pepto bismol for dogs with pancreatitis

Probiotics. 17.5 mg of bismuth subsalicylate per ml of the medicine. It helps break down food and boosts your immune system. It is possible that Pepto Bismol can help dogs relieve their diarrhea, but it should never be given to them on a daily basis. Pepto Bismol for Dogs What does it Specifically Treat? Symptoms of pancreatitis have occurred with just one or two doses of Viberzi at the recommended dosage for patients who do not have a gallbladder (75 mg) and who do not consume alcohol. Acute pancreatitis is becoming more common in the U.S. Pancreatitis can affect any breed of dog but is very common in Miniature Schnauzers. You should not give Pepto Bismol to your dog if she is or has: Matted Dog Hair Detangling, Removal, Cutting and Remedies, Cat Crying At Night: Superstition, Why Cats Cry at Night, How To Stop Excessive Cat Meowing at Night, I heard Pepto has added xylitol which is very toxic for dogs. Pepto-Bismol is used to treat diarrhea, nausea, heartburn, indigestion, gas, or upset stomach. The Under the Weather bland diet does not require a veterinary prescription, so you can buy some ahead of time and keep it just in case. A thorough physical exam, patient history, and an established veterinary-patient-client relationship is required to provide specific medical advice. Some affected dogs may develop long-term issues with their pancreas and may need to be fed special diets that are reduced in fat. Liquid can be placed in an empty syringe and squirted onto the back of your dog's tongue. If you've found our information useful please donate today. Pepto-Bismol can cause your dogs stool to turn black, which can be alarming. Pepto-Bismol), OTC loperamide (Imodium) and prescription diphenoxylate/atropine (Lomotil) can be used to treat diarrhea. Pepto-Bismol is used to treat several digestive problems such as diarrhea, indigestion, nausea, gas, burping, heartburn, and the feeling of fullness. Some health conditions are: If your pet is vomiting, has abdominal pain (groaning, rapid panting, avoiding being touched, etc. You are good to go. Making specific lifestyle changes can help ease pain and lessen the risk of future attacks. Manage pancreatitis symptoms with lifestyle changes and natural remedies. However, in general, Pepto-Bismol can be used to help settle an upset stomach, relieve nausea, and reduce diarrhea in dogs. NOTE: Do not use any of the flavored varieties of Metamucil, especially those with chocolate. Save the cooked rice for later use. increased thirst. More severe cases can be more complicated and your dog may take a week or longer to recover. Pepto Bismol is a popular over-the-counter medication that treats nausea, heartburn, upset your dog's stomach, diarrhea, and vomiting. "First things first, check with your veterinarian," Fischer told The Dodo. The dog is excreting a lot of liquid which means it is losing electrolytes in the system, and you can also give it unflavored Pedialyte [3] to replace loss electrolyte. White Rice Pepcid and Prilosec, for example, are some of the medications that should be administered with your veterinarians permission. Since the drug is not FDA-approved for use in dogs, we recommend talking to your vet before use. There are electrolyte solutions made specifically for pets, as well. There is some evidence that certain supplements may ease symptoms. Therefore, patients should consider other treatment options. If the black, tarry stool does not go away, you should consult a veterinarian. Losing weight requires behavior and lifestyle changes like exercising more and limiting your portion sizes. Veterinary treatment is usually supportive, but affected dogs may need regular monitoring as well as intravenous fluids and medications to help manage pain and nausea. It helps promote hydration, which is important when dogs have diarrhea. Sometimes a change of diet or food brand is to blame for upset stomach in dogs. Although Pepto-Bismol can sometimes be given to dogs, it should be . Pancreatitis can affect any breed of dog but is very common in Miniature Schnauzers. It's very painful and can be fatal in severe cases. Patients with pancreatitis have lower levels of antioxidants and higher levels of free radicals. Verywell Health's content is for informational and educational purposes only. The participants rated their pain on a scale of one to 10. It was first developed and is most popular for treatment of diarrhea in babies. Discontinue if your dog starts vomiting and contact your veterinarian. You should also watch out for fever, lethargy (your dog becomes less active and alert and appears weak), and signs of abdominal pain. Pepto Bismol is safe for relief of stomach upset (indigestion, stomachache, etc.) Gut. Pancreatitis can be life-threatening and must be treated by your vet. It is always