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742 Pancreatitis, Dog

Pancreatitis, Dog Client Education
Sheet
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PHYSICAL EXAM FINDINGS
BASIC INFORMATION
• Abdominal pain • Measurement of serum amylase activity
is neither sensitive nor specific for canine
Definition • Dehydration pancreatitis.
Pancreatitis is an inflammatory condition of • Fever • Serum total lipase activity can be measured
the pancreas. It can be acute or chronic, which • Possible icterus using various substrates and assays, but
can be differentiated only histopathologically. none (including 1,2-diglyceride, triolein,
Etiology and Pathophysiology 1,2-di-O-lauryl-rac-glycero-3-(glutaric acid
Epidemiology • The cause of pancreatitis in many dogs 6-methyl resorufin ester [DGGR]) specifically
SPECIES, AGE, SEX remains unknown. measures pancreatic lipase. Sensitivities vary
No known age or sex predispositions • In general, premature activation of pancreatic widely and cannot be compared, even when
digestive enzymes leads to initiation of pan- using the same substrate.
GENETICS, BREED PREDISPOSITION creatitis, and the inflammatory response leads • A semiquantitative point-of-care test (i.e.,
Miniature schnauzers appear to be more to progression of the disease and systemic SNAP) is available for immediate rule-out
commonly affected. As in some humans complications. of canine pancreatitis. A negative test result
with hereditary pancreatitis, a mutation of should prompt the clinician to evaluate the
the SPINK gene may be responsible. In the DIAGNOSIS patient for other differential diagnoses. A
United Kingdom, English cocker spaniels are positive test result should be confirmed by
considered to be more commonly affected by Diagnostic Overview measurement of a quantitative Spec cPL test.
chronic pancreatitis. Serum levels of canine pancreatic lipase • New point-of-care tests have become available
immunoreactivity (cPLI) are measured with (e.g., VetScan cPL, Vcheck cPL) but have
RISK FACTORS the Spec cPL test, which is the most sensitive not yet been shown to be repeatable or
• Dietary indiscretion and specific laboratory test currently avail- reproducible.
• Blunt abdominal trauma able for pancreatitis, but the diagnosis rests • Serum cPLI concentration (now measured
• Hypercalcemia on a combination of all available clinical by the Spec cPL assay)
• Pancreatic hypoperfusion findings. ○ Measures the concentration of pancreatic
• Pharmaceuticals: potassium bromide, lipase in serum (many other lipases
phenobarbital, L-asparaginase, azathioprine, Differential Diagnosis contribute to serum lipase activity
trimethoprim-sulfadiazine, and others • Primary acute or chronic gastrointestinal measurement).
○ There is little evidence that corticosteroids disorders ○ Reference interval: < 200 mcg/L; cutoff
cause pancreatitis in dogs, and pancreatitis • Acute or chronic metabolic or systemic value for pancreatitis: 400 mcg/L
or a history of pancreatitis are not consid- disorders: hepatic, renal, adrenal, thyroid ○ Highly specific for exocrine pancreatic
ered contraindications for corticosteroid (less likely), reproductive, or central nervous function, but positive tests can occur due
use. system (CNS) disease to diseases other than primary pancreatitis.
• Severe hypertriglyceridemia and disorders of This is especially likely when results
lipid metabolism Initial Database fall in the gray zone between 200 and
• CBC findings are variable and nonspecific. 400 mcg/L.
ASSOCIATED DISORDERS • Findings on a serum chemistry profile vary ○ Highly sensitive for acute and chronic
• In patients with severe disease, acute kidney and are nonspecific; they are most useful in pancreatitis
injury, respiratory failure, myocarditis, dis- assessing the patient for systemic complica- ○ One-time measurement does not allow
seminated intravascular coagulation (DIC), tions and ruling out other disorders with assessment of disease severity, but serial
peritonitis, and multiorgan failure overlapping clinical signs. measurements do allow monitoring of
• Pancreatitis can cause extrahepatic bile duct • Abdominal radiographs are not useful in disease progression in a specific patient.
obstruction (EHBO). diagnosing pancreatitis but are useful in ○ Measurement of cPLI in abdominal
ruling out other differential diagnoses of fluid (if present) is highly reliable for the
Clinical Presentation pancreatitis. diagnosis of pancreatitis. Cutoff value for
DISEASE FORMS/SUBTYPES pancreatitis: 500 mcg/L
• Acute or chronic Advanced or Confirmatory Testing
• Subclinical (no clinical signs), mild (not • Abdominal ultrasound is useful for the TREATMENT
associated with systemic or pancreatic diagnosis of canine pancreatitis.
complications), or severe (associated with ○ Diagnostic criteria: enlargement of the Treatment Overview
systemic and/or pancreatic complications) pancreas, fluid accumulation around the • Address any identified risk factors.
pancreas, pancreatic mass effect, hypoechoic • Treat clinical signs that cause morbidity (e.g.,
HISTORY, CHIEF COMPLAINT pancreas (necrosis), hyperechoic peripan- pain, vomiting, anorexia).
• Often, a history of dietary indiscretion creatic fat (peripancreatic fat necrosis), and/ • Identify and treat complications
(especially high-fat foods) or a dilated pancreatic duct • Nutritional support
• Anorexia and vomiting are common (91% ○ Resolution of equipment and operator
and 90%, respectively, of dogs with severe expertise have increased significantly over Acute General Treatment
pancreatitis). the past 2 decades. • If the clinician can identify a known risk
• Weakness ○ Clinicians must exercise caution not factor, it should be addressed appropriately.
• Abdominal pain is reported for about one- to overdiagnose pancreatitis based on For example, discontinue any medication
half of dogs with severe pancreatitis. ultrasonographic findings. that has been implicated in causing pancre-
• Diarrhea is reported for about one-third of ○ Useful to detect secondary extrahepatic atitis. Medications the patient requires for
dogs with severe pancreatitis. EHBO a concurrent condition should be switched

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