles/PMC1111363/
www.felineoutreach.org/Education/Pancreas.html
www.vin.com/proceedings/Proceedings.plx?CID=WALTHAMTNAVC2003&PID=3670
www.peteducation.com/article.cfm?c=1+1329&aid=334
www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00114.htm
www.vet.uga.edu/vpp/clerk/west/index.php
www.tddslab.co.uk/tddsexeter/downloads/PLI_TLI_pancreatic%20disease.pdf
vetmed.tamu.edu/gilab/research/pancreatitis-information

These are fantastic sites as they have pictures to show the normal pancreas and the inflamed pancreas:
www.soundvet.com/academy-of-imaging/case-studies/feline-pancreatitis
www.all-about-cats.com/pancreatitis.htm
www.felipedia.org/~felipedi/wiki/index.php?title=Pancreatitis
Great article written by a vet:
Real reason not to give begging pet those table scraps: Pancreatitis
www.kearneyhub.com/life/article_2af82982-0d0a-11e1-8265-001cc4c002e0.html
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This is the comfy meatloaf position that most cats lay in
frequently. Legs wrapped underneath the chest area, head
up, eyes relaxed, etc.
This is the "this is my spot" meatloaf position.
"Found me a good place to perch". Both very
normal.
This is the nauseated
meatloaf position. Head
down, lip smacking, eyes
squinted. This usually
indicates acid reflux or
feeling like they're going
to vomit.
And this is the "I'm in pain" meatloaf position. Head slightly up
but hanging, eyes squinted, fur area around the eyes puffed
out and swollen, crouching from cramps and abdominal pain.