Pancreatitis in Dogs and Cats

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Pancreatitis in Dogs and Cats

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Title: Pancreatitis in Dogs and Cats

1
Pancreatitis in Dogs and Cats

Two Different Animals
Wendy Blount, DVM
Nacogdoches, TX

2
Wendy Blount, DVMdrblount_at_vonallmen.netwww.wendy
blount.com

DVM TAMU 1992
Private Practice Houston 2 years
Small Animal
Residency TAMU 1994-1997
Small Animal Internal Medicine
Private Practice Nacogdoches, TX
75 Referrals Internal Medicine and Herbal
Medicine/Nutrition
25 General Practice

3
PancreatitisIntroduction
4
Two types of pancreatitis

Acute Pancreatitis
Abrupt onset
often reversible after treatment
May lead to chronic pancreatitis
Acute necrotizing (cell death) pancreatitis is a
life-threatening condition

Chronic Pancreatitis
Continuing inflammatory disease
Irreversible pathology
Relapsing acute pancreatitis
Exocrine pancreatic insufficiency (EPI)
Diabetes mellitus

Acute
Chronic
2/3
1/3
5
Pancreatitis

Clinical Presentation
Diagnosis
Treatment
Prognosis

6
PancreatitisClinicalPresentation
7
Pancreatitis - Predispositions

Chronic liver Disease Why?
Bile reflux into the pancreas
Especially in cats why?
Because bile pancreatic duct merge
Diabetes mellitus
Intestinal disease

8
Pancreatitis - Predispositions

Hyperlipidemia Why?
Blood sludging - pancreatic ischemia
Lipase and other enzymes released
Hydrolysis of TG in ECF by lipase releases free
fatty acids (FFA)
FFA cause microthrombi and bind to calcium to
cause further damage (saponification)
More lipase is released
Positive feedback vicious cycle

9
Pancreatitis - Predispositions

Obesity
Hypercalcemia
Hyperadrenocorticism
Hypothyroidism
High fat meal How much is too much?
gt50 calories as fat
Careful of U/D in Schnauzers
Refeeding after prolonged anorexia

10
Pancreatitis - Predispositions

Pancreatic neoplasia
If you are treating one of the worst cases of
pancreatitis you have ever seen, rule out
pancreatic adenocarcinoma
Infectious
Toxoplasma gondii
Feline liver flukes Amphimerus pseudofelinus
Feline pancreatic flukes Eurytrema procyonis
FIP

11
Pancreatitis - Predispositions

Drugs
Corticosteroids
Chemotherapeutics/immunosuppressives
L-asparaginase
Azathioprine (Imuran)
Estrogens
Others

12
Pancreatitis - Predispositions

Toxins
Organophosphates
Scorpion stings
Uremic toxins
Vaccines

13
Pancreatitis - Predispositions

Trauma to the pancreas
Abdominal surgery
Ischemia (post-GDV, anesthesia, hypotension,
shock)
Bile duct obstruction
Protracted and severe vomiting why?
Bile reflux into the pancreatic duct
Especially in the cat

14
Pancreatitis - Predispositions
Hyperadrenocorticism both Hypothyroidism dogs High
fat meal dogs Refeeding after anorexia dogs Pancr
eatic neoplasia both

Dog vs. Cat - Quiz
Chronic Liver Disease
both
Diabetes mellitus
both
Intestinal disease
both
Hyperlipidemia
dogs
Hypercalcemia
both

15
Pancreatitis - Predispositions
Trauma to the pancreas dogs gtgt cats Ischemia both
Bile duct obstruction cats gt dogs Protracted
severe vomiting cats gt dogs Vaccines ?????

Toxoplasma gondii
cats
Corticosteroids
dogs
Organophosphates
both
Scorpion sting
both
Uremia
both

16
Breed Predisposition

Dogs
Miniature Schnauzer
Sheltie
Briard
Small dogs (yorkies, poodles)
Cats
Siamese
Himalayan

17
Common Concurrent Diseasesespecially in cats

Cholangiohepatitis
Inflammatory bowel disease
Triaditis
Nephritis
Hepatic lipidosis cats only

18
Most Common Clinical Signs

Dogs
95 of dogs with pancreatitis vomit
Anorexia (91)
Abdominal pain (58)
Cats
Anorexia/weight loss 97
Only 35 of cats with pancreatitis vomit
Dehydration 92
Constipation