helpful to regularly keep a couple of cans or packets at home. Pepto Bismol is an antibiotic that can help treat diarrhea and indigestion symptoms. If your dog is suffering from recurrent pancreatitis see the below information about ongoing care. Rates may differ for those residing outside the U.S. You'll have access to a vet for 7 days. pork, cheese, butter). When giving Pepto Bismol, make sure there's no artificial sweetener (xylitol, for example) because these are thought to be toxic to dogs. Nothing gets a pet owner moving faster than the preemptive sounds of their pet preparing to vomit or have diarrhea. More and more pet owners are however giving this pink medicine to their dogs for the relief of diarrhea, indigestion, and upset stomach. They may also talk to you about not giving your dog fatty treats, such as cheese or fatty meat. Since catnip is a plant, it is made up of different elements that can benefit your dog. 3. We earn a commission for qualifying purchases at no cost to you. Hepatobiliary Pancreat Dis Int. You should always discuss treatment of medical conditions with your veterinarian before using any alternative therapies, natural supplements, or vitamins. This is known as pancreatitis. Pancreatitis is painful swelling or inflammation of the pancreas. Melena is the name given to a stool that is frequently black. It acts as a prebiotic because it stimulates the growth of beneficial bacteria by lowering the pH and providing the nutrients they need. The researchers found that one-third of the people who took the antioxidants reported having less pain after six months. If there is no vomiting or worsening symptoms, you can slightly increase the amount. 3. Summary Used for: Treatment of diarrhea, vomiting, indigestion, and helicobacteriosis Brands: Pepto Bismol, Kaopectate Species: Dogs, cats, ferrets, cattle, swine, and horses Drug type: Gastrointestinal Pregnancy and lactation: Not for use in pregnant or nursing animals. Pancreatitis is swelling or inflammation of the pancreas. Treatment for pancreatitis involves nursing, pain relief, anti-sickness medication and sometimes a drip. The hormones help to control blood sugar levels and the enzymes break down food. Rebound Recuperation Formula for dogs can also be very beneficial. Khatua B, El-Kurdi B, Singh VP. Actions you can take to lower the risk of pancreatitis include: Ideally a prescription diet from your vet - low fat dog foods sold in shops may still contain too much fat. If given with any non-steroidal anti-inflammatory such as Rimadyl, DeramaxxTM, etc., there is an increased risk of intestinal ulcers or perforation. Preventive Vet does not provide medical advice, diagnosis or treatment. Please note, our vets and nurses are unable to respond to questions via this form. The recommended dosage is 1/4 teaspoon per 10 pounds of body weight. This stomach suppressant, also known as Pepto Bismol, is a favorite of humans. Glutamineis an amino acid. 3. in most dogs. It is also known as melena and occurs when you become ill after drinking toxic beverages, having a foreign body in the gastrointestinal tract, or becoming dehydrated. Pepto-Bismol is not recommended for use in puppies or pregnant dogs, and it should always be given with food to avoid stomach upset. Dogs with milder pancreatitis still need treatment but don't necessarily have to be hospitalized. Beth Turner is a veterinarian with over 20 years of experience. Pepto-Bismol is a medication that treats gastrointestinal symptoms in humans. Cathy Wong is a nutritionist and wellness expert. Treatment often involves intravenous (IV) fluids. Think of it as a sort of natural "Pepto-Bismol." (However, Pepto-Bismol itself should not ever be used in pets because it contains salicylate, aka aspirin). The stomach upset can also make the dog not want to eat grass. Yes, but with a few reservations (and no cats permitted). Dog in prayer position due to abdominal pain. Pepto Bismol. The dosage of Imodium is 1 Imodium capsule (2 mg) per 50-pound dog, according to veterinarian Dawn Ruben. This can produce intermittent mild signs of illness, such as: Occasional vomiting Colitis Lack of appetite Longstanding chronic pancreatitis can lead to type 1 diabetes or pancreatic insufficiency. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Pepto-Bismol is not recommended for use in puppies or pregnant dogs, and it should always be given with food to avoid stomach upset. It binds to the receptors inside the lining of the stomach, and helps to reduce stomach acid. Symptoms of pancreatitis often start suddenly and commonly include: Pancreatitis can range from being mild to severe. Dog owners should think about using a bismuth sulfate product that is specifically formulated for dogs. Healthcare providers treated some with glutamine. Accidental overdoses of Pepto Bismol can cause: Vomiting Depression Hyperthermia Internal bleeding Trouble breathing Tremors Seizures Coma Closely monitor the medicine your dog ingests, and be sure to administer it carefully. of weight, every 6 to 8 hours. Chudley has one of the lowest fat contents we have seen for dry dog food at 5%. Your email address will not be published. Metronidazole - 7 mg/lb every 8 hours. So, if you're obese, your healthcare provider will likely recommend losing weight to prevent flare-ups. When you eat, it makes juices containing enzymes that break down food. Pepto-Bismol also should be avoided in dogs who are taking ACE inhibitors (sometimes prescribed for medical conditions like kidney disease or heart disease in dogs ), some diuretics (i.e. Avoid high fat treats like cheese or pork. 40% less likely to have complications, especially infections, 70% less likely to die than those who didn't take the supplement. With regards to frequency, you should repeat the dosage for 2 or 3 times. Nutrients. These medications can be toxic to your dog, especially if dosed incorrectly. Protein is at a fantastic 20%, and the ash contents is pretty good at 6%. According to Drs. Imodium, when administered at safe levels, is not helpful for pain and, therefore, will not relieve any abdominal discomfort your dog may have. 2017;33(5):374-382. doi:10.1097/MOG.0000000000000386, Ahmed Ali U, Jens S, Busch OR, et al. Always start at the lower end of the range since your dog's reaction cannot be predicted. If your dog has intestinal bleeding that you are unaware of, bloody vomit and diarrhea, abdominal pain, and weakness may result. This site also receives a small commission from affiliate links and third-party advertising. Foster and Smith, you can use Pepto Bismol for dogs vomiting if it has a dietary link. However, fasting is done under the supervision of a healthcare provider who will feed you nutrients through an IV drip inserted into your vein. difficulty in speaking or slurred speech. If using Pepto Bismol or any other bismuth subsalicylate preparation for vomiting doesnt do the trick 48 hours down the line, get in touch with your vet. Allergic to either of the components in Pepto Bismol or to aspirin. It is best to give your dog only what he requires, as toxicity can occur. Featuring strong antacid, antiemetic, and anti-inflammatory effects, this pink liquid will quickly ease your dog's diarrhea. Read on to discover everything you need to know about using Pepto Bismol for dogs. Acute pancreatitis can be life-threatening. But if symptoms appear unexpectedly or seem severe, it is . Imodium is available for use in children as young as two years old, but Pepto-Bismol should only be used in children aged 12 and older. It's sometimes used to treat traveler's diarrhea. The general dosing guide for pepto bismol in dogs is 10 mg per pound. If your dog is affected by pancreatitis they may need to be monitored and treated by your vet for several days. Some anecdotal evidence suggests that the medication may help to relieve some of the symptoms associated with the condition, but there is no concrete evidence to support this claim. Many people keep it around because it's so effective. Limit the amount of caffeine you consume. Your dog is at a higher risk of developing pancreatitis if: After a full examination, your vet might want to run some tests to check for pancreatitis. Supplements that use blood proteins that are rich in immunoglobulins may help reduce inflammation, promote healing, and provide other benefits for dogs. Many herding breed dogs carry a mutant form of the ABCB1 -1 gene that significantly limits their ability to break down certain drugs. Please do not ask emergency or other specific medical questions about your pets in the blog comments. This effect has no effect on you, but it could cause you some pain down the road. According to Drs. 1 Pepto Bismol is safe for most dogs for quick and temporary relief from an upset stomach and/or diarrhea. Thank you, {{form.email}}, for signing up. If you find that rice water isnt your dogs thing, you can try clear, unflavored Pedialyte. Eating something toxic (grapes, chocolate, human medications, etc.) Registered charity nos. She graduated from North Carolina State College of Veterinary Medicine and following graduation, she began her career as an associate veterinarian and worked closely with the local shelter. Pancreatitis ranges from mild to very severe. When a dog consumes too much of this medication, it can become extremely poisonous and even deadly. The pancreas is a small organ that produces enzymes and hormones. If your pet has ingested a toxin or has an infection. The information above suggests that Pepto Bismol should not be given to your dog on a daily basis. The most common antiemetic used to treat this condition is a medication called Cerenia. As a matter of fact, it is a good idea to consult with your vet before giving your dog Pepto Bismol as some dogs are not ideal candidates for this OTC medication. This will ensure we can continue to help pet owners and their sick pets for many years to come. These symptoms warrant the urgent attention of your vet. This is concerning because melena, the sign of gastric bleeding, can indicate a medical emergency. Bismuth works by coating your dogs intestines, thus shielding it from the effects of toxins. It is also used to treat diarrhea and help prevent travelers' diarrhea. 