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THERAPEUTIC NUTRITION

THERAPEUTIC NUTRITION

Useful information about the needs of cats and dogs with nutritionally sensitive health conditions.

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Pancreatic Disorders

Chronic Pancreatitis in Dogs

Although chronic pancreatitis was once thought to be uncommon in dogs, studies during the past 15 years have confirmed that it is a common and clinically significant canine condition.1 Chronic pancreatitis is defined as an ongoing inflammatory disease characterized by irreversible structural changes that can cause refractory pain; progressive, permanent loss of exocrine and endocrine function; and reduced quality of life.2,3 Dogs with chronic pancreatitis may present initially with a clinically severe, apparently acute episode of pancreatitis after a subclinical phase of low-grade inflammation has destroyed pancreatic tissue.4 Chronic pancreatitis may be an incidental finding in some cases.5

Common clinical signs exhibited by dogs with chronic pancreatitis are lethargy and intermittent anorexia with or without vomiting or diarrhea.1,4,5 Physical exam findings can include abdominal pain, elevated body temperature, dehydration, and jaundice.5,6

Dietary modification may play an important role in the successful long-term management of dogs with chronic pancreatitis.1,6

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Did You Know

THERAPEUTIC NUTRITION

Studies in both humans and dogs show that up to 40% of acute pancreatitis cases are actually acute-on-chronic pancreatitis when histopathology is performed.7

Key Messages

  • Nutritional support plays an important therapeutic role in the management of dogs with acute, acute-on-chronic, and chronic pancreatitis, but it can be challenging.8─11
  • An acute exacerbation of chronic pancreatitis, which appears clinically indistinguishable from a single episode of acute pancreatitis, should be treated symptomatically as acute pancreatitis.
  • Lifelong dietary fat reduction is a logical consideration in the nutritional management of all dogs with chronic pancreatitis, regardless of the presence of hyperlipidemia,6 although the link between high dietary fat and naturally occurring pancreatitis is not clear.8
    • Many dogs with pancreatitis are hyperlipidemic, which can be managed with dietary fat reduction.9
    • The amount of dietary fat tolerated is likely patient specific. A diet considerably lower in fat content than the dog’s previous diet is indicated after chronic pancreatitis diagnosis.
    • A fat-free diet is not appropriate because dietary fat provides essential fatty acids (i.e., linoleic acid) and is necessary for proper absorption of fat-soluble vitamins (i.e., A, D, E, and K).
    • Fatty table foods and treats should be avoided.
  • While studies evaluating different diet types and their effects on the course of canine chronic pancreatitis are lacking, a highly digestible diet designed for patients with gastrointestinal disease is commonly recommended.
    • Dogs with hypertriglyceridemia can be fed a high-quality, balanced, ultra-low-fat diet (fat content ≤ 10% DM or 2 to 3 grams per 100 kilocalories of metabolizable energy [g/100 kcal ME]) to achieve lower serum triglycerides and cholesterol.8,12
    • Non-hypertriglyceridemic dogs recovering from pancreatitis can be fed low-fat foods (≤ 15% DM or < 3.5 g/100 kcal ME).12,13 However, if there is no evidence of fat intolerance, an easily digested diet with moderate fat content (4 to 6 g/100 kcal ME) can be fed.8
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THERAPEUTIC NUTRITION

“Our goal is to manage the potential progression of damage to your dog’s pancreas. We also want to reduce the chances of acute episodes, or flare-ups, that could result in your dog being hospitalized. To do this, your dog will need to be on a special diet with low-to-moderate fat content to help manage [his/her] chronic pancreatitis.”

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References

  1. Watson, P. (2012). Chronic pancreatitis in dogs. Topics in Companion Animal Medicine, 27(3), 133─139. doi: 10.1053/j.tcam.2012.04.006
  2. Watson, P. (2015). Pancreatitis in dogs and cats: Definitions and pathophysiology. Journal of Small Animal Practice, 56(1), 3─12. doi: 10.1111/jsap.12293
  3. Watson, P. J., Roulois, A. J. A., Scase, T., Johnston, P. E. J., Thompson, H., & Herrtage, M. E. (2007). Prevalence and breed distribution of chronic pancreatitis at post-mortem examination in first-opinion dogs. Journal of Small Animal Practice, 48(11), 609─618. doi: 10.1111/j.1748-5827.2007.00448.x
  4. Watson, P. J., Archer, J., Roulois, A. J., Scase, T. J., & Herrtage, M. E. (2010). Observational study of 14 cases of chronic pancreatitis in dogs. Veterinary Record, 167(25), 968─976. doi: 10.1136/vr.c4912
  5. Bostrom, B. M., Xenoulis, P. G., Newman, S. J., Pool, R. R., Fosgate, G. T., & Steiner, J. M. (2013). Chronic pancreatitis in dogs: A retrospective study of clinical, clinicopathological, and histopathological findings in 61 cases. The Veterinary Journal, 195(1), 73─79. doi: 10.1016/j.tvjl.2012.06.034
  6. Xenoulis, P. G., Suchodolski, J. S., & Steiner, J. M. (2008). Chronic pancreatitis in dogs and cats. Compendium: Continuing Education for Veterinarians, 30(3), 166─181.
  7. Hess, R. S., Saunders, H. M., Van Winkle, T. J., Shofer, F. S., & Washabau, R. J. (1998). Clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in dogs with fatal acute pancreatitis: 70 cases (1986─1995). Journal of the American Veterinary Medical Association, 213(5), 665─670.
  8. Jensen, K. B., & Chan, D. L. (2014). Nutritional management of acute pancreatitis in dogs and cats. Journal of Veterinary Emergency and Critical Care, 24(3), 240─250. doi: 10.1111/vec.12180
  9. Mansfield, C., & Beths, T. (2015). Management of acute pancreatitis in dogs: A critical appraisal with focus on feeding and analgesia. Journal of Small Animal Practice, 56(1), 27─39. doi: 10.1111/jsap.12296
  10. Mansfield, C. S., James, F. E., Steiner, J. M., Suchodolski, J. S., Robertson, I. D., & Hosgood, G. (2011). A pilot study to assess tolerability of early enteral nutrition via esophagostomy tube feeding in dogs with severe acute pancreatitis. Journal of Veterinary Internal Medicine, 25(3), 419─425. doi: 10.1111/j.1939-1676.2011.0703.x
  11. Whittemore, J. C., & Campbell, V. L. (2005). Canine and feline pancreatitis. Compendium on Continuing Education for the Practicing Veterinarian, 27(10), 766─776.
  12. Davenport, D. J., Remillard, R. L., & Simpson, K. W. (2010). Acute and chronic pancreatitis. In M. S. Hand, C. D. Thatcher, R. L. Remillard, P. Roudebush, & B. J. Novotny (Eds.), Small animal clinical nutrition (5th ed., pp. 1143─1153). Mark Morris Institute.
  13. Shmalberg, J. (2016). To feed or not to feed? Controversies in the nutritional management of pancreatitis. Today’s Veterinary Practice, 6(6), 45─51.