The Importance of Pancreatic Lipase Testing

Before the launch of today's more advanced pancreatic testing methods, veterinarians had to rely on measuring general lipase for diagnostic information. However, this enzyme is additionally produced from adipose tissue and gastric and duodenal mucosa.¹ In contrast, pancreatic lipase testing measures only the lipase produced from pancreatic acinar cells, ensuring increased specificity.

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If pancreatic disease is left undiagnosed and untreated, the patient can develop chronic pancreatitis, which can lead to more severe diseases, such as diabetes mellitus and exocrine pancreatic insufficiency.^2-3

3 Critical Components of a Pancreatitis Workup

If a patient presents with possible signs of pancreatitis, the veterinary team must recognize three early and essential components of the workup. The first component is identifying the clinical signs suggestive of pancreatitis. These signs may vary per patient but generally include hyporexia/anorexia, vomiting, abdominal pain, dehydration, hypovolemia, and weakness or lethargy.

The second part involves obtaining an accurate signalment and thorough history. The veterinarian must consider any increased risk factors, such as concurrent diseases, current medications, predisposed breeds, high-fat canine diets, and previous dietary indiscretions.

  Watch the "Pancreatitis: Lipase is on the case!" webinar with Dr. Beth Schooley to learn more about pancreatitis and the role of lipase testing.

Finally, a complete physical examination must be performed as the core of any diagnostic workup, paying close attention to the abdomen, circulatory system stability, and other significant abnormalities.

The Diagnostic Workup for a Patient with Significant Clinical Signs of Pancreatitis

The next step is the diagnostic workup after the veterinary team obtains signalment, history, and physical exam findings and sees suspect clinical signs. Specifically, a foundational database should be performed if clinical signs are significant (like systemic complications and general malaise) or are intermittent or chronic. This includes a complete blood count, a chemistry profile with electrolytes, a complete urinalysis, and an in-clinic pancreatic lipase test. Additionally, diagnostic imaging is helpful not only to rule out foreign objects and other medical and surgical diseases but also to evaluate for any changes compatible with pancreatitis.

However, not every case is black and white. Suppose a canine or feline patient only shows mild clinical signs, has no suspicious history, and no predisposing/preexisting conditions or medications. In that case, veterinarians should consider a diagnostic workup depending on the case and utilize a supportive medical therapy and diet for the patient.

Interpretation of Pancreatic Lipase Testing Results

Once the diagnostic workup has been completed, veterinarians can confidently diagnose pancreatitis after learning how to interpret the results of a pancreatic lipase test. Here are the three scenarios seen in canines and felines and what the results indicate:

1. If the pancreatic lipase results for canine patients are greater than or equal to 400 U/L and for feline patients are greater than or equal to 8.8 U/L, then findings are consistent with pancreatitis. If the veterinarian hasn't diagnosed a concurrent disease, appropriate treatment should be initiated.
2. If the results are between 201–399 U/L for canine patients and 4.5–8.7 U/L for feline patients, then pancreatitis is possible, and the veterinarian should reevaluate, as other diseases may be possible. If reevaluation isn't possible immediately, then re-testing should occur in a couple of weeks (especially if the patient shows signs of worsening pancreatitis).
3. If the results are less than or equal to 200 U/L for canine patients and less than or equal to 4.4 U/L for feline patients, then pancreatitis is unlikely.

The Importance of Pancreatitis Testing in Felines

While most veterinarians are comfortable identifying suspect clinical signs of canine pancreatitis, recognizing pancreatitis in cats can prove more difficult, as feline patients tend to show more nonspecific signs of disease, like lethargy, inappetence, weight loss, dehydration, vomiting, and diarrhea. While these can suggest pancreatic disease, they can also be present with inflammatory bowel disease, cholangitis, cholangiohepatitis, hepatic lipidosis, and diabetes mellitus.⁴ To avoid misdiagnosis, feline pancreatic lipase testing can help veterinarians feel more confident in diagnosing pancreatitis and initiating treatment.

Pancreatic lipase testing plays a critical role for acutely ill patients, aiding in the early detection of painful diseases and acting as a stepping stone to more chronic and severe diseases. In-clinic testing empowers veterinarians to reference lab-quality results in real time and take action quickly and accurately.

References

1. Kathrani A, Steiner JM, Suchodolski J, Eastwood J, Syme H, Garden OA, Allenspach K. Elevated canine pancreatic lipase immunoreactivity concentration in dogs with inflammatory bowel disease is associated with a negative outcome. J Small Anim Pract. 2009; 50(3):126–32.
2. Watson PJ. Exocrine pancreatic insufficiency as an end stage of pancreatitis in four dogs. J Small Anim Pract. 2003;44(7):306–12.
3. Watson P. Chronic pancreatitis in dogs. Top Companion Anim Med. 2012;27(3):133–9.
4. Steiner JM. Exocrine pancreas. In: Steiner JM, ed. Small Animal Gasteroenterology. Hannover, Germany: Schlutersche; 2008:285–293.

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