Pancreatitis - Ex 4

Question 1

What two enzymes do we look for when detecting pancreatic injury?

Answer 1

Serum Amylase and Lipase most commonly assayed

• secreted into GI tract to break down carbs/fats
• Very small amounts present in blood normally
• amylase and lipase are NOT specific for pancreatic injury!!

Question 2

Amylase >3-4x upper end of normal =

Answer 2

Suggests pancreatitis

Question 3

Lipase >3-4x upper end of normal =

Answer 3

Very suggestive of pancreatic injury

**Exception = steroids in dogs!!

Question 4

Corticosteroids and Lipase

Answer 4

Appears to be unique to dogs, mechanism unknown

Amylase does not go up

*Dog on steroids –> increased lipase, normal amylase

• *Dexmethasone: up to 5x normal limit
• *Prednisone: generally less of an increase

Question 5

The Kidney & Amylase and Lipase

Answer 5

Kidneys normally excrete amylase & lipase –> any decrease in GFR (renal, pre-renal, or post-renal) can result in increased Amylase & Lipase

*Approx. 50-60% of dogs with renal failure have increased Amylase and/or Lipase

Question 6

Peritoneal Levels of Enzymes > Serum levels

Answer 6

Highly suggestive of pancreatitis

Can be seen with intestinal perforation/trauma

Question 7

Pancreatitis in Cats

Answer 7

Amylase normal or even decreased

Lipase normal

*Can be difficult to diagnose; abdominal levels of amylase/lipase may help

Question 8

Pancreatitis in Horses

Answer 8

Amylase only slightly increased and lipase levels not explored (hard to diagnose)

• Relatively common intestinal disease can result in increase amylase (proximal enteritis or colic)

Question 9

Pancreatitis in NWC

Answer 9

Abdominal levels > serum levels of Amylase and Lipase may help

Vague clinical signs (difficult to dx)

Question 10

Panel abnormalities seen with Pancreatitis (3)

Answer 10

1. Hyperglycemia - combo of stress, excitement, glucagon
2. Hypocalcemia - not always seen; deposition of Ca in saponified abdominal fat
3. Increased liver enzymes - cholestastis: bile duct obstruction, inflammation; hepatocyte necrosis: ischemia, toxic damage, ascending inflammation

Inflammatory leukogram

Question 11

Serum Calcium in Pancreatitis

Answer 11

Hypocalcemia can be seen with pancreatitis

Lipase leaks –> saponification & Ca2+ deposition = hypocalcemia

Question 12

Trypsin-like Immunoreactivity (TLI)

Answer 12

Measure both trypsinogen and trypsin

• leak from injured pancreas
• Trypsinogen is pancreas-specific

RIA only available for dogs/cats

TLI is not very specific!

Question 13

TLI and steroids, azotemia, GI disease

Answer 13

Dexmethasone administeration:

• significant rise in TLI in dogs
• goes back to normal within 7 days after stopping

Increases in TLI have been reported in dogs and cats with azotemia

GI disease (IBD and GI lymphoma) may result in increased TLI levels

Question 14

TLI in Vet Med

Answer 14

• Used mainly to dx EPI
• not generally used for canine pancreatitis (not very specific)
• may have some utility in feline pancreatitis (generally low sensitivity)

Question 15

Pancreatic Lipase Immunoreactivity (PLI)

Answer 15

Specific for pancreatic lipase

Very sensitive

Not affected by renal disease or prednisone administration

Currently offered at Texas A&M GI lab and Idexx

Question 16

PLI in Vet Med

Answer 16

Test of choice for canine pancreatitis

SNAP: high sensitivity, low specificity
* helps rule OUT pancreatitis

One promising study in feline pancreatitis