Title: Pancreatitis (veterinary)

{{Use dmy dates|date=January 2020}}
{{Infobox medical condition
 |name            = Pancreatitis
 |synonyms        = &lt;!-- or |synonym= --&gt;
 |image           = Gray1105.png
 |image_upright   = 
 |image_size      = 
 |alt             = 
 |image_thumbtime = 
 |caption         = Illustration of a dog's pancreas: Alveolus in the illustration refers to the acinar cells of the exocrine pancreas. The cells form circular clusters.&lt;ref name=&quot;ColState&quot; /&gt; They are the cells which produce pancreatic enzymes needed for digestion of food.
 |width           = 
 |image2          = 
 |image2_upright  = 
 |image_size2     = 
 |alt2            = 
 |image_thumbtime2 =
 |caption2        = 
 |width2          = 
 |pronounce       = 
 |pronounce 2     = 
 |specialty       = &lt;!-- from Wikidata; can be overwritten --&gt;
 |symptoms        = Lethargy, anorexia, emesis, abdominal pain
 |complications   = Hypokalaemia, hyponatraemia, hypochloraemia, organ failure
 |onset           = Middle-aged to elderly
 |duration        = 
 |types           = Acute, chronic
 |causes          = &lt;!-- or |cause= --&gt;
 |risks           = Miniature Schnauzer, Cocker Spaniels, obesity
 |diagnosis       = Pancreatic lipase assay, ultrasound
 |differential    = 
 |prevention      = 
 |treatment       = Fluid therapy, feeding
 |medication      = Fentanyl, ketamine, buprenorphine, lidocaine, maropitant, capromorelin
 |prognosis       = 
 |frequency       = 0.6% (cats) 0.8% dogs
 |deaths          = 
 |named after     = &lt;!-- or |eponym= --&gt;
}}

'''Pancreatitis''' is a common condition in cats and dogs. Pancreatitis is [[inflammation]] of the [[pancreas]] that can occur in two very different forms. [[Acute pancreatitis]]&lt;ref name=&quot;Washabau&quot; /&gt; is sudden, while [[chronic pancreatitis]] is characterized by recurring or persistent form of pancreatic inflammation. Cases of both can be considered mild or severe.&lt;ref name=&quot;Steiner&quot; /&gt; It is currently undecided whether chronic pancreatitis is a distinct disease or a form of acute pancreatitis. Other forms such as auto-immune and hereditary pancreatitis are presumed to occur but the existence of these forms has not been proven.&lt;ref name=&quot;sasts&quot;/&gt;

Pancreatitis occurs in approximately 0.8% of dogs and 0.6% of cats. Severe pancreatitis is often fatal.&lt;ref name=&quot;sasts&quot;&gt;{{cite book|first1=Eric|last1=Monnet|first2=Jorg M.|last2=Steiner|first3=Panagiotis G.|last3=Xenoulis|chapter=Pancreatitis|pages=230–250|title=Small Animal Soft Tissue Surgery | publisher=Wiley | date=2023-05-12 | isbn=978-1-119-69368-0 | doi=10.1002/9781119693741}}&lt;/ref&gt;

==Background==
The pancreas is composed of two sections: the smaller [[Islets of Langerhans|endocrine]] portion, which is responsible for producing [[hormone]]s such as [[insulin]], [[somatostatin]], and [[glucagon]], and the larger, [[pancreas|exocrine]] portion,&lt;ref name=&quot;Colorado exocrine&quot; /&gt; which produces [[enzyme]]s needed for the [[digestion]] of food. [[Acinus|Acinar cells]] make up 82% of the total pancreas; these cells are responsible for the production of the digestive enzymes.&lt;ref name=&quot;ColState&quot; /&gt;&lt;ref name=&quot;Cell&quot; /&gt;

==Pathogenesis==
The pathogenesis of pancreatitis is not well understood. Both genetic and environmental factors are involved in developing pancreatitis. In most acute pancreatitis cases there is premature activation and retention of [[zymogen]]s of the [[acinar cell]]s. These zymogens become pancreatic enzymes. Activated enzymes will get into the pancreatic tissue and later the [[peritoneal cavity]] and circulation.  The effects of this include: [[interstitial fluid|interstitial]] [[oedema]], [[necrosis]] of the acinar cells, [[haemorrhage]], and necrosis of the [[peripancreatic fat]]; these trigger an inflammatory response from [[neutrophils]] and [[macrophages]]. The aetiology behind this disruption is unknown.&lt;ref name=&quot;sasts&quot;/&gt;