19
Clinical Signs Dogs and Cats

Lethargy
Icterus why?
Diarrhea with or without blood
Fever (hypothermia more common in cats 68)
Abdominal pain, cranial abdominal mass
Hunched stance or praying position
Elevated respiratory rate
Necrotic skin lesions or red skin why?
Ascites

20
Pancreatitis - Sequella

SIRS
Systemic Inflammatory Response can Precipitate
Thromboembolic disease
Pumonary thromboembolism
DIC
Pancreatic encephalopathy
Arrhythmia
Metabolic acidosis
Respiratory Distress (2 causes)

21
PancreatitisDiagnosis
22
Diagnosis Clues in the Bloodwork

CBC nonspecific
Thrombocytopenia
Neutrophilia with left shift
Anemia
Serology Dogs only
Lipemia after a prolonged fast (TG, chol)
Can present for opaque eyes or anterior uveitis
Hypocalcemia why?
Calcium consumed by saponification of fat
Hypoalbuminemia why?
Massive inflammation, vasculitis, sepsis

23
Diagnosis Clues in the Bloodwork

Serology Dogs only
Amylase
normal in 47
Lipase
Normal in 61
Serology Cats only
Elevated cholesterol (not as often triglycerides)
Amylase and lipase not at all useful

24
Diagnosis Clues in the Bloodwork

Lipase non-specific why?
Digestive lipases
Intestinal lipase
Lipoprotein lipase and hepatic lipase
Hormone-sensitive lipase (adipocytes)
Lysosomal acidic lipase

25
Diagnosis Clues in the Bloodwork

Serology Dogs and Cats
Nonspecific changes
Elevated liver enzymes
Elevated bilirubin why?
Azotemia
Hyperglycemia (cause or effect)
Hypoglycemia why?
Hypophosphatemia why?
Hypochloridemia why?

26
Diagnosis Clues in the Bloodwork

GI Serology Dogs and Cats
B12 may be low why?
Intrinsic factor from the pancreas is required
for absorption
concurrent proximal small intestinal disease
Folate may be low if distal intestinal disease
Folate is absorbed in the ileum
REMEMBER B comes before F

27
Diagnosis Clues in the Bloodwork

GI Serology Dogs and Cats
TLI (trypsin like immunoreactivity)
Highly specific for EPI
Increased in SOME dogs and cats with pancreatitis

28
Diagnosis Clues in the Bloodwork

GI Serology Dogs and Cats
What is the BEST blood test to diagnose
pancreatitis??
cPLI (canine Pancreatic Lipase Immunoreactivity)
97 sensitive for pancreatitis
82 specific for pancreatitis
fPLI (feline Pancreatic Lipase Immunoreactivity)
Much more sensitive and specific for pancreatitis
than any blood test or imaging
Antech and IDEXX
TAMU GI Lab (TVMDL sends to TAMU)

29
Diagnostic tools A comparison
30
Spec cPLTM

cPLI Developed by Drs. Jörg Steiner and David
Williams at the Gastrointestinal Laboratory at
Texas AM University
IDEXX collaborated with Drs. Steiner and Williams
to develop the Spec cPL
IDEXX renamed it Spec cPL
For better name recognition
To trademark the name
Available only at IDEXX Labs

31
Introducing SNAPR cPLTM
Features

2 results Normal or Abnormal
Read time 10 minutes
Storage Refrigeration
Sample type Serum
Read Visual semi-quantitative
lt200 ug/L normal
200-400 ug/L borderline
gt400 ug/L pancreatitis
Same technology as Spec cPL
Correlation to Spec cPL gt95
96 of interpretations are correct

Sample
Reference
32
Comparing Spec cPL values to SNAP results
33
SNAP cPL for Screening
Dog w/ Vomiting, Anorexia, Abdominal pain
CBC Profile/lytes UA SNAP cPL
SNAP Abnormal
SNAP Normal
gt400
200-399
Treat for pancreatitis, Baseline cPLI
Abdominal radiographs Abdominal US Baseline cPLI
Pancreatitis is unlikely pursue other
differential diagnoses
monitor w/ cPLI
US/Rads confirm pancreatitis
US/Rads equivocal
Treat, Monitor, Retest Continue to rule out
other differential diagnoses
Treat for pancreatitis, Monitor with cPLI
34
Diagnosis Clues in the Bloodwork

Urinalysis nonspecific
Ketones
think diabetic with ketoacidosis (if glucosuria)
Or prolonged fasting/starvation
Transient proteinuria
Enzyme mediated glomerular damage

