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 has 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
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."
