Episode 27  ·  13m 47s

Pancreatitis — The Most Overdiagnosed Condition an ER Vet Sees

Dr. Michael LoSasso, DVM & Julie Schwenzer Frisco Emergency Pet Care
Pancreatitis Miniature Schnauzers Fatty food risk Diagnostic imaging Low-fat diet
"When the pancreas becomes inflamed, pets can go from a little off to critically ill in a matter of hours. Knowing the warning signs can save a life."
— Julie Schwenzer

Episode summary

Pancreatitis is common in dogs, rarer in cats (where it often shows up as part of "triaditis" — simultaneous inflammation of the liver, gallbladder, and pancreas), and genuinely tricky to pin down by symptoms alone. Dr. LoSasso says roughly two-thirds of affected dogs vomit, about two-thirds have diarrhea, and two-thirds to three-quarters show abdominal pain — but these are overlapping populations, not universal symptoms, so a dog might show just one, several, or occasionally none at all.

The mechanism comes down to the pancreas's fat-digesting job. A fatty meal — trash, bacon scraps, the fatty trimmings off a steak — can trigger inflammation, and once the pancreas is angry, its digestive enzymes can leak onto surrounding tissue: the small intestine, the right kidney, even the liver. That's part of why pancreatitis is so uncomfortable and can make a dog genuinely sick fast.

"Just because your pancreas is inflamed doesn't mean pancreatitis is your main problem. Sometimes that's important to distinguish."
— Dr. Michael LoSasso, DVM

That distinction is exactly why Dr. LoSasso calls pancreatitis one of the most overdiagnosed conditions he sees. Older tests only reported "normal" or "abnormal" with no severity attached, and inflammation anywhere nearby — the intestine, gallbladder, liver — can make the pancreas look mildly inflamed too, even when it isn't the actual root cause. Newer tests give an actual number: under 200 is normal, while values around 600 or 1200 point to more severe, likely primary inflammation. Most cases are inflammatory rather than infectious, so antibiotics generally aren't the answer; the more severe, and occasionally fatal, form is necrotizing pancreatitis, where part of the organ is actually dying, or an abscessed, truly infected pancreas.

The breed that can't avoid it: Miniature Schnauzers

Miniature Schnauzers — not Standards, not Giants — carry a breed-wide tendency toward chronically high triglycerides; their blood can look visibly milky with fat even on a normal day. That constant fat exposure repeatedly irritates the pancreas over a lifetime. Chronic pancreatitis from this ongoing irritation can scar the pancreas, and scar tissue means reduced insulin production — so repeated pancreatitis episodes in this breed can eventually lead to secondary diabetes. After a pancreatitis episode, recovery support for any dog centers on a low-fat diet and keeping them out of the trash.

Dr. LoSasso shares the case that shaped how carefully he investigates a pancreatitis diagnosis now: more than 15 years ago, he aggressively treated a dog for presumed pancreatitis over an entire weekend — plasma, intensive therapy, the works — only for her regular vet to take her to surgery Monday morning and find a stuffed animal obstructing her intestine. The pancreatic inflammation had been real, but secondary to the actual problem underneath it. Since then, he insists on imaging or thorough testing before committing to a pancreatitis diagnosis, specifically to avoid missing a surgical case hiding behind it.

Questions answered in this episode

The following questions are answered by Dr. LoSasso in this episode, drawn directly from the conversation. These are real clinical answers from a practicing emergency veterinarian with 30+ years of experience.