35
Diagnosis Clues in the Bloodwork

Coagulation panel
Thrombocytopenia
Vasculitis (enzyme mediated)
DIC
PT, PTT, ACT
Elevated
Antithrombin III
Low
FDP, d-Dimers
high

36
Diagnosis Clues in the Bloodwork

Electrolyte panel/blood gases (venous is fine)
HCO3,TC02, pH, pC02
Low - Metabolic acidosis
What clue will your patient give you to check
venous blood gases?
Panting
Potassium
Low why?
H outside the cell exchanged for K inside the
cell
K lost in the urine
Especially a problem with diabetics why?
Insulin is required to get potassium into the
cell where it is needed

37
Diagnosis Abdominal Ultrasound

BEFORE PLI, WAS THE BEST TEST FOR DIAGNOSIS OF
PANCREATITIS
Highly specific, but not that sensitive
60 of cats with pancreatitis have normal US
Pancreatitis (gt 1 cm thick)
Enlarged pancreas
Hypoechoic
May have cavitary lesions
Fluid accumulation around the pancreas
Pancreatic duct may be tortuous and dilated

38
Diagnosis Abdominal Ultrasound

Duodenum
Dilated and hypomotile (lt5 waves per minute)
Sometimes corrugated
Common Bile Duct
Dilated and tortuous
Gall bladder
Enlarged, wall edema/hyperechoic, sludge
Ascites
Peripancreatic fat and omentum
hyperechoic

39
Diagnosis Abdominal Ultrasound

Ultrasound truly IS for everyone
Time-consuming
time to warm up reagants
10 minutes to run the test
Expensive
Used Toshiba Analog 12k in 2000
Cost 1714 per year
3 US a week x 150 x 50 weeks 22.5K
Subject to user experience
No more subjective than x-rays

40
Diagnosis Radiographs

Abdominal radiographs
Often normal (sensitivity 24)
Ascites generalized or localized
Peritonitis loss of detail ground glass
Stomach displaced left, dilation
Duodenum displaced caudal and right, gas
Dilated, thickened, corrugated
Colon displaced caudal
Calcification of fat

41
Diagnosis Radiographs

Upper GI Barium Series
Delayed emptying of stomach and duodenum
Corrugation of duodenal wall
Thoracic radiographs
Can be normal
Pleural effusion
Pulmonary edema
Severe vasculitis
if severe hypoalbuminemia
25-50 of cats have either pleural effusion or
ascites
Sometimes pneumonitis (interstitial pattern)

42
Diagnosis Abdominocentesis, Thoracocentesis

Usually modified transudate
Occasionally exudative (suppurative)
Rarely hemorrhagic

43
Diagnosis Exploratory Laparotomy

Pancreas
Edematous, hemorrhagic, abscesses, cysts
Enlarged if acute
Very small, wasted, fibrotic if chronic
Can appear grossly normal in cats
Peripancreatic tissues
Saponification of fat
Inflammation
Adhesions

44
Diagnosis Exploratory Laparotomy

Histopathology - pancreas
Definitive diagnosis in cats
Chronic pancreatitis fibrosis, inflammation,
nodular hyperplasia
Acute pancreatitis edema, hemorrhage, necrosis,
inflammation
Few side effects after Bx of cat pancreas
Culture/Cytology any abscesses
Usually sterile (do cytology first)
Bacterial infection is not very common in dogs
and cats

45
PancreatitisTreatment
46
Pancreatitis Treatment Dogs and Cats

PRIMARY THERAPIES
Fluid therapy
Colloids
Antibiotics
Analgesia
Antioxidants

47
Pancreatitis Treatment Dogs and Cats

Fluid therapy why so crucial
Need to support pancreatic perfusion
Pancreatitis pancreatic ischemia bad things
35-45 ml/lb/day until eating well
less if low albumin, until colloids restored
Supplement potassium according to the sliding
scale
One scale for animals with severe acidosis
One scale for animals with normal venous blood
gases

48
Pancreatitis Treatment Dogs and Cats

Fluid therapy why so crucial
Why do pets with acidosis need more potassium?
In a state of acidosis, there are excess hydrogen
ions (H) in the extracellular fluid
As the acidosis is corrected by therapy,
potassium that had left the cells in exchange for
H goes quickly back into the cells
This can drop potassium precipitously, causing
arrhythmia, weakness or even respiratory
paralysis
Most common culprits are DKA and RTA

