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A 5-year-old, spayed female Domestic Longhair cat

Autumn is presented for vomiting, ptyalism, and anorexia. Some remodeling was done in the home and Autumn has been hiding under the bed for most of that time. The owner also reports she is unsure how much Autumn has eaten in the past week. Yesterday, the cat began vomiting bile and drooling.
Autumn previously had a body condition score of 7/9 but today is scored a 6/9. Her body weight has decreased by approximately 1.5 pounds since her last exam which was 6 months ago.
On exam, Autumn exhibits icterus of the sclera, pinnae, and mucous membranes. She is about 10% dehydrated and salivating, with elevated heart and respiratory rates. The rest of her exam is unremarkable.

Pancreatic Disorders

Pancreatitis in Cats

Although its exact incidence in cats is unknown, pancreatitis is now recognized as a common and clinically important inflammatory disorder of the feline exocrine pancreas.

Pancreatitis is divided into acute and chronic forms based on histology, not time course as can be the case for other health conditions.^1─3 Both forms can be mild to severe in presentation. However, chronic pancreatitis, which is more common in cats than the acute form,² tends to be mild while acute pancreatitis is usually more severe.⁴

Clinical signs associated with pancreatitis in cats are vague, nonspecific, and frequently subtle.^3,5 The most common clinical signs and physical examination findings are lethargy, partial or complete anorexia, dehydration, and weight loss, regardless of the type of pancreatitis. Other clinical signs and findings may include vomiting, hypothermia, diarrhea, abdominal pain, pale mucous membranes, and icterus.^3,5─7 Clinical presentation may be complicated by the potential for one or more concurrent conditions, including diabetes mellitus, chronic enteropathies, hepatic lipidosis, and cholangitis.^4,6,7

Management of cats with pancreatitis is generally supportive care aimed at controlling symptoms. Due to anorexia and the risk of developing hepatic lipidosis, cats with moderate to severe disease typically need to be hospitalized for intensive medical management and nutritional support. Those cats with mild disease often can be managed on an outpatient basis using dietary modification and medical management.

Key Messages

Management of cats with pancreatitis has been divided into hospitalized patient and outpatient care because:
- a definitive diagnosis of acute versus chronic pancreatitis is not always possible⁸
- pancreatic biopsy is performed infrequently, particularly in first-opinion practices, since patients are often poor anesthetic risks⁶
- initial medical management should not wait until diagnosis is confirmed via histopathology¹ as results are unlikely to change patient management⁷
Regardless of pancreatitis type, management of cats with pancreatitis focuses on a combination of nausea and/or vomiting control; pain management; nutritional support, including consideration of appetite stimulation and parenteral cobalamin (vitamin B12) supplementation if indicated; and replacement of fluids and/or electrolytes.

Since chronic pancreatitis often occurs concurrently with other diseases and has no specific treatment options (other than symptomatic and supportive care), management of concurrent disease usually takes clinical priority.^4,8
A nutritional assessment that includes evaluation of the current foods’ nutritional content should be performed to determine if the food is appropriate for the patient.
- Dietary modification is typically not needed unless concurrent disease or persistent hyperlipidemia is present.
- A low-fat diet and/or omega-3 fatty acid supplementation may benefit cats with persistently elevated cholesterol.⁸

Many cats with pancreatitis present with a history of anorexia or hyporexia of varying duration. Early enteral nutrition is recommended to prevent hepatic lipidosis, protein-energy malnutrition, atrophy of gut villi, bacterial translocation, and lean muscle loss. The current standard of care is to:¹
- administer antiemetics immediately at presentation, then as needed to control nausea and vomiting
- begin enteral feeding as soon as possible
  - If oral intake is inadequate, an appetite stimulant may help restore voluntary food intake and enable oral feeding.
A feeding tube should be placed if a cat does not respond to an appetite stimulant, has experienced prolonged anorexia, or has severe pancreatitis with or without concurrent disease.
- Feeding tubes (e.g., nasogastric, nasoesophageal, and esophagostomy) are well tolerated, allow convenient delivery of nutrients, and are associated with few complications.
- Nasoesophageal and nasogastric feeding tubes are good options for initial or short-term support since they can be inserted without sedation. Only liquid diets should be used with these tubes due to their small diameter.
- If the cat is stable for general anesthesia and long-term assisted feeding is anticipated, esophagostomy tubes are well tolerated. Esophagostomy tubes allow tailored feeding of canned diets as a gruel.
- If the patient is vomiting, it is essential to confirm placement of the feeding tube before each use.
The dietary needs of hospitalized cats with pancreatitis have not been determined. In most cases, a highly digestible diet that is high in protein (7─8 g/100 kcal ME or > 40% of ME calories) and low in carbohydrate is recommended.
- If the cat will eat voluntarily, foods designed for critical care/recovery or for management of GI conditions can be gradually introduced. In cases with suspected food intolerance, a hydrolyzed or novel protein formula may be needed.
- If a nasoesophageal feeding tube has been placed, a liquid veterinary diet formulated for convalescence or critical care can be fed. These diets are energy dense and typically have a moderate to high protein content.
  - In a retrospective study that evaluated nasogastric tube feeding in cats with acute pancreatitis, feeding a high-fat (45% of total calories), moderate-protein (35% of total calories) liquid enteral diet was well tolerated.⁹
When feeding hospitalized cats that have been anorexic, nutrition should be reintroduced gradually over several days to avoid refeeding syndrome.
- The starting point for assisted feeding is to calculate the patient’s resting energy requirement (RER):
  - RER (kcal/day) = 70 x BW_kg^0.75 or RER (kJ/day) = 293 x BW_kg^0.75
- On the first day, feed 25% to 33% of the calculated RER divided into 4 or more feedings daily. The amount given per meal when bolus feeding should be limited to 5 to 10 mL/kg BW. Feed slowly over 10 to 15 minutes to allow for stomach expansion.¹⁰
- Watch for signs of nausea such as drooling or licking of the lips. If seen, temporarily stop the feeding and resume once resolved.
- If food is well tolerated, the percentage of RER can be increased by 25% to 33% every 12 to 24 hours, until full RER is reached.
For cats with severe pancreatitis, intractable vomiting, and persistent anorexia, partial or total parenteral nutrition should be considered to prevent further undernutrition.¹¹

