Pancreatitis in cats
Spot the signs of pancreatitis in cats and get expert advice on treatment, including recommended diets and treatment for feline pancreatitis.
The pancreas is an abdominal organ, situated close to the stomach and duodenum (the first part of the small intestine).
It has two main jobs and each job is done by specific clumps of tissue. One type of tissue, the exocrine pancreatic tissue, produces digestive enzymes that run down a small tube called the pancreatic duct, into the duodenum; the second type of tissue, known as the endocrine pancreatic tissue, produces chemicals including insulin that regulate blood glucose levels.
What is feline pancreatitis?
When the exocrine pancreas becomes inflamed, we call this pancreatitis. The digestive enzymes secreted by the pancreas shouldn’t become activated until they reach the small intestine, but if something activates them sooner, they begin to digest the pancreas itself. Cats aren’t the only ones to suffer from pancreatitis – humans and dogs can also get it.
Feline pancreatitis is thought to be much more common than people realise. One reason it is underdiagnosed is that the clinical symptoms are vague and non-specific and can also be mild. A vomiting or collapsed cat, or one who just doesn’t seem themselves, could both be suffering from pancreatitis, as well as from many other conditions. Cats tend not to show clear signs of abdominal pain, so not all cats who have been a little quiet for a few days are taken to see their vet, even though they may be feeling much worse than they look.
We divide feline pancreatitis into two clinical types. The difference between the two is strictly made on microscopic examination of the pancreas. However, the delicate pancreas is rarely biopsied, so we normally make this distinction according to the clinical presentation and severity. Chronic pancreatitis appears to be more common than acute pancreatitis. Some cats with chronic pancreatitis show few to no signs at all that they are unwell, whereas acute pancreatitis can cause much more severe symptoms. Even so, there is some overlap between the two types, in terms of symptoms and in diagnostic testing.
What are the symptoms of pancreatitis in cats?
Feline pancreatitis can produce a wide spectrum of symptoms. In both acute and chronic feline pancreatitis, cats usually seem lethargic and inappetent. In one study of cats with pancreatitis, lethargy was the only symptom in almost one-fifth of the cats. The same study found that around two-thirds of the cats did not want to eat. Between one-third and about half of the cats were vomiting. When they were examined by vets, half of the cats had an abdominal mass. Some of the less frequently seen symptoms include jaundice, a high or low temperature and dehydration.
Sometimes, the severe symptoms seen in cats with pancreatitis are signs of complications or associated conditions. These include collapse and shock related to diabetes, organ failure or blood clotting problems.
How is feline pancreatitis diagnosed?
Feline pancreatitis can be challenging to diagnose. The symptoms are often either difficult to recognise (cats don’t make it obvious when they have abdominal pain, for instance) or they are non-specific, which means that they also feature in other diseases. Many of the changes seen in blood tests occur commonly in other conditions. A specific blood test is available in many vet practices that looks at the levels of an enzyme called feline pancreatic lipase (fPL). While this is useful in diagnosing acute feline pancreatitis, it may not pick up every mild, chronic case. If a cat has a positive or borderline result using this test, the sample is usually submitted to a laboratory to confirm this and measure the exact levels of the enzyme.
Diagnostic imaging may be helpful. Abdominal X-rays can rule out other possible reasons for the symptoms, while X-rays of the chest may identify signs associated with complications of feline pancreatitis. Ultrasound scanning of the pancreas varies in its ability to pick up mild changes. However, when scanning detects certain changes to the fat around the pancreas in a cat displaying symptoms suggestive of pancreatitis, it’s very likely that this is the correct diagnosis.
I think my cat might have pancreatitis. What should I do?
If you’re worried that your cat could be showing signs of pancreatitis, however mild, it’s important to make an appointment for them to see their vet. The vet will listen to your concerns and ask you some questions about your cat’s symptoms and history. They’ll examine your cat from nose to tail and they’ll be considering all possible causes for what you’re seeing at home. Depending on what they find, they may suggest further investigations, such as blood tests or diagnostic imaging.
