Chronic Pancreatitis and
the Cavalier King Charles Spaniel
The cavalier King Charles spaniel is one of four canine breeds found to have an increased risk for chronic pancreatitis. The other breeds are the Cocker spaniels, collies, and boxers.
What It Is
The pancreas is a gland which consists of about 98% exocrine acinar cells
and 2% endocrine islets. The exocrine cells secrete enzymes* which aid the
digestion of protein in the smaller intestine. The endocrine cells secrete
insulin, which helps control carbohydrate metabolism, and glucagon, which
offsets the action of the insulin.
*Enzymes secreted include lipase, alpha-amylase,
phospholipase and the proteolytic enzymes elastase, chymotrypsin, and
trypsin.
A normally functioning pancreas is protected from premature activation of these caustic digestive enzymes, which could result in digesting the pancreas itself. Pancreatitis occurs when the enzymes are activated while still in the pancreas, thereby causing death to its tissue by auto-digestion.
Pancreatitis is a common inflammatory disorder of the dog's pancreas, which can be either "acute" or "chronic". Acute pancreatitis is an inflammation which does not cause permanent damage to the pancreas and therefore is potentially reversible. Chronic pancreatitis, for which the cavalier is at an increased risk, is a continuous inflammation which can cause permanent damage to the pancreas’ exocrine and endocrine tissues and result in insufficient creation and secretion of its enzymes, particularly an exocrine pancreatic insufficiency (EPI).
The end stage of chronic pancreatitis may result in diabetes mellitus, due to extensive destruction of pancreatic tissues.
Symptoms
Classic signs of chronic pancreatitis include abdominal pain, vomiting, and loss of appetite. The pain can be severe and may cause the dog to take a “praying” position. The affected dog may also pass diarrhea or voluminous feces, with small amounts of fresh blood and/or mucous.
The clinical signs of pancreatitis will vary with the severity of the disease. Low-grade cases may not show all of the classic symptoms and may be confused with inflammatory bowel disease. In severe cases, the dog may become dehydrated, may collapse, be in shock, and may even suffer renal shutdown and distressed breathing.
If a dog which has diabetes mellitus suddenly begins to lose weight unexpectedly, despite having a good appetite and being under diabetic control, the dog may have developed an exocrine pancreatic insufficiency due to pancreatitis.
Diagnosis
Low grade chronic pancreatitis can be difficult to diagnose because their symptoms can be confused easily with other conditions. Recent studies have found a high rate of under-diagnosis of chronic pancreatitis in dogs.
The “gold standard’ for diagnosing pancreatitis is a biopsy by making an incision through the abdominal wall. Alternatives to biopsies include blood tests, enzyme assays, x-rays, and ultrasounds. Usually blood counts, pancreatic enzyme assays and x-rays are conducted in combination, as any one alone would be insufficient to accurately diagnose chronic pancreatitis.
Enzyme assays -- catalytic, immuno, and enzymatic -- involve measuring levels of circulating pancreatic enzymes, including lipase, amylase, trypsin (cTLI), and canine pancreas specific lipase (cPLI). Measurement of elevated circulating enzymes, including amylase, lipase, cTLI, and cPLI currently are the best tests available for diagnoses.
Ultrasounds can be very specific for pancreatitis, depending upon the extent of inflammation, when performed by skilled operators. Therefore, pancreatic ultrasounds should be performed by ultrasound specialists. Low grade chronic pancreatitis is the most difficult to detect using ultrasound.
Researchers are constantly seeking to improve the accuracy of diagnosing pancreatitis. IDEXX Laboratories claims that its Spec cPL test is the most accurate, even more so than ultrasounds. See the IDEXX website for details.
Other diagnostic tests are being studied, including peptides in the blood and urine, and levels of inflammatory mediators and cytokines in the blood.
Treatment
Unless a specific cause has been determined, most cases of pancreatitis are treated to relieve the symptoms. If the cause is known (more likely in acute cases than chronic ones), the treatment includes removing that cause.
Mild cases with vomiting and dehydration may require oral or intravenous fluids and pancreatic rest, meaning no solid food, followed by a change to a more appropriate diet. Hospitalization may be required to assure proper treatment and rest.
Antiemetics may be prescribed to reduce excessive vomiting, but they may have side effects which could increase pancreatic pain. A phenothiazine antiemetic such as chlorpromazine may avoid the additional pain, but it is not licensed for use by small animals.
Since pancreatitis can be very painful, hospitalized dogs may be given analgesia such as a morphine agonist or partial agonist, particularly buprenorphine. Non-steroidal anti-inflammatory drugs (NSAIDs) usually are not given because of an increased risk of gastroduodenal ulceration and a potential renal failure reaction.
A long-term low fat diet, along with supplementary enzymes, likely will be recommended.
Severe cases, in which the tissue has begun to die (necrotize) and the liver has been affected, are unlikely to recover.
Related Links
Carol Fowler's Cavalier Campaign Website
EPI (Exocrine Pancreatic
Insufficiency)-4-Dogs Website
Veterinary Resources
Control of Canine Genetic Diseases. Padgett, G.A., Howell Book House 1998, pp. 198-199, 232.
Pancreatitis in the dog:. dealing with a spectrum of disease. Penny Watson. In Practice, Feb 2004; 26:64-77.
