When I was a child, one of my mother’s officemates posted a parable above her desk. This was in the day before email mass forwards, and the posted parable was a photocopy of a photocopy of a photocopy, times many dozens of iterations. It was barely legible.

Although I do not remember the exact words of the parable, I remember its gist. It discussed the start of humanity, at a time when the various organs and structures of the human body were arguing about who should be boss. In the end it came down to a race between the brain and the anus. Both structures went on strike, and after several days it was determined that the brain is optional but the anus is mandatory; the anus was duly elected boss. The moral of the story was that one needn’t be a brain to be the boss; rather, one should be an ass.

What on earth does this parable have to do with Catster and with pancreatitis? It turns out, that in the race to see which organ can wreak the most havoc on the body when it goes awry, the brain and the anus don’t have the matter locked up. The pancreas could have been a contender.

The pancreas is a small structure situated at the base of the stomach. It serves two known roles in the lives of cats (and dogs and humans). It regulates blood sugar by releasing the hormones insulin and glucagon. And it produces digestive enzymes that help to turn ingesta (that’s how doctors say food) into absorbable nutrients.

There’s something else you should know about the pancreas: It will not tolerate being trifled with. It is small, but it punches way above its weight. It takes itself so seriously that when I was studying surgery in veterinary school my professor professed that the No. 1 rule of surgery was this: “Don’t piss off the pancreas.”

So what, besides rough handling during surgery, pisses off the pancreas? In humans the No. 1 cause of pancreatitis (which is the fancy way of saying an inflamed or angry pancreas) is alcoholism. That’s not a factor in cats. In dogs, pancreatitis is linked to severe dietary indiscretion such as occurs when they consume entire turkey carcasses on Thanksgiving, and also to certain medications. But as you know, cats are not little dogs. These factors do not appear to play a role in feline pancreatitis.

So what causes pancreatitis in cats? Beats me. And I’m not alone. Nobody knows why cats develop this mysterious condition. Several risk factors, including trauma, inflammatory bowel disease, and a history of vomiting have been posited. With the exception of inflammatory bowel disease, most of the cat’s I’ve known with pancreatitis have had none of the risk factors. In the end, nobody knows why some cats suffer from the condition. And I’m saddened to say that they suffer.

Here’s what I (and medical science in general) do know. When the pancreas becomes inflamed, it releases its digestive enzymes upon itself and the surrounding structures. It therefore begins to digest itself and other structures in the abdomen. In cats, pancreatitis is most frequently a low-grade, chronic issue that leads to vomiting, poor appetite, pain, and deterioration of body condition. Treatment options are limited, and primarily supportive. Commonly employed tactics include fluid therapy, gastrointestinal protectants, pain killers, nutritional supplements, and vitamin B12 injections. The prognosis is guarded, and long-term treatment is often necessary. What’s more, pancreatitis often comes in combination with inflammatory bowel disease and inflammation of the bile-releasing ducts in the liver. This triad of problems, which appropriately is called triaditis, is a scourge for affected cats.

So, how can one tell whether one’s cat has pancreatitis? In this regard, the condition also is completely frustrating. The only definitive method is histopathology. Histopathology involves studying a sample of the pancreas under a microscope. There are two ways of sampling the pancreas, and neither is palatable: The pancreas may be sampled during an autopsy, or it may be sampled by surgical biopsy (which not only involves an invasive procedure, but also is highly likely to piss off the already testy little gland).

Because the gold standard method is not generally practical, veterinarians have relied on two other methods: blood tests and ultrasound. I therefore read with great interest a paper published in the May 1, 2014 Journal of the American Veterinary Medical Association (JAVMA) entitled, “Agreement of serum feline pancreas-specific lipase and colorimetric lipase assays with pancreatic ultrasonographic findings in cats with suspicion of pancreatitis: 161 cases (2008-2012).”

The paper compared the results of blood tests and ultrasound in cats with possible pancreatitis. The abstract of the paper says it best:

Conclusions and Clinical Relevance — Agreement between [the two types of tests] was only fair. It remains unknown [which test] constitutes the more accurate test for diagnosing pancreatitis; therefore, results of both tests need to be interpreted with caution.

In other words, not only does nobody know what causes diagnosis, but nobody even knows, realistically, how to diagnose it.

If you came to this article hoping for a straightforward explanation or a simple description, I’m sorry to disappoint you. If I told you that I understand feline pancreatitis, I’d be a liar. And so is anyone else who claims that the condition is anything other than complicated, mysterious, and poorly understood.

I hope that the mystery of feline pancreatitis is unravelled soon. Until then vets, owners, and especially cats can only hope for more answers in the future.

Learn more about your cat with Catster:

• I’m Willing to Bet That Your Cat Hates Her Litter Box — Here’s Why
• Weird Cat Facts: 8 Reasons Your Cat Likes to Lick You
• Our Best Tips for Getting Your Cat to Let You Sleep

Got a question for Dr. Barchas? Ask our vet in the comments below and you might be featured in an upcoming column. (Note that if you have an emergency situation, please see your own vet immediately!)