120 | Feline pancreatitis and triaditis: what do we REALLY need to know about it to nurse these patients confidently?

This week, we’re talking about a commonly misunderstood condition - feline pancreatitis.

We’re actually talking about a few conditions that overlap in our cats; alongside pancreatitis, many present with concurrent GI and hepatobiliary disease (‘triaditis’).

Many cats with cholangiohepatitis, pancreatitis, chronic enteropathy and combinations of these disease present with similar clinical signs, which can make distinguishing from them challenging. Nursing these patients begins with understanding each of these diseases, how they relate to each other, and the impact they have on our patients - and that’s exactly what we’re talking about today.

We’re going to spend the next half an hour or so chatting all about pancreatitis and related diseases - the myths, misconceptions, nursing needs, and the skills you can use in practice when caring for these often challenging patients.

Let’s start by looking at the pathophysiology of pancreatitis in cats - and how it differs to dogs.

As we chatted about in last week’s episode, episode 119, the pancreas is an organ of both endocrine and exocrine function - and it’s the exocrine functions, it’s ability to create and secrete digestive enzymes, that we’re interested in today.

To briefly recap, those digestive enzymes are not activated until they enter the duodenum, where they begin to break down macronutrients in food. 

Pancreatitis occurs when there is premature activation of these enymes. Trypsin, a protein-digesting-enzyme, activates other enzymes such as amylase and lipase, which break down starches and fats, respectively.

Since our tissues within the body (including the pancreas) are comprised of things like proteins and fats, premature activation of the these enzymes causes pancreatic autodigestion, necrosis and oedema.

White blood cells (and other cells) then infiltrate the pancreas in response to that inflammation. In severe cases, that inflammation doesn’t just impact the pancreas - inflammatory mediators can cause widespread systemic inflammation with severe consequences, just like we discussed last week.

Just like with dogs, we see both acute and chronic forms of feline pancreatitis.

Acute pancreatitis is characterised by neutrophilic inflammation - so neutrophils respond to the pancreatic necrosis and oedema and flock to the area, releasing inflammatory proteins and other substances to stimulate the immune system while they’re at it. This is the more severe form of the disease, and the one where we’re likely to see systemic complications, as those neutrophils can leave the pancreas and enter the bloodstream, essentially spreading that inflammation.

In cats, evidence suggests we chronic pancreatitis far more commonly - though without histology, it’s virtually impossible to differentiate between the two.

Chronic pancreatitis is characterised by lymphoplasmacytic inflammation, where lymphocytes and plasma cells are the primary inflammatory infiltrates within the pancreas. Alongside this, patients typically have pancreatic fibrosis causing permanent scarring of the pancreas.

There’s also an acute-on-chronic form of the disease, where we have an acute-onset exacerbation of an existing chronic pancreatitis. But it isn’t as clear-cut as ‘acute’ ‘chronic’ and ‘acute-on-chronic’ - instead, its suggested that acute and chronic pancreatitis in cats likely sit at opposite ends of a disease continuum.

Pancreatitis is also much more common in our cats than it seems.

There is a huge range in reported prevalence - between 0.6% to 67% - but what gets really interesting is when you focus in on asymptomatic patients.

One post-mortem study found that 45% of apparently healthy cats - cats that died of something completely unrelated - had evidence of pancreatitis on histology. So there’s actually a huge amount of that low-grade, ongoing inflammation that goes undetected, meaning that looking for subtle signs - and knowing how different cats with pancreatitis present compared with dogs - is vital.

Concurrent disease is also really common in these patients, reported in up to 83% of cats with acute pancreatitis. These diseases include diabetes mellitus and DKA, hepatic lipidosis, and concurrent intestinal and biliary inflammation (‘triaditis’).

So that’s what feline pancreatitis is, but what clinical signs do we see, and which of our patients get it?

If we look first at risk factors, the vast majority of both acute and chronic cases are idiopathic. 

There are some recognised triggers, including abdominal/pancreatic trauma (RTAs, falls from height, high-rise syndrome, etc), hypoperfusion and ischaemia in the case of acute pancreatitis.

Established risk factors for chronic pancreatitis, on the other hand, include infections such as toxoplasmosis, coronavirus, calicivirus and herpescirus, hypercalcaemia, certain medications, and potentially autoimmune disease. Interestingly, high-fat diets are also described in some papers, though it’s important to note that cats do naturally have higher fat requirements compared with dogs.

