Feline pancreatitis is a complex disease and therefore often goes undiagnosed. Cats with pancreatitis have subtle clinical manifestations, which mainly include lethargy, decreased appetite, dehydration, and weight loss. Physical examination and routine laboratory tests have no specific manifestations, and diagnostic tools for pancreatitis are limited. We can now purchase FPL (feline pancreatic-specific lipase) rapid test to diagnose and monitor cats with pancreatitis.

1. Treatment of cat pancreatitis

The main treatments for feline pancreatitis include intravenous fluid infusion, analgesia, and nutritional support. Many cats with pancreatitis develop complications (such as diabetes, fatty liver disease, cholangiohepatitis, and inflammatory bowel disease). Correct diagnosis and management of pancreatitis and its complications are critical to successful treatment.

2. Infusion therapy

Infusion of sick animals can ensure adequate perfusion of the pancreas. Hospitalized animals should be rehydrated within the first 12-24 hours to correct dehydration, while ensuring the maintenance of body water and replenishing the amount of water that is being lost and the amount that is being lost.

Acid-base ion disorders should be closely monitored and corrected. If hypocalcemia occurs, it should be supplemented with calcium gluconate at a dose of 50-150 mg over 12-24 hours, and serum calcium concentrations should be monitored. Use colloid solutions such as dextran or hydroxyethyl starch for rehydration to increase colloid osmotic pressure, especially when sick animals have hypoalbuminemia.

Plasma should be transfused when there is evidence of coagulation abnormalities or disseminated intravascular coagulation (DIC).

3. Analgesia management

Cats with pancreatitis rarely present with abdominal pain. However, many cats experience significant clinical improvement with analgesic therapy; therefore, all cats with acute pancreatitis should be given analgesic therapy. Opioids are recommended. One recommended procedure is to administer a sedative such as buprenorphine intravenously for immediate analgesia, followed by a fentanyl patch to maintain long-term analgesia. Cats with chronic pancreatitis may also improve their condition with analgesic treatment. Outpatient analgesic treatments include fentanyl patches, sublingual buprenorphine, and oral butorphanol or tramadol.

4. Antiemetic treatment

Cats with pancreatitis may not vomit or may vomit intermittently. It is recommended to administer antiemetics to stop vomiting when vomiting occurs, and to suppress nausea when vomiting does not occur. Metoclopramide (Reglan®) remains a popular antiemetic. However, since metoclopramide is a dopamine antagonist, it works by blocking the chemoreceptor trigger zone (CRTZ) can achieve the purpose of inhibiting vomiting by using central nervous system (CNS) dopamine receptors. Since cats have a small number of central nervous system dopamine receptors in the chemoreceptor trigger zone, for cats, metoclopramide is used to stop vomiting. Vomiting is basically ineffective.

Dolasetron (Anzemet®) and ondansetron (Zofran®) act on the serotonin HT3 receptor at the CRTZ and are very effective in cats. Maropitant citrate (Cerenia®) acts on neurokinin (NK) receptors in the vomiting center. Its instructions for use indicate that it is only used in dogs, but the drug has become widely popular and well-established among feline doctors. Effective medicine.

5. Nutritional support

Previous recommendations that animals with pancreatitis should be fasted (NPO) are no longer accepted by the veterinary community.

In addition, if insufficient calories are not provided, it is easy to cause fatty liver in cats. External nutrition can stabilize the gastrointestinal barrier, improve the health of intestinal epithelial cells and immune function, improve gastrointestinal motility, prevent catabolism, and reduce morbidity and mortality. Cats with pancreatitis are reluctant to exercise and therefore do not consume large amounts of food to provide sufficient calories. Force feeding is not recommended. Not only does force feeding fail to provide sufficient caloric intake, on the contrary, it may cause food resistance in cats. External nutrition can be provided through a variety of feeding tubes, including nasogastric tubes, nasogastric feeding tubes, esophagostomy feeding tubes, gastrostomy feeding tubes, or jejunostomy feeding tubes.

If vomiting cannot be effectively controlled, peripheral intravenous nutrition (PPN) or total parenteral nutrition (TPN) support should be performed. However, parenteral nutrition cannot nourish intestinal epithelial cells. Therefore, feeding food through a feeding tube in a trickle allows the intestinal epithelium to be nourished and prevents possible complications of fasting.

6. Diet choices

There are currently no studies on dietary choices in cats with pancreatitis. In cats, high-fat foods do not necessarily cause pancreatitis. However, many medical veterinarians choose to avoid feeding high-fat foods when treating pancreatitis in cats. Liquid diets are required when using nasogastric tubes, nasogastric tubes, and jejunostomy feeding tubes. The existing CliniCare® canine and cat liquid food on the market has a high fat content, but we usually still use it for tube feeding of cats with pancreatitis. Artificially formulated liquid foods contain too little protein and are not recommended for cats. When placing an esophagostomy feeding tube or a gastrostomy feeding tube, low-residue, low-fat, easily digestible mixed canned foods may be used.