==Pathophysiology==
Pancreatitis is caused by autodigestion of the pancreas thought to begin with an increase in secretion of pancreatic enzymes in response to a stimulus,&lt;ref name=&quot;Colorado endocrine&quot; /&gt;&lt;ref name=&quot;CoPES&quot; /&gt; which can be any source from table scraps to getting into the garbage to drugs, toxins, and trauma.&lt;ref name=&quot;Steiner&quot; /&gt;&lt;ref name=&quot;Tufts&quot; /&gt; The [[digestive enzyme]]s are released too quickly and begin acting on the pancreas instead of the food they normally digest.&lt;ref name=&quot;Washabau&quot; /&gt;&lt;ref name=&quot;Tufts&quot; /&gt;&lt;ref name=&quot;UGA&quot; /&gt;&lt;ref name=&quot;Steiner 2003&quot; /&gt; Once the process cascades, inflammatory mediators and free radicals are released and pancreatitis develops, causing amplification of the process.&lt;ref name=&quot;UGA&quot; /&gt;

==Causes==
The [[aetiology]] of pancreatitis in cats and dogs is unknown in the majority of cases. The amount of described causes for dogs is low and even lesser for cats. The causes of pancreatitis in humans is vastly different from that of cats and dogs.&lt;ref name=&quot;sasts&quot;/&gt; Two studies have suggested that [[hypertriglyceridaemia]] is a cause of pancreatitis in the [[Miniature Schnauzer]];&lt;ref&gt;{{cite journal | last1=Xenoulis | first1=Panagiotis G. | last2=Suchodolski | first2=Jan S. | last3=Ruaux | first3=Craig G. | last4=Steiner | first4=Jörg M. | title=Association Between Serum Triglyceride and Canine Pancreatic Lipase Immunoreactivity Concentrations in Miniature Schnauzers | journal=Journal of the American Animal Hospital Association | publisher=American Animal Hospital Association | volume=46 | issue=4 | date=2010-07-01 | issn=0587-2871 | doi=10.5326/0460229 | pages=229–234}}&lt;/ref&gt;&lt;ref&gt;{{cite journal | last1=Xenoulis | first1=P.G. | last2=Levinski | first2=M.D. | last3=Suchodolski | first3=J.S. | last4=Steiner | first4=J.M. | title=Serum Triglyceride Concentrations in Miniature Schnauzers with and without a History of Probable Pancreatitis | journal=Journal of Veterinary Internal Medicine | publisher=Wiley | volume=25 | issue=1 | date=2010-12-08 | issn=0891-6640 | doi=10.1111/j.1939-1676.2010.0644.x | pages=20–25| doi-access=free }}&lt;/ref&gt; however, there is no evidence of this as a cause in other breeds.&lt;ref name=&quot;sasts&quot;/&gt; Another study has identified mutations of the ''[[SPINK1]]'' gene in the Miniature Schnauzer as being associated with pancreatitis;&lt;ref&gt;{{cite journal | last1=Bishop | first1=Micah A. | last2=Xenoulis | first2=Panagiotis G. | last3=Levinski | first3=Melinda D. | last4=Suchodolski | first4=Jan S. | last5=Steiner | first5=Jörg M. | title=Identification of variants of the SPINK1 gene and their association with pancreatitis in Miniature Schnauzers | journal=American Journal of Veterinary Research | publisher=American Veterinary Medical Association (AVMA) | volume=71 | issue=5 | year=2010 | issn=0002-9645 | doi=10.2460/ajvr.71.5.527 | pages=527–533}}&lt;/ref&gt; however, another study found no association between ''SPINK1'' mutations and pancreatitis, it instead demonstrated that the mutations were common amongst Schnauzers.&lt;ref&gt;{{cite journal | last1=Furrow | first1=E. | last2=Armstrong | first2=P.J. | last3=Patterson | first3=E.E. | title=High Prevalence of the c.74A&amp;gt;C''&lt;scp&gt;SPINK&lt;/scp&gt;1''Variant in Miniature and Standard Schnauzers | journal=Journal of Veterinary Internal Medicine | publisher=Wiley | volume=26 | issue=6 | date=2012-10-13 | issn=0891-6640 | doi=10.1111/j.1939-1676.2012.01013.x | pages=1295–1299| doi-access=free }}&lt;/ref&gt;&lt;ref name=&quot;sasts&quot;/&gt;

