The Critical Role of Pancreatic Lipase Testing for Detecting Pancreatitis in Veterinary Patients
Pancreatitis is the most common exocrine pancreatic disease in both dogs and cats. However, due to the nonspecific or even subclinical signs, pancreatitis can sometimes be difficult to detect or accurately diagnose. Additionally, there can be presentation differences between dogs and cats and in patients with acute or chronic pancreatitis.
Let's dive deeper into why detection of this inflammatory disease is crucial to patient health and outcomes and how to best utilize this testing in small animal practice.
Clinical Signs of Pancreatitis
Unfortunately, clinical signs of pancreatitis can be vague and nonspecific, ranging from mild gastrointestinal upset and lethargy to severe abdominal pain and systemic illness. Additionally, they vary between canine and feline pancreatitis. In dogs, typical clinical signs that should prompt testing include vomiting, anorexia, and abdominal pain.
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Cats tend to show more nonspecific signs on history and physical exam, including lethargy, inappetence, dehydration, weight loss, vomiting, and diarrhea. The underlying cause of pancreatitis in dogs and cats is often idiopathic. In cats, we often see concurrent disesease such as inflammatory bowel disease, cholangitis, cholangiohepatitis, hepatic lipidosis, and diabetes mellitus.1
However, while the clinical signs that prompt investigation may differ, the testing protocol remains the same using pancreatic lipase testing.
Why Pancreatic Lipase Testing Is Important
Preserving pancreatic health is a focus for veterinarians as the pancreas is a vital organ without the ability to regenerate. Its health can also be affected by other concurrent diseases, certain specific drugs, breed predispositions, trauma, lack of blood flow or ischemic events, and commonly in dogs (not cats), dietary indiscretions. Left undiagnosed and untreated, chronic pancreatitis can lead to more severe diseases like diabetes mellitus and exocrine pancreatic insufficiency.2-3
Pancreatic lipase testing should be pursued for disease detection in dogs and cats presenting with suspect clinical signs. When in doubt and signs are subtle, testing is best. Pancreatic-specific lipase testing measures the lipase solely produced by the pancreatic acinar cells. It allows a precise evaluation of the pancreas's health compared to general lipase testing, which measures enzyme production from adipose tissue, gastric, and duodenal mucosa as well.4
Accurately Detecting Pancreatitis in Our Patients
While pancreatitis is often at the top of our differential list when we see canine and feline patients present with some of the clinical signs previously discussed, it's important to remember an additional two points about pancreatic lipase testing results.
- Similar Clinical Signs: Other disease conditions can present with similar signs and physical exam findings. In some patients, gastrointestinal obstruction and liver disease can both mimic the clinical signs of pancreatitis, and additional testing is essential to confirm the diagnosis, as these three conditions require vastly different treatment plans for resolution.
- Concurrent Disease: It's also important to remember that a diagnosis of pancreatitis does not exclude the possibility of concurrent disease, such as a gastrointestinal foreign body, which might even be the primary cause of the clinical signs.
When multiple components of the gastrointestinal system are involved, there can be confusion about where the disease originated. Pancreatic lipase testing is one diagnostic to always include in this patient's journey. It aids in isolating pancreatitis from other conditions, ensuring accurate diagnosis and appropriate management. While pancreatitis is relatively common in both canine and feline medicine, especially in certain breeds, after dietary indiscretions or associated with another gastrointestinal disease in cats, there are instances in which other differentials must be included on the list and may dictate additional diagnostic imaging to identify. These could consist of pancreatic duct obstruction as well as tumors of the pancreas, such as pancreatic adenocarcinoma.
Pancreatic Lipase Testing
Today, pancreatic lipase testing can help veterinarians confidently diagnose pancreatitis and now with in-clinic testing is even easier. Specifically, with acutely ill patients, clinicians have access to a pancreatic lipase slide for chemistry analyzers for a quantitative result—giving results in less than 10 minutes allowing for timely treatment decisions. This testing modality offers accurate quantitative results that align with the reference lab for both canine and feline patients through an easy, load-and-go workflow.
Given how common pancreatitis is in both canine and feline patients, having an accurate in-clinic pancreatic lipase test is essential when these patients present due to illness. In-house analyzers make real-time testing for pancreatitis easy, accurate, and efficient.
References:
1. Steiner JM. Exocrine pancreas. In: Steiner JM, ed. Small Animal Gasteroenterology. Hannover, Germany: Schlutersche; 2008:285–293.
2. Watson PJ. Exocrine pancreatic insufficiency as an end stage of pancreatitis in four dogs. J Small Anim Pract. 2003;44(7):306–312.
3. Watson PJ. Chronic pancreatitis in dogs. Top Companion Anim Med. 2012;27(3)133–139.
4. Kathrani A, Steiner JM, Suchodolski J, Eastwood J, Syme H, Garden OA, et al. Elevated canine pancreatic lipase immunoreactivity concentration in dogs with inflammatory bowel disease is associated with a negative outcome. J Small Anim Pract. 2009; 50:126-132.