Prevalence and breed distribution of chronic pancreatitis at post-mortem examination in first-opinion dogs. P. J. Watson, A. J. A. Roulois, T. Scase, P. E. J. Johnston, H. Thompson, and M. E. Herrtage. J Small Animal Prac (2007) 48:609–618. Quote: "Cavalier King Charles spaniels, collies and boxers had increased relative risks of chronic pancreatitis."
Breed Predispositions to Disease in Dogs & Cats (2d Ed.). Alex Gough, Alison Thomas. 2010; Wiley-Blackwell Publ. 52.
Prevalence of hepatic lesions at post-mortem examination in dogs and association with pancreatitis. P. J. Watson, A. J. A. Roulois, T.J. Scase1, R. Irvine, M. E. Herrtage. J. Sm. An. Prac. Nov 2010;51(11):566–572. Quote: "To assess the prevalence of canine chronic hepatitis (CH) and other liver diseases in first opinion practice and identify associations with concurrent chronic pancreatitis (CP). ... The prevalence of CH was 12%. Some breeds had an increased RR of CH, although sample sizes were small. Dogs with CP had an increased RR of reactive hepatitis but no significant association with the other liver diseases. ... CH is common in the first opinion dog population but less common than CP. CP was significantly associated with reactive hepatitis but not CH. Possible breed associations mirrored another recent UK study. Some dogs with CP may be erroneously diagnosed clinically as having CH on the basis of increased serum liver enzymes because of concurrent reactive hepatitis if the diagnosis is not confirmed histologically."
Observational study of 14 cases of chronic pancreatitis in dogs. P. J. Watson, J. Archer, A. J. Roulois, T. J. Scase, M. E. Herrtage. Vet. Rec. Dec. 2010;167(25):968-976. Quote: "This study reports the clinical, clinicopathological and ultrasonographic findings from dogs with chronic pancreatitis (CP). Fourteen dogs with clinical signs consistent with CP and histological confirmation of the disease were evaluated. ... (...two Cavalier King Charles spaniels). ... Spaniels were the most common breed with CP, representing seven of the 14 dogs in this study. ... ...with Cavalier King Charles and cocker spaniels having a perilobular pattern, while other breeds had an intralobular distribution... There were a large number of spaniels in the current study, mirroring a pathology study (Watson and others 2007) that found an increased relative risk of pancreatitis in Cavalier King Charles and cocker spaniels, providing further evidence for breed-related disease in spaniels. ...CP was histologically severe in nine cases. Most dogs showed chronic low-grade gastrointestinal signs and abdominal pain. Five dogs had exocrine pancreatic insufficiency and five dogs had diabetes mellitus. The sensitivity of elevated trypsin-like immunoreactivity for CP was 17 per cent. The sensitivities of canine pancreatic lipase immunoreactivity, lipase and amylase for CP were 44 to 67 per cent or 14 to 28 per cent depending on the cut-off value used. Cholesterol was elevated in 58 per cent of samples. Liver enzymes were often elevated. The pancreas appeared abnormal on 56 per cent of ultrasound examinations. Ten dogs had died by the end of the study period; only one case was due to CP. CHRONIC pancreatitis (CP) in dogs is poorly documented clinically. However, a recent study reported the prevalence of CP to be 34 per cent in postmortem examinations of dogs from first opinion practice ... ."
Sensitivity and Specificity of Canine Pancreas-Specific Lipase (cPL) and Other Markers for Pancreatitis in 70 Dogs with and without Histopathologic Evidence of Pancreatitis. S. Trivedi, S.L. Marks, P.H. Kass, J.A. Luff, S.M. Keller, E.G. Johnson, B. Murphy. J Vety Int Med Nov/Dec 2011;25(6):1241-1247. Quote: "Pancreatitis is a common disorder in dogs for which the antemortem diagnosis remains challenging. Objectives: To compare the sensitivity and specificity of serum markers for pancreatitis in dogs with histopathologic evidence of pancreatitis or lack thereof. Animals: Seventy dogs necropsied for a variety of reasons in which the pancreas was removed within 4 hours of euthanasia and serological markers were evaluated within 24 hours of death. Methods: Prospective study: Serum was analyzed for amylase and lipase activities, and concentrations of canine trypsin-like immunoreactivity (cTLI) and canine pancreas-specific lipase (cPL). Serial transverse sections of the pancreas were made every 2 cm throughout the entire pancreas and reviewed using a semiquantitative histopathologic grading scheme. Results: The sensitivity for the Spec cPL (cutoff value 400 μg/L) was 21 and 71% in dogs with mild (n = 56) or moderate-severe pancreatitis (n = 7), and 43 and 71% (cutoff value 200 μg/L), respectively. The sensitivity for the cTLI, serum amylase, and lipase in dogs with mild or moderate-severe pancreatitis was 30 and 29%; 7 and 14%; and 54 and 71%, respectively. The specificity for the Spec cPL based on 7 normal pancreata was 100 and 86% (cutoff value 400 and 200 μg/L, respectively), whereas the specificity for the cTLI, serum amylase, and lipase activity was 100, 100, and 43%, respectively. Conclusion and Clinical Importance: The Spec cPL demonstrated the best overall performance characteristics (sensitivity and specificity) compared to other serum markers for diagnosing histopathologic lesions of pancreatitis in dogs."