[[Iatrogenic]] pancreatitis is caused by certain drugs. The most common drugs that cause iatrogenic pancreatitis are [[potassium bromide]], [[phenobarbital]], [[L-asparaginase]], [[azathioprine]], and [[meglumine antimonate]].&lt;ref name=&quot;sasts&quot;/&gt;

Suspected causes of pancreatitis in cats includes: [[abdominal trauma]], [[ischaemia]], acute [[hypercalcaemia]], [[organophosphate]] toxicity, [[pancreatic tumour]], and pancreatic ductal obstruction.&lt;ref name=&quot;sasts&quot;/&gt;

[[Glucocorticoid]]s were once considered a cause of pancreatitis in both dogs and humans. Better understanding of both pancreatitis and glucocorticoids has led to this belief disappearing. Glucocorticoids are not considered a risk factor for pancreatitis anymore.&lt;ref name=&quot;sasts&quot;/&gt;

==Clinical signs==
Clinical symptoms of pancreatitis vary. Some animals will be asymptomatic or just have mild [[anorexia (medicine)|anorexia]] whilst others will have serious symptoms such as cardiac problems. Most symptoms are not directly caused by pancreatitis itself.&lt;ref name=&quot;sasts&quot;/&gt;

One study found the most common symptoms of pancreatitis in dogs to be: [[lethargy]] (88%), anorexia (86%), [[emesis]] (83%), and abdominal pain (59%).&lt;ref&gt;{{cite journal | last1=Berman | first1=Chad F. | last2=Lindquist | first2=Eric | last3=Lobetti | first3=Remo G. | title=Comparison of clinical findings in 293 dogs with suspect acute pancreatitis : different clinical presentation with left lobe, right lobe or diffuse involvement of the pancreas | journal=Journal of the South African Veterinary Association | publisher=Medpharm Publications | volume=91 | issue=1 | year=2020 | issn=1019-9128 | doi=10.4102/jsava.v91i0.2022 | pages=1–10| pmc=7203193 }}&lt;/ref&gt;&lt;ref name=&quot;sasts&quot;/&gt;

Symptoms common in cats with pancreatitis include: anorexia (63–97%), [[dehydration]] (33–96%), lethargy (28–100%), emesis (35–76%), [[pallor]] (30%), [[Jaundice|icterus]] (16–24%), weight loss (20–61%), and diarrhoea (11–33%).&lt;ref name=&quot;sasts&quot;/&gt;

Symptoms of severe pancreatitis in cats includes: [[disseminated intravascular coagulation]], [[pulmonary thromboembolism]], [[cardiovascular shock]], and [[organ failure]]. Pancreatitis is a common cause of disseminated intravascular coagulation and thromboembolism in the cat. Two studies found 26% of cats with disseminated intravascular coagulation and 11.8% with pulmonary thromboembolism had pancreatitis.&lt;ref name=&quot;sasts&quot;/&gt;

Acute pancreatitis can trigger a build-up of fluid, particularly in abdominal and thoracic (chest) areas, [[acute kidney injury]], and cause inflammation in arteries and veins.  The inflammation triggers the body's [[coagulation|clotting factors]], possibly depleting them to the point of spontaneous [[bleeding]].&lt;ref name=&quot;Tufts&quot; /&gt;&lt;ref name=&quot;Brooks&quot; /&gt; This form can be fatal in animals and in humans.&lt;ref name=&quot;Merck&quot; /&gt; Severe acute pancreatitis also causes [[cardiovascular shock]], [[disseminated intravascular coagulation]], [[systemic inflammatory response syndrome]], and [[organ failure]].&lt;ref name=&quot;sasts&quot;/&gt; Dehydration is observed in nearly all dogs with severe acute pancreatitis.&lt;ref name=&quot;sasts&quot;/&gt;

