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Veterinary Focus

Issue number 29.3 Exocrine Pancreas

Acute feline pancreatitis

Published 12/03/2020

Written by Karin Allenspach

Also available in Français , Deutsch , Italiano , Português , Română and Español

Feline pancreatitis is one of the most commonly encountered diseases in small animal practice. Professor Allenspach offers a brief overview of the disease and discusses a holistic approach to treatment.

Acute feline pancreatitis

Key Points

Pancreatitis in cats is a common yet often overlooked condition, and diagnosis should be based both on clinical signs and appropriate tests.

Early intervention in any anorexic cat with pancreatitis is desirable; a high-protein diet given by the enteral route is the preferred method to supplement nutrition.


Pancreatitis in cats is a very common disease: in one retrospective study, 67% of 115 cats had histological lesions found on post-mortem examination 1. However, the condition is also probably underdiagnosed, as many of the clinical signs associated with feline pancreatitis are very non-specific. The etiology of pancreatitis in cats is, as with dogs, largely unknown; however, unlike the situation in dogs, dietary indiscretion is not a common cause in cats. However, one specific consideration is to include toxoplasmosis as a potential infectious cause of feline pancreatitis 2. Other etiologies that have been associated with acute onset of pancreatitis in cats are recent general anesthesia, hypoxia secondary to acute heart failure episodes, and organophosphate intoxication.

Clinically, cats with pancreatitis show less specific signs than dogs, with anorexia, lethargy, dehydration, weight loss, hypothermia, vomiting, icterus and fever being amongst the most common signs. In a few cases, abdominal pain can be present, and the patient may also have diarrhea. However, it is important to consider the possibility that any cat with suspected pancreatitis could have abdominal pain, and appropriate treatment may greatly improve the clinical demeanor of the cat.


On hematology, many affected cats show anemia or hemoconcentration; either leukocytosis or leucopenia is also common. The biochemistry profile often includes hypoalbuminemia, which can also be a negative prognostic indicator. Hypocalcemia may also be present (from saponification of the mesenteric fat) and should be treated if present.

On radiography it is occasionally possible to identify bicavitary effusion (i.e., effusion in both pleural and peritoneal cavities) in affected cats. As noted above, hypoalbuminemia is a common finding in feline pancreatitis, and can also contribute to this. Ultrasound is often employed to help with the diagnosis of pancreatitis, but has been shown to have very variable sensitivity, between 10-70%. This is dependent on the experience of the ultrasonographer, as well as the severity of clinical signs. In acute pancreatitis, the sensitivity of ultrasound is much higher than in chronic cases. Typical signs on ultrasound are hyper- or hypoechogenic pancreatic tissue, free fluid surrounding the pancreas, and hyperechogenic mesenteric fat.

Feline pancreatic lipase (fPLI) or DGGR lipase assay are the laboratory tests that currently offer the best sensitivity and specificity for the diagnosis of pancreatitis in cats, when compared with histological identification of pancreatitis as the gold standard. Since we do not know how relevant histological pancreatitis is in the clinical setting, the results of these tests must be carefully interpreted in light of other clinical findings. In fact, feline pancreatitis is always a clinical diagnosis and diagnosis should never be made on the basis of a single test, but rather based on a combination of clinical signs, laboratory and ultrasound findings.

Placement of an esophagostomy feeding tube. The tube bypasses the mouth and pharynx and can be left in place for many weeks if necessary, but general anesthesia is needed for placement, which may not be ideal in a compromised patient.
Figure 1. Placement of an esophagostomy feeding tube. The tube bypasses the mouth and pharynx and can be left in place for many weeks if necessary, but general anesthesia is needed for placement, which may not be ideal in a compromised patient. © Rene Doerfelt

In a recent large retrospective study of 157 cats with pancreatitis, hypoglycemia, azotemia, pleural effusion and persistent anorexia during hospitalization were the factors most commonly associated with poor outcome 3. This hints towards the importance of nutritional support, which is most often best achieved by naso-esophageal or esophageal tube feeding (Figure 1). Furthermore, withholding antibiotic treatment was associated with a poorer outcome in these cats. This is an important finding, and concurs with recent literature indicating bacterial infections in cats with pancreatitis. It is assumed that bacterial infection of the liver and pancreas is a result of ascending infection from the upper small intestine through the bile and pancreatic ducts. Most commonly, bacterial DNA from E.coli species have been found to be present in such cases 4. It is therefore prudent to assume bacterial infection with enteral species in severely sick acute pancreatitis cases, and to empirically treat with antibiotics.

Medical treatment

As mentioned above, analgesia is very important for all cats with pancreatitis. The best options are morphine derivatives such as buprenorphine administered parenterally. Anti-emetics should also be given; maropitant and ondansetron, sometimes in combination, have empirically been shown to have good efficacy in these cases. Furthermore, although dopamine D2 receptors have historically not been reported to occur in cats, metoclopramide may have an effect on functional ileus in feline pancreatitis, and can therefore also play a role in the management.

