scott@vtx-cpd.com

Great question.

I am not sure there is one paper that totally answers this question. Several trials involving people with acute pancreatitis have demonstrated the attributes of enteral, rather than parenteral, nutrition, including decreased mortality rates. So we know we definitely have to feed them and not withhold food. In one study enteral feeding a low-fat diet via oesophagostomy tube in dogs with severe acute pancreatitis, within the first 12-24 hours of admission, was well tolerated and resulted in fewer complications when compared with parenteral nutrition. In another study, dogs with pancreatitis were fed very low fat diets (e.g., less than 25 g fat per 1000 kcal), although no significant difference in the degree of pancreatic physiologic response in healthy dogs fed diets with 16% or 5% crude fat (as fed) was reported.

Dietary management for cats with acute pancreatitis has not been well described. Excessively high fat foods should probably be avoided. Early placement of a nasogastric or esophagostomy tube is important in anorectic cats due to their risk of hepatic lipidosis. In a study of 55 cats with suspected acute pancreatitis, nasogastric tube feeding was well tolerated.

Overall, in the acute pancreatitis case, I would not get too tied up in the actual fat percentage. Choosing a food with a lower fat content is probably a good idea, but any nutrition is better than none. I do not think we have to reach for anything ultra low fat.

In chronic cases…

It is recommended that obese or hypertriglyceridemic pancreatitis dogs or cats be fed ultra-low fat diets, with fat percentage on a dry matter basis (DMB) ≤10% for dogs and ≤15% for cats. Non-obese dogs and cats without elevated triglycerides may be fed diets with <15% and <25% fat DMB, respectively. While there are commercial dog foods available which meet these criteria, there are fewer cat foods. Some low calorie or senior diets, which may not contain sufficient calories for an ill cat, are low in fat. Adverse effects have been reported with tube feeding elemental diets to cats, so a better approach may be to use a liquid diet formulated for use in cats if using a nasogastric tube. If esophageal tube feeding is used or the cat has returned to voluntary eating, a diet with moderate fat content may be used (e.g., most commercial adult maintenance diets).

Hope that helps.

Scott 🙂

Thanks so much for sharing the images.

This is an interesting case.

How has the patient done?

Scott 🙂

From my imaging specialist pal…

“If it is emphysematous gastritis then they would see gas in the gastric wall on ultrasound, which would appear as hyperechoic foci with reverberation artefacts, this can be difficult to appreciate when there is gas in the lumen, so usually takes several goes at looking through the gastric wall carefully and possibly from different sides/angles (pic below from that paper). Usually, the gastric wall looks thickened and abnormal as well. They may also see it on radiographs (see pic below again from paper).

It appears from that paper if the patient does not have systemic signs then they tend to do ok and the diagnosis would be more of a benign gastric emphysema and treatment wise just standard gastritis treatment. If patient not doing well, then more towards emphysematous gastritis and then they do not do very well (all patients in that paper were PTS). I specifically remember one of the cases from that paper as I scanned it, which was a case that did well and the gastric emphysema was presumed clinically insignificant in that case…. I have not had any further cases since.

If the dog in question is doing well not sure how useful any more imaging/follow-up ultrasound images of stomach would be tbh.”

Turns out she was involved with some of the cases in the paper!

Hope that helps!

Scott 🙂