Serious and severe symptoms that are not uncommon include: [[hypokalaemia]], [[hyponatraemia]], and [[hypochloraemia]]. [[Hyperkalaemia]], [[hypernatraemia]], and [[hypocalcaemia]] are reported but rare.&lt;ref name=&quot;sasts&quot;/&gt;

Pancreatitis can result in [[exocrine pancreatic insufficiency]], if the organ's acinar cells are permanently damaged; the pancreatic enzymes then need replacement with [[pancrelipase]] or similar products.  The damage can also extend into the endocrine portion of the pancreas, resulting in [[diabetes mellitus]].&lt;ref name=&quot;Hoskins&quot; /&gt; Whether the diabetes is transient or permanent depends on the severity of the damage to the [[endocrine pancreas]] [[beta cell]]s.&lt;ref name=&quot;Brooks&quot; /&gt;

[[Extrahepatic biliary duct obstruction]] has been reported in both the cat and dog. The pancreas —being inflamed— compresses the [[bile duct]] which leads to biliary system distension and [[Jaundice|icterus]].&lt;ref name=&quot;sasts&quot;/&gt;

==Risk factors==
Although various causes of dog pancreatitis are known, such as drugs, fatty diet, trauma, etc., the pathophysiology is very complex.&lt;ref name=&quot;Washabau&quot; /&gt;&lt;ref name=&quot;IDEXX&quot; /&gt; Pancreatitis can be [[idiopathic]]; no real causation factor can be found.&lt;ref name=&quot;UGA&quot; /&gt;&lt;ref name=&quot;Merck&quot; /&gt; [[Dog health#Nutrition and obesity|Obese]] &lt;!-- [[Dog health]]--&gt; animals as well as animals fed a diet high in fat may be more prone to developing acute and chronic pancreatitis.&lt;ref name=&quot;Washabau&quot; /&gt;&lt;ref name=&quot;ArmstrongWestern2011&quot; /&gt;&lt;ref name=&quot;Williams&quot; /&gt; Certain breeds of dogs are considered predisposed to developing pancreatitis including [[Miniature Schnauzer]]s, [[Cocker Spaniel]]s, and some [[terrier]] breeds.&lt;ref name=&quot;Tufts&quot; /&gt;&lt;ref name=&quot;UGA&quot; /&gt;&lt;ref name=&quot;ArmstrongWestern2011&quot; /&gt;&lt;ref name=&quot;Simpson&quot; /&gt; Miniature Schnauzers as a breed tend toward developing [[hyperlipidemia]], an excess of circulating fats in the blood.&lt;ref name=&quot;Xenoulis&quot; /&gt; The breed that appears to be at risk for the acute form of pancreatitis is the [[Yorkshire Terrier]], while [[Labrador Retriever]]s and [[Poodle|Miniature Poodles]] seem to have a decreased risk for the acute form of the disease.  Genetics may play a part in the risk factor.&lt;ref name=&quot;Washabau&quot; /&gt; Certain cat breeds may have a predisposition.&lt;ref name=&quot;sasts&quot;/&gt; Dogs suffering from [[Diabetes in dogs|diabetes mellitus]], [[Cushing's disease (veterinary)|Cushing's disease]] (hyperadrenocorticism), [[Hypothyroidism in dogs|hypothyroidism]], and [[List of dog diseases#Nervous system|epilepsy]] have been reported to have an increased risk but no there is a lack of evidence to support a link between the conditions and pancreatitis.&lt;ref name=&quot;sasts&quot;/&gt; Diabetes and hypothyroidism are also associated with hyperlipidemia.&lt;ref name=&quot;Herrtage&quot; /&gt;&lt;ref name=&quot;ACVIM&quot; /&gt; Those with other types of gastrointestinal conditions and dogs that have had previous pancreatitis attacks are also at increased risk for the disorder.&lt;ref name=&quot;Washabau&quot; /&gt;