Dr. LoSasso says roughly two-thirds of dogs with pancreatitis vomit, about two-thirds have diarrhea, and two-thirds to three-quarters show abdominal pain — but these are overlapping, not universal, populations, so a dog might show only one sign, several, or none at all, which makes it a genuinely tricky condition to catch by symptoms alone.
The pancreas has an exocrine function responsible for digesting dietary fat. A fatty meal — getting into the trash, bacon scraps, fatty steak trimmings — can trigger inflammation. When the pancreas becomes inflamed, its fat-digesting enzymes can leak onto surrounding tissue like the small intestine, the right kidney, and even the liver, which is part of why an angry pancreas causes so much pain and illness.
Older pancreatitis tests only reported "normal" or "abnormal" with no severity information, and inflammation in nearby organs — the intestine, gallbladder, liver — can cause the pancreas to appear mildly inflamed too, even when it isn't the actual primary problem. Newer tests give a numerical value (under 200 is normal; values around 600 or 1200 indicate more severe inflammation), which lets vets grade severity more precisely instead of just getting a yes/no answer that can lead to unnecessary treatment.
Usually not. Dr. LoSasso explains most pancreatitis cases are inflammatory, not infectious, so antibiotics aren't the right tool. Severe cases can involve necrotizing pancreatitis, where part of the pancreas is actually dying, or an abscessed and infected pancreas — those are more serious and harder to recover from, and are when pancreatitis becomes a potentially fatal problem.
Dr. LoSasso says Miniature Schnauzers (not Standards or Giants) have a breed-wide tendency toward chronically high circulating triglycerides — their blood often looks visibly milky with fat. That constant fat exposure repeatedly irritates the pancreas over the dog's lifetime. Chronic pancreatitis from this ongoing irritation can lead to scar tissue, which reduces the pancreas's ability to produce insulin — meaning repeated pancreatitis episodes can eventually cause secondary diabetes in this breed.
Years ago, he treated a dog aggressively for presumed pancreatitis over an entire weekend, only for the dog's regular vet to take her to surgery Monday morning and find a stuffed animal obstructing her intestine — the actual cause, with the pancreatic inflammation only secondary to that blockage. Since then, he's insistent on imaging or more thorough testing before committing to a pancreatitis diagnosis, specifically to avoid missing a surgical problem hiding underneath it.
JulieWhen the pancreas becomes inflamed, pets can go from a little off to critically ill in a matter of hours. Knowing the warning signs can save a life. Could you share the signs of pancreatitis in dogs and cats?
Dr. LoSassoIt's a bit more rare in cats — frequently we see it there as part of what we call triaditis, which is inflammation of the liver, gallbladder, and pancreas together, forming a triad. In dogs it's a lot more common, and honestly, I think the single most overdiagnosed problem we see in dogs. Clinical signs: about two-thirds of dogs with pancreatitis vomit, about two-thirds have diarrhea, and roughly two-thirds to three-quarters have abdominal pain — but those are different, overlapping populations, so you might have one or two of those problems, or you might be one of the dogs that has none of them, which is more challenging to pick up.
Dr. LoSassoLet's talk about what the pancreas does and why it's a problem. It has two totally separate jobs — an endocrine function, secreting insulin and glucagon to control blood sugar, that's the beta cells. And a super important exocrine function: digesting fats. So when you have a fatty meal — trash, bacon scraps, the fatty trimmings off a steak — the pancreas gets inflamed, and all those fat-digesting enzymes ooze out of a really angry pancreas onto the small intestine, the right kidney, maybe even the liver. If the pancreas isn't happy, nobody's happy — it's really uncomfortable and can make them sick. Conversely, if you've got inflammation in the small intestine, gallbladder, or liver, the pancreas often gets a bit inflamed secondary to that. A lot of the tests we've had for years just say normal or abnormal — doesn't tell you it's your main problem. It's gotten better now with tests that give a number: under 200 is normal, 600 or 1200 indicates severe inflammation, probably not secondary to something else, and that dog should probably be treated with a drug called Panoquell. It's been out three or four years, an anti-inflammatory that's only active within the canine pancreas specifically — it really quiets things down and gets dogs out of hospital sooner, though it's pretty expensive, especially in a big dog — a few hundred dollars just for the drug, given once every 24 hours until signs resolve or the dog's discharged.
Dr. LoSassoWhat we normally do is look with X-rays and ultrasound ourselves — if we can't determine a reason for the vomiting or nausea, and there's a history of getting into the trash, we'll bring in our ultrasonographer, our radiologist, because full disclosure, I can't find a pancreas with ultrasound to save my life, it's not a distinct organ. Someone skilled with a better machine can find it and tell me the pancreas is really inflamed, or that it's actually necrotizing — so severely inflamed that part of it is dying — or abscessed and infected. Most cases are inflammatory, not infectious, so we don't use antibiotics unless it's actually infected. Necrotizing pancreatitis is tough to come back from — that's when it becomes a potentially fatal problem.
JulieIf it's not fatal, what can owners do after discharge to support recovery and avoid it happening again?
Dr. LoSassoA low-fat diet and keeping them out of the trash. You can't have a pancreatitis conversation without bringing up the Miniature Schnauzer — not Standards, not Giants, only the minis. They have a breed-wide problem with high circulating triglycerides at all times. If you and I eat and then get blood drawn, we're typically lipemic, fat in the blood interferes with testing, which is why you fast before bloodwork. Miniature Schnauzers almost always have lipemia — their serum looks like milk. That's a challenge for bloodwork, but more importantly, those dogs are poking their pancreas with a stick their whole lives, constantly insulting it with all that fat. If they develop chronic pancreatitis from that, chronic inflammation leads to scar tissue, and scar tissue means the pancreas doesn't secrete much insulin — so they can become diabetic secondary to all those pancreatitis episodes. The Miniature Schnauzer is kind of behind the eight ball on pancreatic health.
JulieIs pancreatitis still one of the more overdiagnosed conditions, even with improved testing?
Dr. LoSassoIt's getting better as testing improves, but hospitals still using the old "normal or abnormal" test will say your dog has pancreatitis and should be treated. I got burned on this more than 15 years ago — had an aggressive pit bull, hard to get near, that a referring doctor had diagnosed with pancreatitis. We didn't have the number tests back then. We treated her for pancreatitis Friday night into Saturday, gave her plasma, got really serious about the intensity of treatment, continued through Sunday. Monday morning, since we were a nights-and-weekends hospital, we closed and sent her back to her regular vet — who took her to surgery and pulled a stuffed animal out of her belly. That resolved it. Her pancreatitis was secondary to an intestinal problem, not the primary issue. That's why we get frustrated when somebody just says "it's pancreatitis" — I want an ultrasound or more bloodwork to confirm, to make sure it's not a surgical case. Once bitten, twice shy. We're all human, we all miss things, but we can learn — and I've learned from a lot of hindsight over the years.

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