4. It contains prebiotics and antioxidants, which are essential in helping to support the immune system for recovery. Just like with us, rest is important. Most dogs don't really like the taste of Pepto Bismol. In severe cases, this can damage cells and tissue within your pancreas. Pepto Bismol for dogs is usually administered at a rate of 1 teaspoon for every 10 pounds of body weight, and it is usually given every 6 hours or so. For the high range, divide 13.61 by 2 = 6.8 teaspoons. Dogs can become dehydrated and develop electrolyte imbalances. Some small studies have shown that omega-3 fatty acids may reduce inflammation from pancreatitis and repair damaged tissue. Pepto-Bismol is a medication that can help to treat the symptoms of colitis in dogs. Note if you have a cat: If you have been advised by your veterinarian to give either Pepto Bismol or Kaopectate to your dog and you have a cat, do not let your cat consume these medications. dizziness or lightheadedness. It is thus not surprising that the question, can I give my dog Pepto Bismol for diarrhea? arise pretty often among pet owners. Uses of Pepcid AC For Dogs. Its use in dogs, cats, ferrets, and horses at certain doses to treat diarrhea is . 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. These key pieces of information change in pooping habits, changes in poop color, firmness, amount, etc. If you don't have any omeprazole at home and can't . Pepto-Bismol is sometimes helpful in relieving stomach pain. The pancreas is an organ that sits close to the stomach and helps digest food. Severe cases can be more difficult to treat and the outcome less predictable. 2013;13(5):468-74. doi:10.1016/j.pan.2013.07.282, Lei QC, Wang XY, Xia XF, et al. mental depression. If there is too much blood involved, the use of insulin can lead to black diarrhea. Foster and Smith of PetEducation.com, Pepto Bismol is generally safe for dogs but not for cats. Pieces of chicken breast or small bits of carrot are perfect. It helps to soothe the lining of the stomach and intestines which in effect stops diarrhea. Foster and Smith, Pepto Bismol are used for treating diarrhea caused by dietary indiscretion as opposed to other factors such as parasitic infection. Pancreatitis is inflammation of the pancreas, which causes pain and vomiting. This ingredient is a derivative of salicylic acid or aspirin. When Pepto Bismol is specifically given along aspirin, salicylate levels of blood could rise so much as to cause salicylate poisoning. Cats tend to be particularly sensitive to the aspirin in Pepto Bismol; in fact, it can be fatal. If your dog has had pancreatitis in the past, they may be at risk of developing it again in the future. Inaccurate X-ray reading. Pepto-Bismol (bismuth subsalicylate) Find out how Pepto-Bismol treats heartburn and acid reflux, indigestion, diarrhoea and feeling sick, and how to take it. 2015;7(4):2261-73. doi:10.3390/nu7042261. Treatment with this protocol will last for approximately 21 days. DogsCatspets is a participant in the Amazon Services LLC Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising & linking to amazon.com. During this period of time, you can give your dog rice water. Hold your pets muzzle for a couple seconds to ensure that she swallows all the medicine and that is it. Pepto Bismol Dosage for Dogs. This side effect is caused by a minor malfunction in the machine, which is not harmful or permanent. medications that remove fluid from the body), and digoxin (a medication used for heart conditions). As always, it is best to consult with your veterinarian before giving your dog any medication. It is likely best to be a place close to a door to go outside, and that has an easy-to-clean floor for those unfortunate poop accidents. It is however important that the medication is used properly to avoid adverse effects side. 2023 Preventive Vet. Catnip has been found to help some dogs with indigestion, cramps, diarrhea, and gas. In our own experience, our dogs loved the taste of their supplements. Symptoms may include nausea, vomiting, weight loss, and oily stools. Start with smaller, more frequent meals. Pepto Bismol For Dogs With Pancreatitis There is no definitive answer as to whether or not pepto bismol is effective in