In cats, a study found an association with [[inflammatory bowel disease]] and [[cholangitis]] with pancreatitis.&lt;ref&gt;{{cite journal | last1=DJ | first1=Weiss | last2=JM | first2=Gagne | last3=PJ | first3=Armstrong | title=Relationship between inflammatory hepatic disease and inflammatory bowel disease, pancreatitis, and nephritis in cats | journal=Journal of the American Veterinary Medical Association | publisher=J Am Vet Med Assoc | volume=209 | issue=6 | issn=0003-1488 | pmid=8800259 | page=}}&lt;/ref&gt; [[Triaditis]] is a medical condition/term for when a cat has all three conditions. 50–67% of cats with pancreatitis have triaditis. In cats with [[cholangitis]] 50–80% have pancreatitis. The cause of this and the relationship between the conditions is not understood.&lt;ref name=&quot;sasts&quot;/&gt;

There is no sex predilection.&lt;ref name=&quot;sasts&quot;/&gt;
===Age of onset===
Pancreatitis can occur at any age but most animals with pancreatitis are middle-aged to elderly.&lt;ref name=&quot;sasts&quot;/&gt;
==Diagnosis==
Histopathological methods of diagnosis have been reported to diagnose up to 90% of clinically healthy dogs and 65% of cats with pancreatitis. Histopathology is not recommended for the diagnosis of pancreatitis on its own.&lt;ref name=&quot;sasts&quot;/&gt;

[[Complete blood count]], [[serum biochemistry]], and [[urinalysis]] are not helpful for diagnosing pancreatitis; however, they are useful to exclude differential diagnosis and confirm comorbidities.&lt;ref name=&quot;sasts&quot;/&gt;

Haemotological findings that can occur include: [[anaemia]], [[leukopaenia]], and [[thrombocytopaenia]]. These are not indicative of pancreatitis but instead symptoms of it.&lt;ref name=&quot;sasts&quot;/&gt;

===Pancreatic lipase assay===
[[Pancreatic lipase]] is an enzyme produced by the acinar cells of the pancreas. This makes measurement of it the most effective way to diagnose pancreatitis. Pancreatic lipase immunoreactivity assays are the most accurate type of assay for this. The sensitivity for  these assays are quite accurate.&lt;ref name=&quot;sasts&quot;/&gt;
===Serum amylase and lipase activities===
Serum amylase and lipase activities are not a useful indicator for pancreatitis as it can be synthesised by non-pancreatic tissue and the tests cannot distinguish the tissue origin. In one study 50% of dogs with increased amylase and lipase activities did not have any other evidence of pancreatitis. In cats the test has little to no clinical use.&lt;ref name=&quot;sasts&quot;/&gt;
===Trypsin-like immunoreactivity===
Serum [[trypsin-like immunoreactivity]] assays measure the amount of [[trypsinogen]] and [[trypsin]] in the serum. The tests are different for cats and dogs. In dogs results indicative of pancreatitis may also be caused by [[renal failure]] and [[enteropathies]]. In cats low sensitivity and other conditions—gastrointestinal diseases, azotemia—that produce similar results mean it is not a useful tool for diagnosis of pancreatitis.&lt;ref name=&quot;sasts&quot;/&gt;
===Radiography===
The majority of cats and dogs with pancreatitis show no abnormalities on [[radiograph]]s. Instead radiography serves as a way to diagnose or exclude other conditions. Findings possible in animals with pancreatitis include:f increased opacity of soft tissue, a decrease in [[serosal detail]] in the [[cranial]] right abdomen, [[gastric displacement]], [[duodenum displacement]], [[ascites]], and a cranial abdominal mass.&lt;ref name=&quot;sasts&quot;/&gt;
===Ultrasound===
[[Ultrasonography]] of the abdomen is the best method of diagnosing pancreatitis in cats and dogs. Due to advances in ultrasonography it is a routine procedure for diagnosing pancreatitis. [[Hypoechoic]] areas within the pancreas, an increase in [[echogenicity]] of the [[mesentery]] around the pancreas, and pancreatic abnormalities are all common ultrasonographic findings in cases of pancreatitis. Some patients with pancreatitis will not present with any ultrasonographic abnormalities.&lt;ref name=&quot;sasts&quot;/&gt;
===Pathology===
Tissue samples should be collected from pancreatic lesions that can be seen during surgery. These lesions may include [[peripancreatic fat necrosis]], [[pancreatic haemorrhage]], and [[pancreatic congestion]]. Lesions are not always present and cannot always be distinguished from [[nodular hyperplasia]] and [[neoplasia]].&lt;ref name=&quot;sasts&quot;/&gt;