Clinical signs can differ significantly between cats and dogs - and the signs are often incredibly subtle in our feline patients.

Even in acute pancreatitis, the more severe form of the disease, many patients show vague and non-specific signs. 

One evaluation showed that 17% of cats with acute pancreatitis only had lethargy as their initial sign, while another reported 62% with anorexia. 

Vomiting was described in less than ~50% of cases, while abdominal pain is incredibly rare - even when there is strong evidence of pancreatitis. 

Pyrexia is less common than hypothermia - in one study around 25% of cats were pyrexic, 25% were normothermic, and around half actually had a low temperature.

Interestingly, around 25% of cats with acute pancreatitis seem to have what feels like an abdominal mass on palpation, which may easily be mistaken for something like neoplasia, intussusception or a foreign body if diagnostic imaging is not performed.

The signs are similarly non-specific in patients with chronic pancreatitis, with weight loss, lethargy, inappetence, diarrhoea and behavioural changes among the reported signs, though many cats are asymptomatic.

And if patients have concurrent hepatobiliary disease, we’re likely to see things like jaundice, or other specific signs depending on their comorbidities.

So if we compare this to dogs, feline pancreatitis is nowhere near as obvious. 

Dehydration is often less marked, pain is likely to be hidden, and vomiting is rare - and these are the signs we classically associate with pancreatitis.

On top of that, the signs we DO see in cats can be caused by any number of things - and often we’re faced with overlapping conditions causing similar signs.

What about triaditis - what is it, how does it link to pancreatitis, and why do cats get it?

This seems like a good time to talk about triaditis, because pancreatitis and triaditis are closely linked - and while we nurse these patients very similarly, we need to understand the relationship between the two diseases.

Triaditis is three inflammatory conditions in the same cat at once - pancreatitis, cholangitis (biliary inflammation), and chronic intestinal inflammation (chronic inflammatory enteropathy, or what you’ve previously heard referred to as IBD). 

It’s relatively common, with incidences of 17-39% reported, and it’s a disease specific to cats because of their unique anatomy.

You may remember from episode 119 that the digestive enzymes made in the pancreas leave it and enter into the small intestine via the pancreatic duct and accessory pancreatic duct.

In cats, the pancreatic duct and the common bile duct - where bile enters the small intestine from the gall bladder - join together and enter the duodenum together, at one small opening called the duodenal papilla. 

Cats also have a shorter small intestine and a heavier bacterial load in the duodenum than dogs. And on top of this, around 80% of them don’t have an accessory pancreatic duct, meaning there’s one entry and exit point between the pancreas and the intestinal tract. 

All of this put together means that the enteric bacteria - the natural population of bacteria in the gut - can ascend up that shared pathway and cause inflammation of both the biliary tract (and liver), AND the pancreas.

Vomiting can cause pressure changes that push duodenal contents back up into the ducts. And if the pancreas is inflamed, this can limit flow through the pancreatic duct, meaning those enzymes have nowhere to go.

This makes the autodigestion worse, causing more inflammation, more pancreatic outflow obstruction, and a vicious cycle for our patients.

There’s also thought to be an immune component to the disease. Intestinal inflammation can recruit immune cells like lymphocytes, which can then infiltrate the liver and pancreas. 

On top of this, some cats have been documented to have something called Sphincter of Oddi dysfunction or SOD. The sphincter of Oddi is the valve that controls the flow of bile and pancreatic secretions into the small intestine. This sphincter can spasm, or fail to relax properly, causing digestive enzymes and bile to back up in the pancreas and biliary tract.

This disorder is strongly liked to inflammatory GI disease, because inflammation near the sphincter can make it malfunction.

So it isn’t as simple as just the pancreas being affected - in many patients, we need to look for evidence of inflammation in the neighbouring organs, too.

Just like pancreatitis, we don’t completely understand why triaditis happens - but we do know that we don’t tend to see asymptomatic cases of triaditis, and the more severe the intestinal inflammation, the more other organs within the body seem to be affected.

Regardless of whether our patient has triaditis, pancreatitis, cholangiohepatitis, inflammatory enteropathy or a combination of two or more of these, they’ll likely have incredibly similar clinical signs - and similar nursing needs.

So how do we diagnose pancreatitis (and comorbidities) in cats?

Just like our dogs, we can’t use one simple test to confirm the diagnosis, and instead we’re building it based on a combination of examination findings (if any), imaging results, general bloodwork, and pancreatic testing.

