Author: Christal Pollock, DVM, Dipl. ABVP-Avian
Date: June 17, 2007
Keywords: Pancreatitis, pancreas, exocrine pancreatic insufficiency, obesity, maldigestion, medium chain triglycerides, polyunsaturated fatty acids, parenteral nutrition.
Introduction
Pancreatitis is probably an under-diagnosed condition in the avian patient. Interpretation of blood work is difficult and there are technical challenges involved in endoscopy and biopsy of the avian pancreas. There are a variety of potential causes of pancreatitis including obesity, high fat diet, zinc toxicity, mycotoxins, and viral disease.
Signs of acute pancreatitis in the avian patient may include non-specific signs of illness, tachypnea, vomiting or regurgitation, and evidence of abdominal pain such as guarding and rigidity. Chronic pancreatitis is associated with weight loss, maldigestion, and malnutrition. Exocrine insufficiency is not a universal feature of chronic pancreatitis, but signs may include weight loss and polyphagia.
Nutritional management of pancreatic disease
Since pancreatitis is poorly described in the avian patient, nutritional management of pancreatic disease is directly extrapolated from care of small animals and humans.
Rehydrate the patient and provide supplemental heat. Small mammals may be fasted from 1 to 3 days, and water and food is only very gradually reintroduced. However the high metabolic rate of birds makes extended fasting difficult to impossible in many avian patients.
- Reduce fat intake to minimize pancreatic enzyme secretion. Gradually convert birds on an oil-seed based-diet to pellets and healthy table food.
- Carbohydrates appear to have a negligible effect on pancreatic stimulation, and they can also serve as an excellent energy source to the weak bird. This is why dogs are often fed rice, a highly digestible carbohydrate, in pancreatitis.
- Medium chain triglycerides may serve as an excellent source of lipids and calories, and they are directly absorbed by the small intestine without a need for micelles or pancreatic secretion of lipase.
- The addition of omega-6 and omega-3 polyunsaturated fatty acids may shorten the course of pancreatitis. Doneley has described the use of a 5:1 ratio combination of omega-6:omega-3 fatty acids (0.11 ml/kg PO q24h) for birds with acute pancreatitis.
- Pancreatic enzyme supplements (i.e. Viokase, Axean-Scandipharm or Harrison’s Bird Food, Avian Enzyme®) are indicated for the management of pancreatic exocrine insufficiency. Avian patients with pancreatic exocrine insufficiency may exhibit pale, fluffy stool frequently described as “popcorn stool”. The ideal pancreatic enzyme preparation should contain a high levels of lipase and proteases while being resistant to gastric acid. Efficacy is based on clinical signs such as body weight, resolution of diarrhea and absence of visible fat in the droppings. Use of enzyme supplements is generally considered safe, however there are anecdotal reports of death associated with regurgitation and aspiration of even very small amounts.
- Parenteral nutrition or partial parenteral nutrition may be useful short-term in severe acute pancreatitis.
References
Doneley RJT. Acute pancreatitis in parrots. Aust Vet J 79(6):409-412,2001.
Elliott Denise. Nutritional management of canine pancreatitis. World Small Animal Veterinary Association World Congress Proceedings, 2006.
Lasztity N, Hamvas J, Biró L, et al. Effect of enterally administered n-3 polyunsaturated fatty acids in acute pancreatitis—a prospective randomized clinical trial. Clin Nutr 24(2):198-205, 2005.
Obideen K, Yakshe P. Chronic pancreatitis. eMedicine. July 27, 2006. Accessed June 17, 2006 at http://www.emedicine.com/med/topic1721.htm#section~treatment.