Histopathology can differentiate acute and chronic pancreatitis. Pancreatic [[fibrosis]] and acinar [[atrophy]] suggest chronic instead of acute pancreatitis.&lt;ref name=&quot;sasts&quot;/&gt;
===Cytology===
Cytological examination of the pancreas can be done with [[fine needle aspiration]]. This is less invasive than histopathology. FNA can differentiate acute pancreatitis, on a smear there will be [[hypercellularity]] and degraded [[neutrophils]].&lt;ref name=&quot;sasts&quot;/&gt;
==Treatment==
Due to the unknown aetiology treatment is supportive and based on what symptoms the animal shows. Underlying conditions such as infections, toxicity, and endocrinopathies, etc. should be treated.&lt;ref name=&quot;sasts&quot;/&gt;
===Fluid therapy===
Severe pancreatitis can cause dehydration and [[hypovolaemia]], this can be treated with [[intravenous fluid therapy]]. When the patient has [[hypoalbuminaemia]] or [[hypotension]] [[colloid fluid]]s should be used instead of [[crystalloid fluid]]s that are normally used.&lt;ref name=&quot;sasts&quot;/&gt;
===Feeding===
Historically it was believed withholding food was beneficial, this is no longer the case. Current practice is to provide [[enteral]] and [[parenteral]] [[alimentation]]. [[Jejunal feeding]] is the preferred method for this.&lt;ref name=&quot;sasts&quot;/&gt;

[[Jejunostomy]] [[feeding tube]]s can be inserted following either a [[laparoscopy]] or [[laparotomy]] 
===Plasma transfusion===
Frozen plasma transfusion is a controversial treatment for pancreatitis in dogs. There is little supportive evidence it helps, with one study finding dogs treated with plasma transfusion to have worse outcomes, although the study did not control for treatment and did not randomise the groups.&lt;ref name=&quot;sasts&quot;/&gt;
===Analgesia===
Pancreatitis causes pain which can be responsible for numerous side effects, including: [[Anorexia (medicine)|anorexia]], decreased blood flow to abdominal organs, [[tachycardia]], and [[catabolism]]. Analgesia should be given to all patients with pancreatitis. [[Opioid]]s are usually required. The most common analgesics for pancreatitis are: [[buprenorphine]], [[fentanyl]], [[hydromorphone]] [[morphine]], [[lidocaine]], and [[ketamine]].&lt;ref name=&quot;sasts&quot;/&gt;
===Antiemesis===
[[Antiemesis]] is important in treating pancreatitis; [[maropitant]] (cerenia) is the drug of choice for treating emesis in pancreatitis cases. Maropitant is very safe and effective and may also have analgesic and anti-inflammatory effects which leads to it be the main drug for treating nausea and emesis in patients with pancreatitis.&lt;ref name=&quot;sasts&quot;/&gt;
===Hyporexia===
Patients with pancreatitis often develop [[anorexia (medicine)|anorexia]] from nausea, whilst treating nausea resolves the anorexia patients are still often [[hyporexic]]. An [[orexigenic]] will help resolve hyporexia. [[Capromorelin]] is the preferred treatment in both cats and dogs. [[Mirtazapine]] is another good option for cats and can be used in dogs.&lt;ref name=&quot;sasts&quot;/&gt;
===Surgery===
Surgery is only required in a few instances, namely: correction of [[biliary obstruction]], feeding tube placement, and [[diagnostic peritoneal lavage]]. A [[laparoscopy]] allows for most of these procedures.&lt;ref name=&quot;sasts&quot;/&gt;

==Postpancreatitis management==
A low-fat diet is indicated.&lt;ref name=&quot;Steiner&quot; /&gt; The use of drugs that are known to have an association with pancreatitis should be avoided.&lt;ref name=&quot;IDEXX&quot; /&gt;&lt;ref name=&quot;Brooks&quot; /&gt; Some patients benefit from the use of pancreatic enzymes on a supplemental basis.  One study indicated that 57% dogs followed for six months after an acute pancreatitis attack, either continued to exhibit inflammation of the organ or had decreased acinar cell function, though they had no pancreatitis symptoms.&lt;ref name=&quot;IDEXX&quot; /&gt;&lt;ref name=&quot;MerckChronic&quot; /&gt;