49
Pancreatitis Treatment Dogs and Cats

Fluid therapy why so crucial
Add glucose if hypoglycemic
Add bicarbonate if
Acidosis is immediately life threatening
Acidosis will not be corrected by treating other
problems
See handout
Avoid LRS if severe liver disease and needs
alkalinizing why??
Liver must transform lactate to bicarbonate

50
Pancreatitis Treatment Dogs and Cats

Flop
Chief Complaint Not doing well since treating
abscess on a toe 1 week ago, vomiting blood
3 days ago regular vet did a UA and blood glucose
UA showed ketones and glucose , blood
glucose 296
Has been treating with IV fluids since, getting
worse
Did not start insulin because cat not eating
Exam - Dehydrated, lethargic, icteric, RR 56
vomited coffee grounds and collapsed on abdominal
palpation, HR 65/bpm
Responded to atropine IV and fluid bolus

51
Pancreatitis Treatment Dogs and Cats

Flop - diagnostics
CBC granulocytes 16,000
Profile glucose 200, BUN 41
TG 500, Chol 297
Bili 4.2, ALT 148, ALP normal
Ca 7.0, Phos 1.6
UA SG 1.027, ketones , glucose , inactive
sediment
Electrolytes K lt2.0, Na 133, iCa 1.08
pH 7.032, BE -24, HCO3 7, TCO2 8
pCO2 26.5,
No chest rads or abdominal US done
Urine culture pending

52
Pancreatitis Treatment Dogs and Cats

Flop - diagnosis
Initial life threatening problems
Severe ketoacidosis
treatment insulin, bicarbonate, IV fluids
Severe hypokalemia
treatment IV KCl or K-phosphates
Severe hypophosphatemia
treatment IV K-phosphates
(pancreatitis, hematemesis, abscess on toe)
(treatment feed, antacids, sucralfate,
antibiotics)

53
Pancreatitis Treatment Dogs and Cats

Flop - treatment
IV fluids of course 45 ml/lb/day
Rehydrates and corrects acidosis which fluids?
Buffered LRS, Ringers, Normosol, Plasmalyte,
etc.
Potassium chloride no disadvantage
Potassium phosphates no disadvantage
(sliding scale) (IV drip rate calculator)
Insulin
Advantage corrects ketoacidosis
Disadvantage makes hypokalemia and
hyposphatemia worse
Bicarbonate (handout)
Advantage corrects acidosis
Disadvantage will make hypokalemia worse
Cefazolin 100 mg IV TID, cimetidine 25 mg IV TID

54
Pancreatitis Treatment Dogs and Cats

Flop reassess in 4 hours
Glucose - 99 (1 unit NPH SC)
PCV 23
pH 7.228, HC03 10, TCO2 11
pC02 23.9,
iCa 1.07, Na 130, K 2.3
Phosphorus 0.7
Red tinged urine, serum icteric
Hydration normal, general condition slightly
improved, no vomiting, not eating

55
Pancreatitis Treatment Dogs and Cats

Flop 2 days later
Glucose - 325
PCV 20
pH 7.403, HC03 18.8, TCO2 20
pC02 30
iCa 0.92, Na 134, K 3.7
Phosphorus 3.4
Urine clear, serum slightly icteric
Hydration normal, general condition greatly
improved, eating small amounts, no vomiting

56
Pancreatitis Treatment Dogs and Cats

Colloids why so crucial
Low albumin vasculitis fluid therapy
pulmonary edema
Hetastarch 5-10 ml/lb/day
Plasma 10 ml/lb/day, over 2-3 hours
Premedicate with diphenhydramine
Can repeat daily until improved
Also treats DIC when incubated with heparin 35-75
U/kg for 30 minutes prior to administration
Provides antiproteases and alpha-macroglobulins
Whole blood if significantly anemic (hemolysis)

57
Pancreatitis Treatment Dogs and Cats

Antibiotics controversial
Increased survival in people with pancreatitis
who are treated with antibiotics
But bacterial pancreatitis is much less common in
dogs and cats
Should prevent systemic infection from bacterial
translocation across the gut
Treat concurrent infection, of course (UTI)
Penicillins (avoid Clavamox it causes vomiting)
Cephalosporins
Quinolones alone arent the best choice why?