Sometimes, the results from one test will suggest the need for further testing, for example, an initial blood test might lead to a second type of testing on the sample. Tests that produce a negative result help to narrow down the list of possible causes, so they are as useful as tests that show a positive result.
Your vet may need to hospitalise your cat to support and treat them even while tests are being processed. Severe complications can develop quickly in cats who are not eating and your vet may suggest placing a feeding tube to prevent these from happening. If your cat’s symptoms seem mild, you may be able to take them home, perhaps with some initial treatment, while you await test results.
Treatment for pancreatitis in cats
Early medical support for cats with acute pancreatitis is critical. The pancreas is sensitive to reduced blood supply and blood pressure so, if your vet suspects acute pancreatitis in your cat, they will discuss the treatment options with you.
We can’t always tell whether a cat has abdominal pain or nausea, but antiemetics (drugs that reduce vomiting and nausea) are given to cats with pancreatitis. Some antiemetic drugs also provide pain relief, while others speed up the passage of food along the intestinal tract, taking it away from the stomach and pancreas.
Medications to reduce stomach acidity may be used. They can protect the oesophagus and stomach lining from stomach contents and help to prevent ulcers from developing.
Pancreatitis is a painful condition in humans and we can see signs of pain in dogs when they have it. Therefore, we must also assume that cats are in pain when they have pancreatitis, even though they may not show it. If your cat is hospitalised with pancreatitis, powerful pain relief will be administered by injection or through the drip. If your vet has said that your cat can be managed at home, they may give you a strong pain relief medicine that can be given under your cat’s tongue.
Cats can develop severe complications, in particular, a serious liver condition called hepatic lipidosis, if they don’t eat. If your cat is hospitalized, your vet may need to place a special feeding tube to enable calories and nutrients to be given even when your cat doesn’t feel like eating. Two main types of tubes are normally used – one type goes up the nose and into the oesophagus while the other is inserted through the skin and into the oesophagus. This may sound drastic, but it’s vital that cats continue to receive food. Feeding tubes are usually tolerated well by cats and they can still eat if they choose to.
Many owners would like to be able to find a way of treating pancreatitis in cats naturally. Feline pancreatitis is a condition in which many cats with mild, chronic symptoms can lead a virtually normal life. However, the majority of those cats who develop acute pancreatitis will only survive with immediate, intensive medical and nutritional support.
Complications of feline pancreatitis
Both acute and chronic pancreatitis can lead to complications. Cats with acute pancreatitis can quickly develop life-threatening or fatal conditions. Sepsis, which occurs when the immune system is triggered and begins to attack the body itself, can lead to multi-organ failure. Shock and serious blood clotting problems may also occur.
Hepatic lipidosis (also known as fatty liver syndrome) is a life-threatening condition that can develop in cats who haven’t been eating for any reason, particularly if they are overweight. It occurs as part of what we call a starvation response. The cat’s body releases stored fat to burn for energy, but this can overwhelm the liver’s processing capabilities and the fat clogs up the liver and prevents it from working properly. Cats with hepatic lipidosis may develop jaundice (yellowing of the body tissues – best seen on the ears, gums and whites of the eyes) and only have a chance of survival if they are given immediate, intensive therapy. This is why it’s so important to have your cat checked by your vet if they aren’t eating.
Diabetes mellitus (DM) and feline pancreatitis sometimes occur together, although which one leads to the other is a complicated question. Hyperglycaemia, where there is high blood glucose, as seen with DM, has been shown to lead to pancreatitis. On the other hand, pancreatitis causes damage to and loss of the cells required to make insulin, which can lead to DM. In cats with both conditions, improvements in the severity of pancreatitis can mean that the dose requirement for insulin suddenly drops, so these cats need careful monitoring at home to make sure they don’t become hypoglycaemic, which means that their blood glucose drops dangerously low.
Other conditions sometimes go hand-in-hand with feline pancreatitis although they are not complications, as such. Inflammatory bowel disease (IBD) is often seen in cats with pancreatitis and requires regular monitoring and careful management. Sometimes, both pancreatitis and IBD occur alongside cholangitis (inflammation of the network of ducts that transport bile from the liver to the small intestine), in a condition known as triaditis.
