Pancreatitis is an inflammatory condition of the pancreas that occurs frequently in dogs. It can range in severity from mild cases that resolve with just a day or two of supportive care to severe, life-threatening cases that require aggressive treatment such as surgery. Determining whether a dog with pancreatitis needs surgery is based on several factors.
What is pancreatitis in dogs?
The pancreas is an organ located near the stomach that has two main functions: the production of digestive enzymes that help breakdown food and the production of insulin and other hormones that regulate blood sugar levels. Pancreatitis refers to inflammation of the pancreas that disrupts its normal function.
In dogs with pancreatitis, inflammation impairs the flow of digestive enzymes, causing them to build up and damage the pancreas itself as well as surrounding tissues and organs. This can lead to complications such as:
- Dehydration
- Electrolyte imbalances
- Abdominal pain
- Vomiting
- Diarrhea
- Lack of appetite
- Bleeding disorders
- Sepsis
- Multiple organ dysfunction syndrome
The exact cause of pancreatitis is not always known, but potential causes include:
- High fat diet
- Obesity
- Trauma
- Metabolic disorders
- Infections
- Toxins
- Drug reactions
- Anatomic abnormalities
How is pancreatitis diagnosed in dogs?
Diagnosing pancreatitis involves gathering information about the dog’s medical history along with performing diagnostic tests. The vet will ask about any recent diet changes, illnesses, injuries, or exposure to toxins. They will also do a physical exam looking for signs of abdominal pain, vomiting, diarrhea, dehydration, fever, or shock.
Initial screening tests usually include:
- Complete blood count (CBC) – assesses for infection, inflammation, and electrolyte imbalances.
- Biochemistry panel – evaluates kidney, liver, pancreatic, and electrolyte levels.
- Urinalysis.
More specific tests for confirming pancreatitis include:
- Canine pancreatic lipase immunoreactivity (cPLI) – measures levels of pancreatic lipase enzymes in the blood.
- Abdominal ultrasound – provides visual assessment of the pancreas.
- Radiographs (x-rays) – helps rule out foreign objects, tumors, etc.
How is pancreatitis treated?
Treatment of pancreatitis aims to address dehydration, manage pain and nausea, restore proper nutrition, prevent complications, and give the pancreas time to rest and recover. This involves:
- Intravenous (IV) fluid therapy – To correct dehydration and electrolyte imbalances.
- Antiemetic medication – To control vomiting.
- Pain management – With analgesics to relieve abdominal discomfort.
- Nutritional support – Withholding food at first, then gradually reintroducing bland, low-fat foods.
- Monitoring – Repeating diagnostic tests to assess response to therapy.
Dogs with mild pancreatitis often recover within a few days with this conservative care. Those with severe pancreatitis may require more aggressive treatment in intensive care units along with possible surgery.
When is surgery needed for pancreatitis?
Surgery is only required in a minority of canine pancreatitis cases. It is reserved for dogs with severe disease who do not improve with medical management alone. Reasons why dogs with pancreatitis may need surgery include:
Necrosis or Abscesses
Pancreatic necrosis refers to widespread death of pancreatic tissue. Abscesses are pockets of infected fluid and debris that form within tissues. Either condition requires surgical intervention to remove the diseased, dying tissue and allow the body to heal.
Pseudocysts
Pseudocysts are fluid-filled cavities that arise from pancreatic secretions leaking into surrounding tissues. Large pseudocysts that do not resolve on their own need to be surgically drained and debrided.
Bile Duct Obstruction
The main bile duct runs through the pancreas and can become obstructed due to inflammation, damaging the liver. Surgery opens or bypasses the bile duct to restore normal bile flow.
Bowel Perforation or Necrosis
Severe pancreatitis can damage adjacent intestinal tissues, causing bowel perforation (tears) or necrosis (tissue death). This requires emergency surgery to remove the dead bowel and repair any perforations before infection sets in.
Hemorrhage
Bleeding complications can occur with necrosis of vessels around the pancreas. Surgery locates and stops the source of any significant hemorrhage.
Sepsis
Pancreatitis can trigger an overwhelming, life-threatening systemic inflammatory response known as sepsis. Surgery is aimed at eliminating any septic foci and controlling the spread of infection.
What procedures are involved in pancreatic surgery?
Several types of surgery may be utilized to treat complications of severe pancreatitis in dogs. Common procedures include:
Pancreatic debridement
Necrotic tissue is surgically removed from the pancreas. This may involve partial pancreatectomy (removal of part of the pancreas) if extensive portions are necrotic.
Drainage procedures
Pseudocysts or abscesses may be drained externally through the abdominal wall or into the stomach or intestines. Drainage tubes can be placed temporarily or permanently.
Biliary diversion
The bile duct is exteriorized to bypass an obstruction, or a stent is placed to open the duct. These techniques allow bile to flow into the intestines again.
Bowel resection and anastomosis
Sections of damaged intestine are removed and the healthy ends are sutured back together.
Hemorrhage control
Bleeding vessels are ligated (tied off) or cauterized during surgery. Damaged blood vessels may need to be removed.
Peritoneal lavage
The abdominal cavity is flushed with sterile fluid to clean out inflammatory debris and bacteria in cases of pancreatic sepsis.
What is the prognosis for dogs after pancreatitis surgery?
The prognosis for dogs undergoing surgery for pancreatitis depends on the severity of disease and presence of complications. Some general guidelines on prognosis include:
- Dogs with mild necrosis or localized disease have an excellent prognosis with surgery.
- Pancreatic debridement carries a good to fair prognosis.
- Dogs requiring bowel resection or biliary bypass have a fair to guarded prognosis.
- Prognosis is poor if the dog has developed sepsis or multiple organ failure prior to surgery.
Reported survival rates after surgery for pancreatitis range from 67-93%. Dogs with signs of improvement within 3-5 days after surgery tend to have better long-term outcomes.
Key factors that impact prognosis following surgery include:
- The amount of permanent pancreatic damage sustained.
- Pre-existing health conditions such as kidney disease or diabetes mellitus.
- The development of post-operative complications like infection.
- How well the dog can return to normal eating and nutrient absorption.
With supportive aftercare and monitoring for complications, many dogs go on to live a normal life span following surgery for severe pancreatitis if performed in a timely manner.
Conclusion
Surgery is only required in a small percentage of dogs with pancreatitis, restricted to severe cases with major complications. Specific indications include extensive tissue necrosis, pseudocyst formation, bile duct obstruction, bowel perforations, hemorrhage, and sepsis not responsive to medical therapy. When performed by an experienced veterinary surgeon, dogs have a good chance of recovery and return to normal health after pancreatic surgery as long as irreversible organ damage has not already occurred.