Canine Pancreatitis

Question 1

What are the classical clinical signs of severe, acute, canine pancreatitis?

Answer 1

vomiting, dehydration, lethargy, and abdominal pain

Question 2

What are some signs of chronic canine pancreatitis?

Answer 2

hyporexia/ anorexia, lethargy, behavioural changes

Question 3

How is pancreatitis diagnosed on imaging?

Answer 3

X-rays: decreased cranial abdominal contrast; effusion
- but not sensitive
- good rule out of other issues
AUS: sensitivity depends on operator and severity of clinical signs
- acute, pancreatitis –> hypoechoic region of necrosis
- can be affected by other conditions that can look like pancreatitis
- be aware of pancreatic nodular hyperplasia

Question 4

How useful is serum amylase for canine pancreatitis?

Answer 4

it’s non specific so it’s of little value in the diagnosis of canine pancreatitis

Question 5

How useful is serum lipase for canine pancreatitis?

Answer 5

it’s non specific and it’s not sensitive

Question 6

How useful is serum trypsin-like immunoreactivity for canine pancreatitis?

Answer 6

it’s very specific but lack sensitivity compared to cPLI
- TLI is still the diagnostic test of choice of canine exocrine pancreatic insufficiency

Question 7

How useful is canine pancreatic lipase immunoreactivity for canine pancreatitis?

Answer 7

it’s the most sensitive test available!
- >80% with acute clinical pancreatitis
- >60% for mild pancreatitis

Question 8

What’s the diagnostic utility of the snap cPLI?

Answer 8

it’s a good rule out test
- if positive, should still send in serum for cPLI to confirm

Question 9

What should be done if a non-clinical patient has elevated cPLI?

Answer 9

Recheck in 10-14 days, if still elevated, look for risk factors
- if none found, would still recommend follow-up to complications of chronic pancreatitis

Question 10

How does cytology aid in the diagnosis of pancreatitis?

Answer 10

FNA of the pancreas = little risk
- should find inflammatory cells (ex. neutrophils), and acinar cells (confirm pancreatic orign)
- but in severe cases, may only get cellular debris – non-diagnostic samples
- lack of inflammatory cells does not rule out pancreatitis

Question 11

How valuable is pancreatic biopsy?

Answer 11

Used to be considered the most definitive method, but in some cases (ex. mild chronic pancreatitis), may not see evidence on biopsy, even if multiple samples were sent
- biopsy procedure itself is safe, but anesthesia is considered as a risk factor for worsening pancreatitis

Question 12

What are some risk factors associated with acute canine pancreatitis?

Answer 12

• dietary indiscretion; hypertriglyceridemia
• mini Schnauzer SPINK-1 gene
• severe blunt force trauma (ex. HBC)
• surgical trauma/ hypoperfusion
• drugs (ex. KBr, phenobarbital, calcium)

Question 13

How is acute pancreatitis treated?

Answer 13

Supportive therapy!
- aggressive fluid therapy, correction of acid/base imbalance, and electrolyte abnormalities
- promote enteral feeding; ultra low-fat diet
- analgesics (opioids)
- antiemetics (Cerenia, Ondansetron)

Question 14

What are some treatments that have not been proven to be useful in canine acute pancreatitis?

Answer 14

• proteinase inhibitors
• fresh frozen plasma/ whole blood
• antibiotics
• anti-inflammatories

Question 15

How is chronic pancreatitis treated?

Answer 15

• treat the underlying cause if possible
• analgesics/ antiemetics
• low fat diet
• some will have immune-mediated component which steroids or cyclosporine may be beneficial