What is the best diet for a cat with pancreatitis?
It’s vital that cats with pancreatitis continue to receive calories and nutrients to prevent liver problems that may occur if their bodies produce a starvation response. Unsurprisingly, many of them can’t face food when feeling unwell. If your cat has been hospitalised with acute pancreatitis, they may have been fed via a tube that was placed either through their nose or through the side of their oesophagus. The nursing team will try to encourage cats to eat tempting food but they try to avoid feeding longer-term diets to cats who are feeling really unwell in hospital, as this can create food aversions and rule out their use in future.
Once your cat is home and feeling a bit better, they may be much more likely to want to eat. They could also have been sent home with medicine to increase their appetite. The most important thing is that they continue to take in high-quality nutrients and calories, so it makes sense to choose a balanced diet appropriate to your cat’s age. You might find that providing some of the diet as small portions of warmed pouch or tray food, helps to encourage them to eat. Cats are very much individuals, of course, and some may prefer their usual dry food. In many ways, the best food for a cat with pancreatitis and no other problems is their own preferred diet!
Dogs with pancreatitis generally benefit from being fed on low-fat diets. Although there is currently no substantial evidence to say that the same applies to cats, some people find that their cats with pancreatitis also do well if they are fed a diet that’s low in fat.
Often, cats who have pancreatitis also have other problems alongside it, for instance, diabetes mellitus (DM) or inflammatory bowel disease (IBD). When choosing what to feed a cat with pancreatitis, you’ll need to take into account these concurrent conditions and you may need to prioritise these. A cat with DM will require a high-protein, low-carbohydrate diet, while a cat with IBD will need to be fed on a hypoallergenic diet and may need vitamin B supplementation. Your vet team will advise you on the best diet for your cat’s needs.
In some cases, pancreatitis causes enough long-term damage to the pancreas that the cells that produce digestive enzymes can’t make enough to digest the food properly, which leads to diarrhoea and weight loss. These cats can live a normal life if they are given a supplement of replacement pancreatic enzymes in their food.
What's the prognosis for cats with pancreatitis?
The prognosis and life expectancy of cats with pancreatitis varies, depending on the severity and type of disease and on the ability to diagnose and treat it as soon as possible.
If cats with acute pancreatitis are given early, intensive medical and nutritional support, they can recover and go on to lead normal lives. Sadly, other cats suffer complications, or the cost of intensive or sustained treatment may be outside their owners’ reach.
Some cats will suffer occasional bouts of pancreatitis throughout their lives and will need veterinary care at these times.
Cats with chronic pancreatitis can often be managed at home, long-term. Provided a close eye is kept on them any other conditions they have are also addressed and treated, they can do well and lead normal lives.
A cat with pancreatitis often has a poor appetite, so the most important thing is that they do eat enough food. If your cat has been in hospital with pancreatitis, they may have been fed by a tube to ensure that they receive the calories and nutrients they need. The nursing team will have encouraged your cat to eat by themselves, by offering tempting, small meals. When cats feel unwell, they often associate the food to which they’re exposed at that time with feeling ill and they may develop an aversion to it. If your cat is just home from hospital, it may be best to continue with a different diet from that which you would normally feed until they seem more like themselves. If you reintroduce their usual diet too soon, you may inadvertently put them off it.
Unlike the situation in dogs, diet seems to play a more minor part in the cause and management of feline pancreatitis. Taking into account other conditions your cat may have, an age-appropriate, high-quality diet of the type your cat prefers to eat should be fine for them. Your vet team can help you to choose the right diet if you’re not sure.
Pancreatitis can affect all ages and breeds of cat. Because we don’t yet know what causes the majority of cases, it isn’t easy to know how to prevent it. Until more evidence comes to light, the best prevention is to maintain your cat at a healthy body weight, which will help them to avoid becoming diabetic (since high blood sugar from diabetes mellitus is a risk factor for pancreatitis). Encourage them to lead an active, healthy lifestyle. If you notice anything untoward, particularly a lack of energy or appetite, weight loss or more than occasional vomiting or diarrhoea, or a change in drinking habits, make an appointment to have them checked by your vet.
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