Therapy
Removal of Cause and Supportive Care - Whenever possible the inciting cause should be removed.
Exposure to unnecessary drugs, especially those implicated in causing pancreatitis in dogs or other
species, should be avoided. Aggressive fluid therapy is the mainstay of supportive therapy. Fluid,
electrolyte, and acid-base imbalances need to be assessed, and corrected as early as possible.
Alimentation - The traditional recommendation for any patient with pancreatitis is to give nothing per
os for three to four days. This recommendation is justified in patients that vomit, but there is little
evidence to justify this strategy in patients that do not. In fact, in people with severe acute pancreatitis,
early feeding is considered beneficial.8 Preferred routes of alimentation in patients kept NPO are a
jejunostomy tube or total parenteral nutrition. However, these strategies are impractical in many cases
and a gastrostomy tube or a nasogastric tube are acceptable alternatives if the patient does not vomit.
However, in dogs that do vomit, and where the patient should be held NPO for 3-4 days. After this time
water is slowly reintroduced, followed by small amounts of a carbohydrate-rich and low-fat diet.
Analgesia - Abdominal pain is commonly recognized in dogs with pancreatitis. However, the presence
of abdominal pain should be assumed and analgesic drugs are indicated in all canine patients with
pancreatitis. Meperidine, butorphanol tartrate, or morphine can be used parenterally. Other alternatives
are a fentanyl patch or the intraabdominal administration of lidocaine.
Plasma - Studies in dogs suggest that when α2-macroglobulin, one of the scavenger proteins for
activated proteases in serum, is depleted, death ensues rapidly. Fresh frozen plasma (FFP) and fresh
whole blood not only contain α2-macroglobulin, but also albumin, which has many beneficial
effects in patients with severe pancreatitis. However, in clinical trials in human patients with acute
pancreatitis no benefit of plasma administration could be identified.9 Regardless, the author believes
that FFP administration is useful in dogs with severe forms of pancreatitis.
Antibiotic Therapy - In contrast to humans, infectious complications in canine patients with pancreatitis
are rare in dogs. Therefore, the use of antibiotic agents should be limited to those cases when an
infectious complication can be identified or is heavily suspected.
Anti-inflammatory Agents - There is no data on the use of anti-inflammatory agents in dogs with
severe pancreatitis, but no benefit was found in human patients. In dogs with severe pancreatitis,
corticosteroids should only be used when secondary cardiovascular shock occurs. Corticosteroids may
be needed to treat dogs with IBD and concurrent mild chronic pancreatitis, and do not appear to be
harmful in these patients.
Other Therapeutic Strategies - Many other therapeutic strategies, such as the administration of trypsin-
inhibitors (e.g., trasylol), platelet activating factor inhibitors (PAFANTs), dopamine, antacids,
antisecretory agents (i.e., anticholinergics, calcitonin, glucagon, or somatostatin), or antioxidants and
surgical intervention all have been evaluated in human patients with pancreatitis. With the exception of
PAFANTs and selenium, none of these have shown any beneficial effect at this point. The efficacy of
selenium, which has also been shown to decrease mortality in dogs with pancreatitis in an uncontrolled
study, needs to be further evaluated before its use can be recommended.
Mild chronic pancreatitis - It should also be noted that many dogs have mild forms of chronic
pancreatitis. Often times these patients have concurrent conditions, most notably IBD. Very little is
known about appropriate therapy for these animals and management is often limited to evaluation and
treatment of the concurrent condition, and careful monitoring of the pancreatitis. Serum calcium and
triglyceride concentrations should always be evaluated in these patients in order to identify any risk
factors that can potentially be addressed therapeutically. Also, the use of low fat diets is recommended
in these patients. The use of corticosteroids in patients with mild chronic pancreatitis is controversial. A
subset of human pancreatitis patients is being diagnosed with immune-mediated pancreatitis. These
patients respond well to corticosteroid administration. Many dogs with chronic pancreatitis show
lymphocytic-plasmacytic infiltration of the exocrine pancreas, similarly to what can be observed in
human patients with immune-mediated pancreatitis. Thus, dogs with mild chronic pancreatitis may also
respond favorably to corticosteroid administration. Just as in human patients with chronic pancreatitis,
patients with mild chronic pancreatitis are at risk for developing episodes of severe pancreatitis at any
time or exocrine pancreatic insufficiency later in life.
Prognosis
The prognosis for dogs with pancreatitis is directly related to disease severity, extent of pancreatic
necrosis, occurrence of systemic and pancreatic complications, duration of the condition, and the
presence of concurrent disease.
REFERENCES:
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8. Gupta R, Patel K, Calder PC, et al. A randomised clinical trial to assess the effect of total enteral and
total parenteral nutritional support on metabolic, inflammatory and oxidative markers in patients with
predicted severe acute pancreatitis (APACHE II > or =6). Pancreatology 2003; 3:406-413.
9. Leese T, Holliday M, Watkins M, et al. A multicentre controlled clinical trial of high- volume fresh
frozen plasma therapy in prognostically severe acute pancreatitis. Annals of the Royal College of
Surgeons of England 1991; 73:207-214.
Source:
Harris County Veterinary Medical Association
http://www.hcvma.org/notes/SpeakerNotesJorgSteiner.pdf