Many diseases are defined by a classical set of symptoms, a pattern of abnormal findings on laboratory tests, a known cause or physiological mechanism that is occurring within the body, and a preferred treatment protocol that results in improvement and hopefully a cure. Feline Pancreatitis and Feline Triaditis (dysfunction of the pancreas, liver, and gastrointestinal tract) are two illnesses that seldom meet all of these criteria. What is known about them is that they can become chronic, confused with or complicated by other diseases, difficult to diagnose, and frustrating to treat. Both may be primary problems or secondary to other metabolic or infectious causes. Treatment is both specific and supportive, depending upon how much information can be gathered during the diagnostic process.
Realizing that an explanation this vague – of what is wrong with their cat – can be frustrating to the owner, it is best to understand that the terms pancreatitis and triaditis simply mean inflammation of the associated organs. They are the effect of the disease, while the cause may remain elusive. Still, there is reward in successfully treating these illnesses, understanding that they present a significant challenge.
The organs affected by these diseases are the pancreas, liver, and lining of the stomach and intestinal tract. Inflammation in these systems affects the body’s ability to digest, absorb, and utilize nutrients. Symptoms may include lethargy, anorexia (refusal to eat), weight loss, vomiting, or diarrhea. Usually intermittent at first, the symptoms will become more persistent and increase in severity over time. Eventually, a cascade of systemic toxicosis (elevation of toxins in the bloodstream), bleeding disorders (disseminated intravascular coagulopathy), and organ failure may occur if the disease is not managed.
A thorough physical exam with blood work, fecal examination, and urinalysis is performed during the initial assessment of the cat. These tests are used to rule in or out other primary diseases that can mimic or lead to pancreatitis and triaditis. There is generally no pattern to abnormal primary laboratory results, but changes in associated organ function tests may be noted. Mild anemia, dehydration, electrolyte imbalance, and elevations in non-specific liver and pancreatic enzymes are common findings.
X-rays are usually not rewarding but are necessary to rule out abdominal masses. Ultrasonography may be helpful in revealing an enlarged pancreas surrounded by fluid, thus confirming inflammation of the organ, and may be used to guide a needle biopsy of the liver. Needle biopsy of the pancreas may be counter-productive, and while confirming the presence of inflammatory cells, it is unreliable at determining a cause (i.e. cancer). Ultrasound cannot by itself rule out either disease.
There is a special blood chemistry panel, sometimes referred to as a feline GI panel, which includes a test specific for feline pancreatitis called a spec – fPLI. The panel may also include a TLI, cobalamin (Vitamin B12) test and a folate test, which are helpful in diagnosing Exocrine Pancreatic Insufficiency (EPI) and Inflammatory Bowel Disease (IBD). Both of these diseases cause similar symptoms and may be precursors to feline pancreatitis and triaditis. Chronic cobalamin deficiency leads to anemia and is easily supplemented. Bile acid assays can also be measured to assess the liver’s functional ability. Hepatic lipidosis is a type of liver failure that may stem from any of these diseases when they are not quickly addressed.
Exploratory surgery with tissue biopsies gives the best results in achieving a complete diagnosis. The presence of large numbers of white blood cells in the affected tissues is diagnostic for inflammation and can also rule out cancer and infectious sources of disease. This option should be considered when other tests are inconclusive and before the cat is debilitated to the point that anesthesia and surgery would present too great a risk.
Treating feline pancreatitis and triaditis involves eliminating infection as a cause. Bacterial and viral infections are possible, yet rare or secondary causes. Antibiotics may be needed to treat primary or secondary bacterial infections.
Also, inflammatory bowel disease, which can progress to pancreatitis and triaditis, is thought to have an allergic component. Hypoallergenic diets may improve the symptoms of inflammatory bowel disease and help prevent the development of subsequent organ dysfunction.
Supportive treatment for the effects of dehydration, toxicosis, and clotting disorders are instituted. Intravenous replacement fluids may be given to correct electrolyte imbalance and to support vascular and metabolic function. The cat may be given antiemetic medications to stop vomiting and further fluid loss.
Immunosuppressive drugs such as prednisone and other corticosteroids are commonly prescribed to treat the immune component of pancreatitis and triaditis (i.e. the underlying inflammatory bowel disease). These medications stop the infiltration of white blood cells responsible for inflammation into the organ tissues. Also helpful are antacids, Vitamin B12 injections, and low-residue diets. Digestive enzymes may be of benefit when the digestive function of the pancreas is compromised.
The pancreas is furthermore responsible for the production of insulin. If enough of the viable tissue of the pancreas is damaged, the cat is at risk for developing Diabetes Mellitus.
In short, the disease processes of pancreatitis and triaditis should be treated aggressively to achieve the best possible outcome, or prognosis. The treatment may require careful monitoring and adjustment as symptoms occur and various systems are affected. Some acute cases are resolved entirely with a short course of therapy and diet modification, while other cats may require maintenance doses of medications for a lifetime. The overall prognosis depends on rapid intervention, a thorough diagnostic workup, and a commitment to success.