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References

Armstrong, P. J., & Crain, S. (2015). Feline acute pancreatitis: Current concepts in diagnosis and therapy. Today’s Veterinary Practice, 5(1), 22─27.
De Cock, H. E. V., Forman, M. A., Farver, T. B., & Marks, S. L. (2007). Prevalence and histopathologic characteristics of pancreatitis in cats. Veterinary Pathology, 44(1), 39─49. doi: 10.1354/vp.44-1-39
Ferreri, J. A., Hardam, E., Kimmel, S. E., Saunders, H. M., Van Winkle, T. J., Drobatz, K. J., & Washabau, R. J. (2003). Clinical differentiation of acute necrotizing from chronic nonsuppurative pancreatitis in cats: 63 cases (1996─2001). Journal of the American Veterinary Medical Association, 223(4), 469─474. doi: 10.2460/javma.2003.223.469
Forman, M. A., Steiner, J. M., Armstrong, P. J., Camus, M. S., Gaschen, L., Hill, S. L., Mansfield, C. S., & Steiger, K. (2021). ACVIM consensus statement on pancreatitis in cats. Journal of Veterinary Internal Medicine, 35(2), 703─723. doi: 10.1111/jvim.16053
Hill, R., & Van Winkle, T. Acute necrotizing pancreatitis and acute suppurative pancreatitis in the cat. A retrospective study of 40 cases (1976─1989). Journal of Veterinary Internal Medicine, 7(1), 25─33. doi: 10.1111/j.1939-1676.1993.tb03165.x
Armstrong, P. J., & Williams, D. A. (2012). Pancreatitis in cats. Topics in Companion Animal Medicine, 27(3), 140─147. doi: 10.1053/j.tcam.2012.09.001
Bazell, J., & Watson, P. (2014). Pancreatitis in cats: Is it acute, is it chronic, is it significant? Journal of Feline Medicine and Surgery, 16(5), 395─406. doi: 10.1177/1098612X14523186
Mansfield, C. (2016). The challenges of pancreatitis in cats: A diagnostic and therapeutic conundrum. In S. Little (Ed.), August’s consultations in feline internal medicine (Volume 7, pp. 169─179). Elsevier.
Klaus, J. A., Rudloff, E., & Kirby, R. (2009). Nasogastric tube feeding in cats with suspected acute pancreatitis: 55 cases (2001─2006). Journal of Veterinary Emergency and Critical Care, 19(4), 337─346. doi: 10.1111/j.1476-4431.2009.00438.x
Perea, S. C. (2008). Critical care nutrition for feline patients. Topics in Companion Animal Nutrition, 23(4), 207─215. doi: 10.1053/j.tcam.2008.08.001
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

Practice Scenario

Get to know AUTUMN

Pancreatitis in Cats

Key Messages

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To Share With Pet Owner:

Evaluating Your Cat’s Body Condition

References

Practice Scenario

Get to know AUTUMN

Pancreatitis in Cats

Key Messages

Outpatient Nutritional Management

Nutritional Support of the Hospitalized Cat With Pancreatitis

Download or share this resource

Related Tools and Content:

Nutritional Assessment Is an Iterative Process: Extended Evaluation

Feline Hepatic Lipidosis

Feline Chronic Enteropathy

Feline Cholangitis

The Purina Body Condition System

How to Perform a Body Condition Assessment - Cat

Use Muscle Condition Scoring to Detect Muscle Loss in Patients

Lean Body Mass & Protein

To Share With Pet Owner:

Evaluating Your Cat’s Body Condition

References