If your clinician suspects the patient may have concurrent cholangiohepatitis and/or chronic inflammatory enteropathy, patients will also need additional diagnostics such as bile sampling, liver FNAs, and intestinal biopsies.

Let’s start by looking at bloods.

Biochemistry and haematology may show changes associated with things like anorexia, and increased liver enzymes may be seen in cases of concurrent hepatobiliary disease. Hypocalcaemia may also be seen, usually in acute pancreatitis.

Feline pancreatic lipase immunoreactivity, or fPLi, is another common test performed in these patients. And just like with our dogs, it isn’t 100% accurate - especially in milder forms of the disease, because accuracy is higher in patients with moderate-to-severe clinical signs. This means that a negative result doesn’t always mean your patient is pancreatitis-free, especially if you’re thinking it could be chronic.

Other tests include B12 and folate testing, especially if we’re concerned about GI disease. On top of this, cats make almost all of their intrinsic factor - the protein they need to absorb B12 - in the pancreas. So pancreatic disease can impact B12 levels, too.

In 2025, a study looking at prognostic factors in cats with pancreatitis found that jaundice, azotaemia and hypoalbuminaemia were all associated with poorer outcome in cats hospitalised with pancreatitis, so it’s also worth keeping an eye on these results.

Then we’ve got diagnostic imaging.

Abdominal ultrasound is useful, but not completely accurate, and it depends a lot on the individual person scanning the patient.

Just like in our dogs, a normal-appearing pancreas on ultrasound doesn’t mean our patient is pancreatitis-free - we can see marked inflammation even in a normal-looking pancreas.

Ultrasound is especially useful for assessing those neighbouring organs, looking for evidence of triaditis, and guiding sampling of things like the liver and bile (where appropriate and safe to do so).

Pancreatic histopathology is theoretically the ‘most accurate’ way to diagnose pancreatitis, but it’s not typically performed and in most cases we treat patients presumptively.

The treatment and nursing care cats with pancreatitis/triaditis need (and how to provide it)

In cats with pancreatitis, our treatment and nursing care is entirely supportive and symptomatic - meaning how we manage these patients has a direct impact on their disease.

And just like our dogs, we need to prioritise fluid therapy, nutrition, analgesia and antiemetics. Alongside this, we’re likely to see things like electrolyte abnormalities that need correcting, and our patients may have concurrent diseases that also need managing.

And that means there’s lots to think about for us as veterinary nurses and technicians.

Providing fluid therapy and correcting electrolyte abnormalities in cats with pancreatitis

These patients are often dehydrated, inappetent, and may have vomiting or diarrhoea (though not always). And all of this means fluid balance is an important consideration.

Hypokalaemia is also common and needs careful monitoring and correction.

The importance of providing nutritional support in cats with pancreatitis or triaditis

Just like in our dogs, we’re not going to pursue any period of ‘gut rest’ and instead we’ll focus on providing quality early enteral nutrition, with feeding tubes used as needed.

There’s a high risk of hepatic lipidosis in these patients, so we need to refeed them early and appropriately to prevent ongoing or marked weight loss, without overfeeding which risks metabolic consequences.

In terms of what to feed, there is no strong evidence supporting a low-fat diet in cats with pancreatitis. Instead, we want to feed a highly-digestible diet which is ideally hydrolysed if possible. Because many of these patients have concurrent inflammatory enteropathy, limiting intestinal inflammation is important. In fact, once recent study suggested that, in cats, the protein molecule size in the diet is more important than dietary fat content.

That being said, if our patient won’t eat this, we need to prioritise getting SOMETHING in, rather than holding out for the ideal diet.

Pain management in cats with pancreatitis and triaditis

Because pain is so hard to appreciate in these patients, we should assume these patients are painful and treat them as such at least to begin with, using trial doses to assess response if there’s doubt, and considering multimodal analgesia as we discussed last week.

We play a central role in this as veterinary nurses and technicians, assessing pain, looking for subtle signs, and advocating for changes in analgesia protocols - so please do not underestimate the importance of your role in this.

Nausea and its impact on cats with pancreatitis

Even if the patient isn’t actively or visibly vomiting, there’s a good chance they’re nauseous. And because nausea drives anorexia, antiemetics are often used in these patients - vomiting or no vomiting.

What about concurrent diseases - what other treatment might we use?

Because of that relationship between the gut, pancreas, liver and biliary tract, we're often not just treating pancreatitis.