58
Pancreatitis Treatment Dogs and Cats

Analgesia THIS IS A PAINFUL DISEASE
Butorphanol (1 mg/10 lbs q2-4hrs PRN for pain)
Buprenorphine (0.015 mg/kg q6-12hrs)
Opiate pure agonists whats the catch?
Oxymorphone
Morphine
Hydromorphone
Meperidine
Fentanyl injectable or patch
Intraperitoneal lidocaine or bupivocaine
Be careful of NSAIDs Why?

59
Pancreatitis Treatment Dogs and Cats

Antioxidants
Milk thistle
SAMe
VetriScience Cell Advance
Vitamin E/selenium
Free radical damage is rampant in pancreatitis
People with recurring pancreatitis have fewer
episodes when they take daily antioxidants

60
Pancreatitis Treatment Dogs and Cats

SECONDARY THERAPIES - As indicated
Heparin
Questionable efficacy in cats
Some think it is primary therapy for dogs why?
Even if not in DIC, they are hypercoagulable
May promote pancreatic microcirculation
Preventing a thromboembolism is
Way better than treating one

61
Pancreatitis Treatment Dogs and Cats

SECONDARY THERAPIES - As indicated
Antiemetics - controversial
Definitely make the patient more comfortable
May prevent death from vagal surge
Some would rather not cover up their vomiting
Metoclopramide, Cisapride
Ondansetron (Zofran), dolasetron (Anzemet) - 5HT3
antagonists 0.3-0.6 mg/kg SID to BID
Maropitant (Cerenia) - neurokinin-1 receptor
antagonist 1 mg/kg SID
Careful of phenothiazines why?
dont want hypotension

62
Pancreatitis Treatment Dogs and Cats

SECONDARY THERAPIES - As indicated
B vitamins (especially B12)
H2 blockers/H pump blockers, sucralfate/barium
if blood in the stool or vomit
May prevent reflux esophagitis if vomiting
is severe
Famotidine, Ranitidine, Cimetidine, (omeprazole)
There is some evidence cimetidine
and ranitidine might aggravate
pancreatitis in people

63
Pancreatitis Treatment Dogs and Cats

SECONDARY THERAPIES - As indicated
Treat hyperlipidemia
Handout
Hyperlipidemia predisoposes to pancreatitis
Calcium
Therapy rarely needed
Only if clinical signs, and calcium lt 6.5 mg/dl
Bicarbonate
Already discussed IV therapy
Some cats with severe chronic
pancreatitis need oral HC03

64
Pancreatitis Treatment Dogs and Cats

SECONDARY THERAPIES - As indicated
Surgery/laparoscopy
Biopsy to diagnose neoplasia in dogs and cats
Biopsy to diagnose pancreatitis in cats
Debridement
Restore bile flow (stent)
To treat abscesses or pseudocysts
That recur after US guided
drainage

65
Pancreatitis Treatment Dogs and Cats

SECONDARY THERAPIES - As indicated
Antihelminthics
In the rare case of liver flukes or pancreatic
flukes in cats
Fenbendazole
Praziquantel (high dose in notes)

66
Pancreatitis Treatment Dogs and Cats

CONTROVERSIAL THERAPIES
Dopamine CRI
Protective effect when administered to cats with
experimental pancreatitis within 12 hours
No effect after 12 hours
Can cause vomiting, nausea, seizures in cats
Peritoneal dialysis
To remove chemical irritants from the abdomen
When ascites (especially exudative)

67
Pancreatitis Treatment Dogs and Cats

CONTROVERSIAL THERAPIES
Oral pancreatic enzymes
Reported to reduce pain in people with
pancreatitis
Less likely to be effective in dogs because they
do not have a protease negative feedback
Some have observed clinical benefits
in dogs who have pain associated
with chronic pancreatitis

68
Pancreatitis Treatment Dogs and Cats

CONTROVERSIAL THERAPIES
Drugs to inhibit pancreatic secretion
Seem to work with experimental pancreatitis
Little effect in spontaneous pancreatitis
Glucagon
Gabexate mesylate, nafamostat mesylate
Atropine
Acetazolamide
Somatostatin
calcitonin

69
Pancreatitis Treatment Dogs and Cats

Patient Monitoring
TPR, blood pressure BID or more
Low body temp indicates big trouble
High fever spikes might indicate infection
Increased heart rate??
Pain
Hypovolemia (need more fluids)
Increased respiratory rate??
Pain
Pulmonary edema, pleural effusion, pneumonitis
acidosis

