There are many differential diagnoses to consider for a dog that presents with vomiting and abdominal pain. One possible and common cause is pancreatitis.
The pancreas is an abdominal organ vital to many functions. The exocrine pancreas produces and secretes enzymes and other factors involved in the digestion of food, absorption of nutrients (cobalamin / vitamin B12), and regulation of the bacterial flora of the small intestine. The pancreas is also an endocrine organ - it produces and secretes a variety of hormones including insulin, glucagon, and gastrin. These hormones are also involved in digestion and the absorption of nutrients.
Pancreatitis is a disorder affecting the exocrine pancreas. Although dogs of any age, breed, and sex can develop the condition it is more commonly seen in dogs 5 years of age or older. Some breeds have been suspected to be at greater risk including Miniature Schnauzers, Cocker Spaniels, Cavalier King Charles Spaniels, and Yorkshire Terriers, however a definitive breed predisposition for this disease has not been identified.
Potential risks or contributing factors have been suggested for pancreatitis including:
Clinical Signs are variable and range from mild to severe. Clinical signs can include:
Pancreatitis is not always an easy diagnosis to make. Short of a biopsy of the pancreas, there is no single test that can definitively diagnose pancreatitis. Making a clinical diagnosis is dependent on the collection of several pieces of information including the history, physical exam, and blood work. Abdominal radiographs of patients with pancreatitis may demonstrate a variety of nonspecific findings, and this method of imaging has been shown to have very low sensitivity for making a diagnosis of pancreatitis. Conversely, an abdominal ultrasound can be very helpful and is the preferred method of imaging in suspected pancreatitis cases.
Although blood analysis of amylase and lipase levels is commonly included in the work-up, these measurements have been shown to have poor sensitivity and specificity for making a diagnosis of pancreatitis in dogs. Additional laboratory tests and diagnostic assays have been developed including: SNAP canine pancreatic lipase (cPL), specific cPL (Spec cPL), VetScan cPL Rapid Test, and the Precision PSL - some are point-of-care tests that can be run in the veterinarian's office. These tests are approximately 80% accurate in matching with a diagnosis pancreatitis in dogs. Learn More about these assays
The disease varies in severity from mild to severe, and the mortality rates in dogs with severe cases of pancreatitis range between 27% to 58%. Many recommended therapies are based on findings from experimental studies in other species, and there is no definitive treatment for this condition - rather it is supportive in nature to manage physiologic / “first principles” including:
- Hydration, electrolyte, and acid-base status: dogs with pancreatitis can develop varying degrees of dehydration in association with vomiting, diarrhea, and decreased water intake
- Pain control: abdominal pain in dogs with pancreatitis can range from mild to severe and management typically includes use of opioids
- Nausea & Vomiting: antiemetic drugs are commonly prescribed in dogs that appear nauseous or that are vomiting
- Nutrition: ensuring adequate nutritional support - enterally or parenterally - early in the course of illness should be considered a priority - Learn more
- Blood or plasma transfusion: blood constituents including proteinase inhibitors, albumin, as well as coagulation and anticoagulation factors may be beneficial in dogs with severe pancreatitis
Antibiotic administration prophylactically is not generally considered to benefit dogs with pancreatitis. Although surgical management of pancreatitis is rarely recommended, surgical intervention may be considered in cases in which complications of pancreatitis arise including pancreatic abscess or pseudocyst formation, necrosis, or extrahepatic biliary obstruction.
Learn More on Pancreatitis, Treatment, and Nutritional Management