==See also==
* [[Pancreatitis]]

==References==
&lt;references&gt;

&lt;ref name=&quot;Washabau&quot;&gt;{{Cite web|url=http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2009&amp;Category=8065&amp;PID=53541&amp;O=Generic|title=Canine Pancreatic Disease: What's New in Diagnosis and Therapy?|author=Washabau, Robert J.|publisher=34th Congress-World Small Animal Veterinary Association (WSAVA)|year=2009|access-date=8 April 2011}}&lt;/ref&gt;

&lt;ref name=&quot;Steiner&quot;&gt;{{Cite web|title=Pancreatitis|author=Steiner, Jörg M.|date=August 2003|publisher=Clinician's Brief-North American Veterinary Conference|access-date=9 April 2011}}&lt;/ref&gt;

&lt;ref name=&quot;Colorado exocrine&quot;&gt;{{Cite web|url=http://arbl.cvmbs.colostate.edu/hbooks/pathphys/digestion/pancreas/exocrine.html|title=Exocrine Sections of the Pancreas|publisher=Colorado State University School of Veterinary Medicine|access-date=8 April 2011|archive-url=https://web.archive.org/web/20110514222237/http://arbl.cvmbs.colostate.edu/hbooks/pathphys/digestion/pancreas/exocrine.html|archive-date=14 May 2011|url-status=dead}}&lt;/ref&gt;

&lt;ref name=&quot;ColState&quot;&gt;{{Cite web|url=http://arbl.cvmbs.colostate.edu/hbooks/pathphys/digestion/pancreas/anatomy.html|title=Gross and Microscopic Anatomy of the Pancreas|publisher=Colorado State University School of Veterinary Medicine|access-date=8 April 2011|archive-url=https://web.archive.org/web/20110514223619/http://arbl.cvmbs.colostate.edu/hbooks/pathphys/digestion/pancreas/anatomy.html|archive-date=14 May 2011|url-status=dead}}&lt;/ref&gt;

&lt;ref name=&quot;Cell&quot;&gt;{{Cite web|url=http://www.bioeng.auckland.ac.nz/anatml/anatml/database/cells/cells/parts/part/part_65.html|title= Acinar Cell|publisher=Auckland Bioengineering Institute-University of Auckland|access-date=8 April 2011|archive-url= https://web.archive.org/web/20080226045449/http://www.bioeng.auckland.ac.nz/anatml/anatml/database/cells/cells/parts/part/part_65.html|archive-date= 26 February 2008}}&lt;/ref&gt;

&lt;ref name=&quot;Colorado endocrine&quot;&gt;{{Cite web|url=http://arbl.cvmbs.colostate.edu/hbooks/pathphys/digestion/basics/gi_endocrine.html|title=Enteric Endocrine System|publisher=Colorado State University School of Veterinary Medicine|access-date=8 April 2011|archive-url=https://web.archive.org/web/20110514230652/http://arbl.cvmbs.colostate.edu/hbooks/pathphys/digestion/basics/gi_endocrine.html|archive-date=14 May 2011|url-status=dead}}&lt;/ref&gt;

&lt;ref name=&quot;CoPES&quot;&gt;{{Cite web|url=http://arbl.cvmbs.colostate.edu/hbooks/pathphys/digestion/pancreas/control.html|title=Control of Pancreatic Exocrine Secretion|publisher=Colorado State University School of Veterinary Medicine|access-date=8 April 2011|archive-url=https://web.archive.org/web/20110514223650/http://arbl.cvmbs.colostate.edu/hbooks/pathphys/digestion/pancreas/control.html|archive-date=14 May 2011|url-status=dead}}&lt;/ref&gt;

&lt;ref name=&quot;Tufts&quot;&gt;{{Cite web|title=Big Steak Dinner|publisher=Tufts School of Veterinary Medicine|year=2007|access-date=8 April 2011}}&lt;/ref&gt;

&lt;ref name=&quot;Steiner 2003&quot;&gt;{{Cite journal|author=J. M. Steiner|title=Diagnosis of acute pancreatitis|journal=Vet Clin North Am Small Anim Pract|date=2003|volume=33|pages=1181–1195}}&lt;/ref&gt;