So if there's cobalamin deficiency, we’ll supplement it. If there's a neutrophilic cholangitis with a bacterial cause, antibiotics (based on culture) are used, and if immunosuppressants are needed (eg in cases of inflammatory enteropathy or some forms of cholangitis), steroids are often used. 

And because of the spectrum of disease and the high incidence of chronic and acute-on-chronic cases, the care of these patients often continues long-term - meaning there’s even more opportunity for us to do more in the ongoing care of these patients.

So what do we really know about feline pancreatitis?

We know it's common - much more common than it looks. 

We know that it doesnt affect our cats in the same way as dogs, because their signs are often subtle and this means it can be easy to miss. 

We know that many patients won’t have disease limited to the pancreas, because of the relationship between the pancreas, liver, biliary tract and small intestine.

We know that, like our dogs, diagnosis is made by putting the entire clinical picture together rather than just focusing on something like ultrasound or pancreatic lipase testing, and we know that treatment is typically supportive.

And we know that these patients benefit significantly from nursing care, both in and out of the hospital. 

We’re the analgesia advocates, the ones tempting these patients to eat, the ones monitoring fluid balance, the ones creating tube feeding plans, the ones looking for subtle signs of nausea, and much more. And with all of this, there are lots of opportunities for us to use more of our skills when caring for these patients.

Did you enjoy this episode? If so, I’d love to hear what you think. Take a screenshot and tag me on Instagram (@vetinternalmedicinenursing) so I can give you a shout-out and share it with a colleague who’d find it helpful!

Thanks for learning with me this week, and I’ll see you next time!

References and Further Reading

• Bazelle, J., & Watson, P. (2014). Pancreatitis in cats: is it acute, is it chronic, is it significant?. Journal of feline medicine and surgery, 16(5), 395–406. https://doi.org/10.1177/1098612X14523186

• Armstrong, P. J., & Crain, S. (2015). Feline acute pancreatitis: current concepts in diagnosis and therapy, Today’s Veterinary Practice. Available at: https://todaysveterinarypractice.com/hepatology/current-issue-feline-acute-pancreatitis/

• Černá, P., Kilpatrick, S., & Gunn-Moore, D. A. (2020). Feline comorbidities: What do we really know about feline triaditis?. Journal of feline medicine and surgery, 22(11), 1047–1067. https://doi.org/10.1177/1098612X20965831

• Cridge, H., Parker, V. J., & Kathrani, A. (2024). Nutritional management of pancreatitis and concurrent disease in dogs and cats. Journal of the American Veterinary Medical Association, 262(6), 834–840. https://doi.org/10.2460/javma.23.11.0641

• De Cock, H. E., Forman, M. A., Farver, T. B., & Marks, S. L. (2007). Prevalence and histopathologic characteristics of pancreatitis in cats. Veterinary pathology, 44(1), 39–49. https://doi.org/10.1354/vp.44-1-39

• Forman, M. A., Steiner, J. M., Armstrong, P. J., Camus, M. S., Gaschen, L., Hill, S. L., Mansfield, C. S., & Steiger, K. (2021). ACVIM consensus statement on pancreatitis in cats. Journal of veterinary internal medicine, 35(2), 703–723. https://doi.org/10.1111/jvim.16053

• Fragkou, F. C., Adamama-Moraitou, K. K., Poutahidis, T., Prassinos, N. N., Kritsepi-Konstantinou, M., Xenoulis, P. G., Steiner, J. M., Lidbury, J. A., Suchodolski, J. S., & Rallis, T. S. (2016). Prevalence and Clinicopathological Features of Triaditis in a Prospective Case Series of Symptomatic and Asymptomatic Cats. Journal of veterinary internal medicine, 30(4), 1031–1045. https://doi.org/10.1111/jvim.14356

• Siriphanporn, Y., Wiratsudakul, A., Kasemsuwan, S., Chuchalermporn, P., Vijarnsorn, M., & Kashemsant, N. (2025). Retrospective Evaluation of the Prognostic Utility of Clinical and Laboratory Findings in Hospitalized Cats with Pancreatitis. Animals, 15(7), 1060. https://doi.org/10.3390/ani15071060

• Steiner, J. M. and Lim, S. Y. (2019). Chronic pancreatitis in cats, Today’s Veterinary Practice. Available at: https://todaysveterinarypractice.com/endocrinology/chronic-pancreatitis-in-cats/