Pancreatitis

Question 1

risk factors for pancreatitis

Answer 1

breed, age, drugs, hepatobiliary disease, endocrine disorders, hypercalcemia, hyperlipidemia

Question 2

acute pancreatitis pathogenesis with hypercalcemia

Answer 2

Pancreatic lipase
>Hydrolysis of serum TG in pancreatic microvasculature >Release free fatty acids locally
>Microthrombi and/or
>Bind with calcium to cause further capillary damage
>Releases more pancreatic lipase
>ACUTE PANCREATITIS

Question 3

dietary risk factors for pancreatits

Answer 3

High-fat (>20%DM) foods, treats or human foods
History of dietary indiscretion of high-fat human foods

Experimentally, feeding high-fat, low-protein foods in dogs

Calorically dense, high-fat foods > Obesity

Question 4

etiopathogenesis of pancreatitis

Answer 4

Autodigestion of pancreatic tissue with associated inflammation is self-perpetuating and can eventually affect functions of the pancreas:

Endocrine functions: insulin secretion from beta cells >Insulin-dependent diabetes mellitus (DM)

Exocrine functions: digestive enzyme secretion
>Exocrine pancreatic insufficiency (EPI)

Question 5

key nutritional factors for pancreatitis

Answer 5

fat < 15% for non-obese and non-hypertriglyceridemic
<10% if obese

protein 15-30% for dogs

Question 6

KNF: fat in pacreatitis cases; how do we decide what to give in short term

Answer 6

 Select dietary fat level based on patient’s clinical picture and etiology of pancreatic overstimulation

 Trauma/drug induced > tend to see normal fasting TAG
> choose highly digestible diet with moderate fat (<15% DM)
(overall 12-15% DM)

 Fat-induced > tend to see high fasting TAG > choose lower dietary fat diet (<10% DM)

 Level of restriction depends on the individual:
-Hypertriglyceridemia: <10% DM -Overweight/obese: <10% DM
-Recurring pancreatitis: <10% DM

Question 7

KNF: fat for long-term pancreatitis case

Answer 7

Some patients recover and can be weaned onto an adult maintenance diet, whereas others must remain on a reduced-fat diet long term

Completely removing fat from the diet is NOT an option: Essential fatty acids (e.g. omega 6’s and 3’s)
Fat soluble vitamins (e.g. Vitamins A, D, E, and K)
Energy source
Palatability

Low fat contra-indicted if:
Volume intolerance, weight loss, reduced appetite

Question 8

controversy of omega-3 fatty acids with pancreatitis

Answer 8

may help with pancreatitis? but adds calories and fat so use caution

Gradual increase (by 25% weekly) to avoid diarrhea and
belching and reach target intake

Make sure fasted triglycerides are actually improving
>otherwise discontinue
Make sure cPLI’s are not worsening
>otherwise discontinue

Question 9

KNF: protein effects in pancreatitis

Answer 9

Proteins/amino acids stimulate the exocrine pancreas

Excessive dietary protein is not recommended
>DOGS: 18-30% DM
>CATS: 30-40% DM

Protein level should be near upper limit in pets that: >Require gradual weight loss (to maintain LBM)
>Muscle wasted

Question 10

KNF: fibre in a case of pancreatitis

Answer 10

Highly digestible diet with <5% DM crude fibre

Long term (following recovery)
higher fibre diets (>5% DM) may be used with overweight/obese patients for weight loss
(i.e. veterinary weight loss diets)

Question 11

meal frequency for pancreatitis

Answer 11

Huge benefit from small, frequent meals!
>Lower the absolute amount of fat and protein being
consumed at each meal

-At home: 3-4 meals/day
-In hospital: 6-8 meals/day

Question 12

how can dietary change impact pacreatitis? considerations?

Answer 12

Any sudden dietary change can incite a bout of pancreatitis
Recommend not feeding any commercial treats, bones, chews, or human foods to prevent inciting another bout of pancreatitis
Access to garbage, composters, food on counters, food outside, etc. must be avoided in pets that have a history of pancreatitis

Question 13

how do we avoid pancreatitis problems when transitioning a diet?

Answer 13

Too rapid of a transition to a new diet can lead to vomiting, diarrhea, nausea, or pancreatitis

Use transition schedule:
Day 1-2: 75% of current diet + 25% of the new diet
Day 3-4: 50% of current diet + 50% of the new diet
Day 5-6: 25% of current diet + 75% of the new diet
Day 7: 100% of the new diet

Question 14

are treats and human food in a pancreatitis case?

Answer 14

Low fat!
<10% of daily calories!

Question 15

when should we use a weight loss plan if a dog has pancreatitis?

Answer 15

When recovered from pancreatic episode
Veterinary weight loss diet: low fat, higher fibre
Controlled steady weight loss: 0.5-2.0% BW/wk
Energy requirement: RER for ideal body weight

Question 16

current diet regime for a new case of pancreatitis

Answer 16

 CURRENT: EARLY ENTERAL NUTRITION (EEN)
> Feed through vomiting/diarrhea
> Either per os (PO) or assisted via feeding tube

Purported advantages:
 Correction of negative energy balance
 Preservation of gut integrity & function
 Improved immune function
 Reduced bacterial translocation
 Attenuated release of inflammatory mediators
 Reduced rate of infection & infectious complications
 Reduced duration of hospitalization

Question 17

cat with pancreatitis feeding method and frequency

Answer 17

Small meals frequently: 3-4 at home, 6-8 in hospital
Reduced gastric distension
Decreased gastric secretion
Reduced nausea, vomiting, gastroesophageal reflux
More effective assimilation

Question 18

if cat in hospital for pancreatitis how can we provide nutrition, optionally

Answer 18

cri

Question 19

KNF summary for cat with pnacreatitis

Answer 19

fat: <25% for non obese
<15% for obese

protein: 30-40%

Question 20

hyporexia food intake

Answer 20

Hyporectic patients only eat 1/4 to 1/3 of their energy requirements

Question 21

issues with protein malnutrition, and markers

Answer 21

Weight loss
increased creatinine (muscle breakdown)
decreased albumin/total protein

Question 22

KNF for anorexia

Answer 22

 Recovery diets (30-36% fat, 44-46% protein DM) if:
 Feeding multiple small meals (6-8/day)
 Patient is consuming ≤ RER
 Patient is tolerating the diet

Question 23

important consideration for encouraging eating long term in a case of anorexia

Answer 23

 AVOID FOOD AVERSION!
 Do not feed the diet you want the patient to eat long
term if they are nauseous/vomiting/anorexic

Question 24

anorexia and pancreatitis balancing act

Answer 24

 Balancing act between providing nutrient for recovery from illness vs. stimulating the pancreas

Question 25

in hospital diet plan for anorexia

Answer 25

 Very palatable palatable diet (high protein and fat)
 Fat (calories) and protein are needed for recovery
 Start with small amounts (multiple small meals)

Question 26

what if a cat doesnt want to eat

Answer 26

No forced feeding > food aversion

Stimulate appetite
Warm up the food to body temperature
Small, frequent meals (6-8 per day)
Take the food away after 15 min and try again later

Tube feeding > same schedule as per os feeding > The quicker the better!!

Question 27

weight loss diet long term for cat, type

Answer 27

Lower fat diet appropriate for long term feeding
Highly digestible, low fibre diet
Multiple small meals