&lt;ref name=&quot;UGA&quot;&gt;{{Cite web|url=http://www.vet.uga.edu/vpp/clerk/west/index.php|title=Diagnosing Pancreatitis in Dogs and Cats by Laboratory Methods|author1=West, Laura D. |author2=Almy, Frederic S. |publisher=University of Georgia School of Veterinary Medicine|access-date=8 April 2011}}&lt;/ref&gt;

&lt;ref name=&quot;IDEXX&quot;&gt;{{Cite web
 |title=Diagnosing and Treating Pancreatitis
 |pages=3
 |publisher=IDEXX Laboratories
 |year=2006
 |access-date=21 April 2011
 }}&lt;/ref&gt;

&lt;ref name=&quot;Merck&quot;&gt;{{Cite web|url=http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/23402.htm&amp;word=pancreatitis|title=Pancreatitis|publisher=Merck Veterinary Manual|access-date=8 April 2011}}&lt;/ref&gt;

&lt;ref name=&quot;Williams&quot;&gt;Williams DA, Steiner JM. Canine Exocrine Pancreatic Disease. In Ettinger SJ, Feldman EC (eds): Textbook of Veterinary Internal Medicine, Diseases of the Dog and Cat, 6th ed. St. Louis, Elsevier Saunders, 2005, pp. 1482-1487&lt;/ref&gt;

&lt;ref name=&quot;ArmstrongWestern2011&quot;&gt;{{Cite web|title=Canine Pancreatitis: Diagnosis and Management|author=Armstrong, P. Jane|year=2011|publisher=Western Veterinary Conference|access-date=8 April 2011}}&lt;/ref&gt;

&lt;ref name=&quot;Simpson&quot;&gt;Simpson, KW. Diseases of the Pancreas. In Tams T. (ed): Handbook of Small Animal Gastroenterology, 2nd ed. St. Louis, W. B. Saunders Co, 2003, pp. 353-365.&lt;/ref&gt;

&lt;ref name=&quot;Xenoulis&quot;&gt;{{Cite journal|doi=10.1111/j.1939-1676.2007.tb01942.x|title=Investigation of Hypertriglyceridemia in Healthy Miniature Schnauzers|author1=Xenoulis, Panagiotis G. |author2=Suchodolski, Jan S. |author3=Levinski, Melinda D. |author4=Steiner, Jörg M. |year=2007|journal=Journal of Veterinary Internal Medicine|volume=21 |issue=6 |pages=1224–1230 |doi-access=}}&lt;/ref&gt;

&lt;ref name=&quot;Brooks&quot;&gt;{{Cite web|url=http://www.veterinarypartner.com/Content.plx?P=A&amp;A=2214|title=Canine Pancreatitis|author=Brooks, Wendy C.|publisher=Veterinary Partner|access-date=8 April 2011}}&lt;/ref&gt;

&lt;ref name=&quot;Herrtage&quot;&gt;{{Cite web|url=http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2009&amp;Category=8060&amp;PID=53521&amp;O=Generic |title=New Strategies in the Management of Canine Diabetes Mellitus |author=Herrtage, Michael|year=2009|publisher=WSAVA|access-date=8 April 2011}}&lt;/ref&gt;

&lt;ref name=&quot;ACVIM&quot;&gt;{{Cite web|title=Abstract #216-Association Between Hyperlipidemia &amp; Hypothyroid in Dogs|page=81|year=2004|publisher=American College of Veterinary Internal Medicine|access-date=8 April 2011}}&lt;/ref&gt;

&lt;ref name=&quot;Hoskins&quot;&gt;{{Cite web|url=http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=13321|title=Can You Rule Out Pancreatitis?|author=Hoskins, Johnny D.|year=2002|publisher=DVM 360|access-date=8 April 2011}}&lt;/ref&gt;

&lt;ref name=&quot;MerckChronic&quot;&gt;{{Cite web|url=http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/23403.htm|title=Mild Chronic Pancreatitis|publisher=Merck Veterinary Manual|access-date=8 April 2011}}&lt;/ref&gt;

&lt;/references&gt;

{{DEFAULTSORT:Canine Pancreatitis}}
[[Category:Dog diseases|Pancreatitis]]