Karin Allenspach

Cats are able to digest very high amounts of fat, and there is currently no evidence that fat restriction is indicated when dealing with feline pancreatitis.

Karin Allenspach

Nutritional management

Naso-esophageal feeding tubes are easy to place without general anesthesia and can be removed whenever required.
Figure 2. Naso-esophageal feeding tubes are easy to place without general anesthesia and can be removed whenever required. © Rene Doerfelt

In veterinary medicine, the premise that the gastrointestinal tract plays an important role during critical illness, and that enteral nutrition is preferable to parenteral nutrition whenever possible, is well established. Lack of enteral nutrition can lead to decreased gastrointestinal motility, as well as morphological changes to the intestinal anatomy, such as villus atrophy. Such changes have been associated with a higher rate of bacterial and endotoxin translocation into the peripheral bloodstream. Early enteral nutritional support is therefore important in any anorexic cat, but especially if pancreatitis is suspected. In fact, because most cats present when they have already been anorexic for several days, enteral nutrition should be instigated as soon as possible. In one study, nasogastric feeding was assessed in 55 cases of acute feline pancreatitis 5. Treatment with parenteral amino-acid /dextrose infusion was compared to enteral feeding. Nasogastric feeding was very well tolerated in the study (Figure 2), and there were no differences between the groups in terms of clinical variables or outcome. Enteral feeding is only contraindicated in a cat with intractable vomiting, but antiemetics should be tried in such patients. Esophagostomy or gastrostomy provides a good medium- to long-term option; however, since they both necessitate anesthesia in a sometimes debilitated patient, naso-esophageal tubes can be very effective, especially in the first few days of treatment 6.

The diet fed to these patients should be high in protein, because of the considerable dietary protein requirement of cats 7. This high-protein requirement also makes them susceptible to lean muscle loss during starvation, which needs to be avoided if at all possible. Furthermore, anorexia can result in decreased intake of certain amino acids such as arginine and methionine, which can lead to hepatic lipidosis, as these amino acids are essential to form apolipoproteins to re-distribute fat from the liver to other organs in the body. In addition, there is accumulating evidence in people with severe illnesses that other nutrients, such as glutamine, tryptophan and fatty acids, may play a role in modulating inflammatory and immune-mediated mechanisms. Supplementation of such critical nutrients have been shown to be associated with reduced hospital stay and lower infection rates 8. Note, however, that cats are able to digest very high amounts of fat, and there is currently no evidence that fat restriction is indicated in cats with pancreatitis.

The clinician should be alerted to the fact that pancreatitis in cats can cause vague, non-specific signs, and consequently the disease may be underdiagnosed. Feline pancreatitis is essentially a clinical diagnosis which relies on a combination of clinical signs, laboratory and ultrasound findings. Early and considered intervention should improve recovery rates, and this involves both appropriate medication, including analgesia and antibiotics, and appropriate nutritional support with a high-protein diet given – wherever possible – by the enteral route.


  1. De Cock HE, Forman MA, Farver TB, et al. Prevalence and histopathologic characteristics of pancreatitis in cats. Vet Pathol 2007;44(1):39-49.
  2. Carpenter D. Histologically confirmed clinical toxoplasmosis in cats: 100 cats (1952-1991). J Am Vet Med Assoc 1993;203;1556-1565.
  3. Nivy R, Kaplanov A, Kuzi S, et al. A retrospective study of 157 hospitalized cats with pancreatitis in a tertiary care center: Clinical, imaging and laboratory findings, potential prognostic markers and outcome. J Vet Intern Med 2018;32(6):1874-1885. doi: 10.1111/jvim.15317. Epub 2018 Oct 13.

  4. Twedt DC, Cullen J, McCord KJ, et al. Evaluation of fluorescence in situ hybridization for the detection of bacteria in feline inflammatory liver disease. J Feline Med Surg 2014;16(2):109-117. doi: 10.1177/1098612X13498249.
  5. Klaus JA, Rudloff E, Kirby R. Nasogastric tube feeding in cats with suspected acute pancreatitis: 55 cases (2001-2006). J Vet Emerg Crit Care (San Antonio) 2009;19(4):337-346. doi:10.1111/j.1476-4431.2009.00438.x.
  6. Doerfelt R. A quick guide to feeding hospitalized cats. Vet Focus 2016;26(2);46-48.
  7. Jensen KB, Chan DL. Nutritional management of acute pancreatitis in cats and dogs. J Vet Emerg Crit Care (San Antonio) 2014;24(3):240-250. doi: 10.1111/vec.12180. Epub 2014 Apr 1.

  8. Sakai K, Maeda S, Yonezawa T, et al. Decreased plasma amino acid concentrations in cats with chronic gastrointestinal diseases and their possible contribution in the inflammatory response. Vet Immunol Immunopathol 2018;195:1-6. doi: 10.1016/j.vetimm.2017.11.001. Epub 2017 Nov 8.
Karin Allenspach

Karin Allenspach

Dr. Allenspach qualified from Zurich University in 1994 before undertaking an internship in emergency and critical care at Tufts University. Read more

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