treating pancreatitis in dogs. Probiotics help support a healthy immune system by keeping the intestinal bacteria in good balance and aiding in digestion. If you are worried that your pet is having an emergency or if you have specific medical questions related to your pets current or chronic medical conditions, please contact or visit your veterinarian, an animal-specific poison control hotline, or your local emergency veterinary care center. Antiemetics are used to decrease the level of vomiting your dog is experiencing. If you have determined that it will likely be ok to try and ride out your dogs diarrhea for 24 to 36 hours, then here are some options to help. The general rule of thumb is to give a dosage of 0.5-1ml of the liquid Pepto Bismol per pound of weight. Pepto Bismol has mild anti-inflammatory, antibiotic, and antacid properties which makes it ideal for treatment of diarrhea and indigestion. It is a symptom of diseases or other issues like toxins, foreign body ingestion, etc., that affect the small intestines, large intestines, or other organs outside the gastrointestinal tract. There can be many causes of diarrhea in dogs. You can try regular, unflavored, probiotic-rich yogurt (you want as low a sugar content as possible), or you can pick up a probiotic like Purinas FortiFlora, Nutramaxs Proviable (tablet or paste), VetriScience Fast Balance GI Paste, VetriScience Vetri Probiotic BD, or Iams Prostora Max. Some took antioxidants; some didn't. In addition to diarrhea, issues of the small intestines usually cause vomiting (increasing the risks of dehydration) and weight loss (because of the lack of nutrients). Nutrition advice and recipes. Similar to ibuprofen and Tylenol, Pepto-Bismol's side effects can be harmful to dogs and include gastrointestinal ulcers. Side effects such as gastrointestinal ulcers in dogs can be extremely dangerous. While it isnt a treatment for diarrhea, it acts as a support for recovery. A general guideline is however emphasized that mediations and drugs formulated for human consumption should never be given to dogs and other pets unless directed by a veterinarian, of course. Diarrhea is one of the most common problems that bring dogs into the vet. Plain, boiled, boneless, skinless chicken and rice (the leftover from the rice water). For those dogs not interested, you can add a couple of teaspoons of low sodium chicken broth powder or dog-safe bone broth (be sure it does not contain any onions or garlic). If you are concerned about your pets health, please contact your vet directly. Diarrhea can also be a symptom of more serious underlying health problems. Additionally, read the labels to be sure they do not contain xylitol it is very toxic to pets. You want to use good quality white rice (not minute rice). Dogs with pancreatitis can take Famotidine. Many households have dogs and cats if your cat is willing to share their catnip, it may help with your dog's diarrhea. This medication is effective in relieving your dog of an upset stomach, diarrhea, or vomiting due to stress or eating the wrong food. This medication is used to treat occasional upset stomach, heartburn, and nausea. 2. Imodium, even over-the-counter drugs, can interact poorly with one another. During that time, continue feeding small amounts every 3 to 4 hours. Therefore, when the cause of diarrhea relates to the small intestines, your dog is missing out on a lot of the nutrients they would normally gain from their food. It is also potentially toxic at higher doses, or when used for a period of time, and can make it more difficult to diagnose the cause of your dog's symptoms. 2014;(8):CD008945. It is safe for dogs to take, but it is important to use the correct dosage. If your dog is taking Pepto Bismol, be sure to monitor . For that particular type, the dose is 8.75mg for every 1 pound of body weight. This can result in choking or a potential intestinal obstruction. Widely available over the counter as a pink oral suspension (in pink bottles), Pepto Bismol has bismuth subsalicylate as the active ingredient. About Pepto-Bismol. Whatever you do never use a leftover Pepcid supply on your dog. Blackish stool in dogs is referred to as melena (digested blood in stool) which can indicate serious medical conditions. Pepto Bismols and Kaopectates active ingredient is bismuth subsalicylate. Skip to Section:When diarrhea is an emergency. This lack of fluid balance prevents their bodies from functioning properly. There is no cure for chronic pancreatitis, but certain home treatments can help you manage symptoms and prevent-flare ups. While there are rapid urine tests available that don't require any lab processing, these must be performed by a healthcare provider. Moderation is important when using Pepto Bismol as a diarrhea medicine for dogs. In case of an overdose, take your