Clinical Signs of Pancreatitis

While both canine and feline patients with this inflammatory disease can present with vague, nonspecific clinical signs and histories, a few species-specific trends are noteworthy. When a dog presents with vomiting, anorexia, and abdominal pain, prompt testing is recommended, as these are common clinical signs. Cats, however, are more mysterious and nonspecific in their histories and physical examinations related to this disease. They can exhibit anything from lethargy and inappetence to dehydration, vomiting, diarrhea, and related weight loss. Additionally, cats often have more comorbidities associated, such as chronic inflammatory enteropathy, cholangitis, cholangiohepatitis, hepatic lipidosis, and diabetes mellitus.

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The Utility of a Pancreatitis Lipase Test

While the pancreatic lipase test is primarily recognized for measuring the lipase produced exclusively by the pancreatic acinar cells, it serves several other functions. It plays a crucial role in managing and monitoring the presence and severity of disease at the onset of therapy and progression through treatment. Furthermore, the ability to monitor pancreatic involvement and recovery is vital. There are clear distinctions between cats and dogs when it comes to how best to leverage a pancreatic lipase test for monitoring.

In dogs, pancreatitis is often linked to dietary indiscretions or a high-fat diet, while in cats, no dietary connection exists. Dogs are prone to acute episodes, whereas cats experience chronic or recurrent forms. Let's review a couple specific canine patient scenarios:

• A patient presents with clinical signs suggestive of this inflammatory disease, warranting an initial pancreatic lipase test. If the patient is symptomatic but the test is normal, the recommendation is assess the dog for other causes for the clinical signs and recheck a pancreatic lipase test in 2-3 weeks as the patient's clinical signs resolve or stabilize to assess the resolution of inflammation. However, if clinical signs worsen, recheck testing should be done sooner.
• Another scenario would be a clinically "healthy" dog with an abnormal pancreatic lipase test. If no other diagnostic findings indicate suggestion of disease, subclinical pancreatitis is likely, and the client should be educated about the risk of developing clinical disease. This could include a recheck pancreatic lipase test if clinical signs appear.
• The final scenario is the canine patient who presents with suggestive clinical signs and an abnormal pancreatic lipase test. Any other primary underlying disease that was identified through comprehensive diagnostics must be concurrently treated alongside a standard low-fat diet, pain medications, and other supplements. Frequent pancreatic lipase monitoring to measure the severity of resolution is also indicated.

While felines can also present with acute disease, it's more common to see recurrent or chronic forms associated with comorbidities such as chronic inflammatory enteropathy, cholangitis, hepatic lipidosis, and diabetes mellitus. Given this has multiple causes in cats, timely and accurate diagnosis is essential. Not only will pancreatic lipase testing be necessary early in the diagnostic workup of these patients to establish the presence of a diagnosis, but the client should also be informed of the need for more frequent and/or chronic monitoring due to the more likely course of disease.

How Testing Guides Treatment

A foundational database should be established for a patient exhibiting significant clinical signs or intermittent chronic signs, including a complete blood count (CBC), a chemistry profile with electrolytes, and a complete urinalysis. A CBC can reveal dehydration and inflammation, while a chemistry panel can assist in identifying concurrent diseases in the liver or endocrine systems.

Abdominal imaging can be valuable in dogs and cats through radiographs and/or ultrasound. Radiographs can benefit both species by ruling out other causes of the clinical signs like gastrointestinal foreign bodies or other abdominal diseases and obstructions that may necessitate surgical intervention. However, abdominal ultrasound findings that indicate pancreatitis, such as swelling or peripancreatic fluid accumulation, are more characteristic of acute or severe disease. Imaging can be less helpful for chronic pancreatitis, more prevalent in cats.

Some patients present with mild clinical signs, a normal history, and no predisposing conditions. Traditionally, the diagnostic workups in these cases have been patient-dependent, with supportive care often preferred initially. However, early pancreatic lipase testing enables earlier diagnosis, potentially leading to more conservative, cost-effective treatment, and identifying subclinical cases. Remember this is a painful inflammatory disease and the level of severity may also shape the pain control regimen.

The Benefits of a Quantitative Pancreatic Lipase Test

While a specific qualitative test is always helpful for confirming a disease—especially if it enables earlier detection—a quantitative in-clinic version provides numerous additional benefits. The result is a definitive number that fits three scenarios: There is a starting point indicating the presence or absence of disease and its severity, and subsequent test results can demonstrate objective disease improvement or progression. An increase in the quantitative pancreatic lipase value suggests worsening inflammation, guiding adjustments or additions to the current treatment plan. In contrast, a decrease in the quantitative pancreatic lipase value indicates improvement or disease resolution, which can lead to modifying or discontinuing therapy.

Veterinarians frequently see canine and feline patients with clinical signs suggesting pancreatitis. Pancreatic lipase testing can improve patient outcomes by quantitatively assessing severity, guiding treatment decisions, and monitoring therapy responses.

Reference

Steiner JM. Exocrine pancreas. In: Steiner JM, ed. Small Animal Gastroenterology. Hannover, Germany: Schlutersche; 2008:285–293.

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