70
Pancreatitis Treatment Dogs and Cats

Patient Monitoring
Electrolytes/blood gases, lactate
SID-BID when critical
QOD when stable
Weigh BID when concerned about kidney function
Why?
Increase in body weight 10 is the first sign
of fluid retention
If you catch this early, you can prevent
pulmonary edema, and give your patient
more time to start making urine

71
Pancreatitis Treatment Dogs and Cats

Patient Monitoring
HCT
SID if stable
BID if phosphorus low, especially if DKA
Albumin
daily if lt1.5
QOD if gt2.0, as long as on fluid therapy
Monitor for DIC
Platelets
If decreasing, do PT, PTT, FDP/d-dimers, AT3

72
Pancreatitis Treatment Dogs and Cats

Patient Monitoring
Glucose
Every 2 hours when unstable
Give insulin ONLY as needed
Glucose can be very erratic in DKA
When stable enough, can do every 2 hours during
the day, and not overnight
If you MUST spot check, then do so 6 hours
after insulin (glucose low)
Insulin nadir is much more important
than peak when deciding dose

73
Pancreatitis Treatment Dogs and Cats

Patient Monitoring
Urine ketones if diabetic daily until stable
cPLI or fPLI
Long term, to monitor resolution of pancreatitis,
and need for ongoing dietary therapy and
antioxidant supplementation
Abdominal US
To follow resolution of pancreatic abscesses or
cysts

74
Treatment Canine Pancreatitis

Glucocorticoids contraindicated
NPO
At least 48 hours
Offer water after no vomiting for 24 hours
Offer food when no vomiting for 24 hours with
free choice water
2-3 very small meals the first day (2 teaspoons
to 2 tablespoons)
Gradually work up to full feed over 3-5 days
If any vomiting, start over at the top

75
Treatment Canine Pancreatitis

Nutrition
Low fat Why?
lt15-20 of calories
Low fiber, at first Why?
Can go to higher fiber later
Low protein Why?
lt25 of calories
Avoid turkey why?
Tryptophan potently stimulates the pancreas

76
Treatment Canine Pancreatitis

Nutrition
Suitable commercial diets
Hills I/D canned and dry
Medi-Cal Canine Gastro Formula canned and dry
Leo Specific Digest (CIW canned CID dry)
Purine CNM EN canned and dry
Select Care Canine Sensitive Formula canned and
dry
Home made food
Fat free cottage cheese and white rice is ideal

77
Treatment Canine Pancreatitis

Nutrition
Monomeric (elemental food)
Water soluble liquid foods in their simplest
nutritional state
Should in theory minimally stimulate the pancreas
Some have added glutamine to support enterocyte
recovery from disuse atrophy
Can cause diarrhea, as many are hyperosmolar

78
Treatment Canine Pancreatitis

3-5-7 Rule
If dog cant be fed PO within 5-7 days, consider
TPN, or PPN
Requires a central line, and monitoring multiple
times daily
Probably should not be administered while dog is
unattended (extravasation is bad)
Excellent catheter care is a must
Nutrients are expensive hundreds of dollars to
mix up a batch
Needs to be mixed aseptically, under a laminar
flow hood
Gut atrophy continues
TPN Resource Handout
After Recovery
2 weeks or more after recovery, consider
switching to low fat, high fiber diet
May or may not eventually be able to go back to a
maintenance type diet

79
Treatment Canine Pancreatitis

Nutrition
Suitable High Fiber Low Fat foods for long term
Hills R/D and W/D
Leo Specific CRW (canned) and CRD (dry)
Medi-Cal Canine Fibre Formula canned and dry
Medi-Cal Canine Weight Control/Geriatric canned
and dry
Purina CNM OM canned and dry
Purina CNM DCO dry, Purina CNM GL dry
Select Care Canine HiFactor Formula canned and
dry
Waltham/Pedigree Canine High Fiber canned and dry
Dogs with persistently high triglycerides
will probably have to stay on this type diet

80
Treatment Feline Pancreatitis

Glucocorticoids
Indicated for feline pancreatitis why?
Controlling concurrent IBD and cholangiohepatitis
will remove predisposition to pancreatitis
Can be immune mediated per se in cats
Prednisone 1 mg/lb/day
Dexamethasone 0.1 mg/kg every other day
Wean to lowest effective dose over 2-4 months,
after clinical response

81
Treatment Feline Pancreatitis