dog to the vet right away. It is critical however to see a vet if diarrhea continues or more than 48 hours as this could be an indication of a more serious underlying cause. Bismuth compounds are given by mouth in the form of a . Some research even shows that using antacids may trigger acute pancreatitis in some people. Such cases can benefit from giving your dog an appropriate dose of Pepto Bismol. No, you cannot test for pancreatitis at home. Heightened levels of salicylate in the blood cause it to thin out. Pancreatitis can be very serious, so its important that you do not wait to see if your dog improves before seeking advice. Painful tummy - you may notice your dog stretching into a prayer position because their abdomen is painful (see picture). Others didn't get the supplements. There are two reasons. Don't drink any alcohol. It can also cause irritation of the digestive tract. For $1, you can connect with a veterinarian to discuss your dogs diarrhea issue. However, you should consult a veterinarian before giving the medication to your dog. Try wrapping the medication in a small piece of cheese or hotdog and giving it to your dog as a treat. Pepto Bismol For Dogs With Colitis This commonly used medication is given to dogs with colitis, a diarrheal disorder characterized by larger bowel movements, and it can also be used to treat other gastrointestinal problems. If your dog gets the wrong dose, toxicity can result. Please share your experiences and stories, your opinions and feedback about this blog, or what you've learned that you'd like to share with others. Pepto Bismol is an over-the-counter medication that's commonly used to treat diarrhea, upset stomach, and other digestive issues in humans. Acute pancreatitis requires immediate hospital attention, and should not be treated at home. This medicine is used for heartburn and acid reflux, indigestion, diarrhoea and feeling sick (nausea). For tablets, this is equivalent to a tablet for every 20 pounds of body weight. Probiotics may be helpful when dealing with diarrhea. The color of your stool will return to normal within a few days of stopping Pepto Bismol. When your pancreas gets swollen or inflamed, the enzymes mistakenly attack the very tissues that make them. For example, if your dog weighs 30 pounds (13.61 kgs), divide 13.61 by 8 = 1.7 teaspoons for the low range of catnip. Uses. The researchers found that omega-3 fatty acids reduced the risk of death by about 75% among the patients who were treated with the supplements via feeding tubes. There is no definitive answer to this question as it depends on the individual dogs health and history. This household medicine draws its efficacy in the bismuth and salicylate components of the active ingredient, bismuth subsalicylate. In addition to rest, fasting, and a bland diet, there are some other things you may find helpful in dealing with diarrhea issues at home. Hope this is helpful. Why Do Dogs Urinate Inside After Being Outside? You will end up feeding smaller portions more frequently than what is their usual feeding routine. According to the Canine Journal, dogs eat grass to induce vomiting. Dog pancreatitis treatment at home and at the vet can include: Pain relievers Again, only a small amount is needed. This will ensure you have all the support you need to care for them. If your pain starts suddenly and lasts for a few days, you have an acute form of pancreatitis. The second reason is the overdosing of the medicine that can cause internal injury and bleeding that usually appear in your dog pop. Antioxidants for pain in chronic pancreatitis. Treatment for pancreatitis involves nursing, pain relief, anti-sickness medication and sometimes a drip. Probiotics help support a healthy immune system by keeping the intestinal bacteria in good balance and aiding in digestion. Because caffeine can cause dehydration, they recommend sticking to just one cup of coffee or tea per day. Its important that dogs are not given unhealthy table scraps and fatty foods are kept out of paws reach from your dog. But if he's not getting any better, consider taking him for a medical checkup. As an online informational resource, Preventive Vet is unable to and does not provide specific medical advice or counseling. Additionally, it helps inhibit harmful bacteria in the intestines. It is also a mild antacid, which helps reduce too much stomach acid and eases any discomfort. These changes include not drinking alcohol, cutting back on caffeine, following a low-fat diet, and watching your weight. in most dogs. Other studies have found no benefit to treatment with antioxidants. This form of pancreatitis can worsen over time and cause organ damage, diabetes, kidney failure, and breathing problems.

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pepto bismol for dogs with pancreatitis