Dietary recommendations for cats with pancreatitis vary based on the opinions of each veterinarian. Allow trial and error to occur in the hope thatObtain a suitable diet formula for a particular affected cat. Cats with pancreatitis often have complications. If the cat only has pancreatitis and no other complications, you can choose to feed it with high digestibility and low residual food. However, if it is complicated by intestinal disease, new protein food will be a better choice.

7. Stimulate appetite

Stimulating appetite can help cats with pancreatitis absorb calories, reduce the need for feeding tubes, reduce long-term dependence on feeding tubes, and help remove feeding tubes. Mirtazapine (Remeron®) and cyproheptadine are two effective appetite stimulants in cats. The use of the former is not indicated in its indications.

8. Glucocorticoid treatment

It is very common for cats with pancreatitis to develop other complications. We use the term "trisomy" to describe the combination of cholangiohepatitis, inflammatory bowel disease, and pancreatitis. Treatment with anti-inflammatory doses of prednisone, prednisolone, or dexamethasone is not inappropriate in these affected cats. In fact, only cats with chronic pancreatitis improved when treated with anti-inflammatory doses of corticosteroids.

9. Antibiotic treatment

Feline pancreatitis is usually a sterile inflammation, and antibiotics are rarely used. Antibiotics can cause nausea and vomiting in cats, so they are generally not used unless indicated. In cases such as sepsis (possibly due to bacterial transfer from the gastrointestinal tract), bacterial peritonitis, other infections (such as feline urinary tract infections), and in those with suppurative cholangiohepatitis and suspected suppurative pancreatitis, this may be required Indications for antibiotic therapy.

10. Anti-acid treatment

The use of H2 receptor antagonists (ranitidine or famotidine) or proton pump inhibitors (pantoprazole) is generally not recommended, but should be considered when gastrointestinal ulceration is suspected. ​​​​​​

　11. Antioxidant treatment

Some basis is needed for considering antioxidant treatment in cats with pancreatitis. Vitamins C and E, silymarin, S-adenosylmethionine (SAMe), and omega-3 fatty acids can be prescribed. Veterinary products on the market include MarinTM (vitamin E and silymarin), Denosyl® (SAMe) and Denamarin® (SAMe and silymarin), which are all antioxidant drugs that can be used in cats.

Supplementing cobalamin (vitamin B12) cobalamin (vitamin B12) is aA water-soluble vitamin that is absorbed in the ileum. Decreased serum cobalamin concentrations may be seen in cats with gastrointestinal disease. Feline pancreatitis is often accompanied by inflammatory bowel disease, so it is recommended to measure the cobalamin concentration in the serum of affected cats. Cobalamin can be supplemented by parenteral injection at a dose of 250 μg per week for 6 weeks; thereafter, the same dose of cobalamin is injected every two weeks for 6 weeks; and monthly thereafter.

12. Insulin treatment

Cats with acute pancreatitis can become insulin resistant and develop transient diabetes. This type of diabetes can resolve, but it can also be life-long, especially if chronic pancreatitis persists. Insulin treatment should be tailored to each cat. The amount of insulin used varies with the severity of pancreatitis.

　13. Monitoring

Hospitalized animals require close monitoring. Monitor body weight and respiratory rate to ensure infusion is being tolerated. Blood pressure and urine output should be assessed daily. Repeat laboratory testing at regular intervals to monitor the course of the disease in affected cats. Hospitalized cats can have repeated monitoring of SpecfPL concentrations every 2-3 days to assess pancreatic inflammation. How often cats cared for at home need to be re-evaluated depends on the progression of their disease, the presence of complications, and their treatment plan. Initially it is necessary to come to the hospital every two weeks for assessments of energy levels, appetite and weight. Whether laboratory testing is performed depends on the status of their complications, and measurement of SpecfPL concentration levels can be used as a tool to evaluate pancreatitis.

When treated with corticosteroids, cats must be reexamined 10-14 days after starting treatment. Whether to continue or discontinue treatment depends on clinical response and trends in laboratory test results, including SpecfPL. Cats with concurrent pancreatitis and intestinal disease should have cobalamin and SpecfPL concentrations checked again one month after starting cobalamin supplementation.

　14. Prognosis

The prognosis of feline pancreatitis is related to the severity of the disease. Acute severe pancreatitis, especially after systemic complications, has a poor prognosis. Hypocalcemia is a complication of acute necrotizing pancreatitis in cats and also carries a poor prognosis8. Cats with concurrent episodes of acute pancreatitis and fatty liver disease have a worse prognosis than cats with fatty liver disease alone.

Chronic pancreatitis is very common in cats and requires long-term management and the owner’s due diligence. In addition, pancreatitis may need to be managed in conjunction with concurrent medical conditions such as diabetes, inflammatory bowel disease, and cholangiohepatitis, and the health of these affected cats depends on successful resolution of all complications.