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In the last 20 years, the diagnosis of pancreatitis has become more frequent as a result of improved diagnostic modalities such as abdominal ultrasound examination, advanced imaging, and immunoassays for the measurement of pancreatic lipase. Our aim is to provide a state‐of‐the‐art overview of the clinical diagnosis of acute pancreatitis (AP) in dogs with a particular focus on pancreatic lipase assay validation and clinical performance, in addition to advanced imaging modalities. We also discuss the potential indications for cytology and histopathology in dogs with suspected AP.

Background Pancreatitis in cats, although commonly diagnosed, still presents many diagnostic and management challenges. Objective To summarize the current literature as it relates to etiology, pathogenesis, diagnosis, and management of pancreatitis in cats and to arrive at clinically relevant suggestions for veterinary clinicians that are based on evidence, and where such evidence is lacking, based on consensus of experts in the field. Animals None. Methods A panel of 8 experts in the field (5 internists, 1 radiologist, 1 clinical pathologist, and 1 anatomic pathologist), with support from a librarian, was formed to assess and summarize evidence in the peer reviewed literature and complement it with consensus clinical recommendations. Results There was little literature on the etiology and pathogenesis of spontaneous pancreatitis in cats, but there was much in the literature about the disease in humans, along with some experimental evidence in cats and nonfeline species. Most evidence was in the area of diagnosis of pancreatitis in cats, which was summarized carefully. In contrast, there was little evidence on the management of pancreatitis in cats. Conclusions and Clinical Importance Pancreatitis is amenable to antemortem diagnosis by integrating all clinical and diagnostic information available, and recognizing that acute pancreatitis is far easier to diagnose than chronic pancreatitis. Although both forms of pancreatitis can be managed successfully in many cats, management measures are far less clearly defined for chronic pancreatitis.

Background Acute pancreatitis (AP) in dogs has a broad clinical presentation and variable progression, making prognostication challenging. Hypothesis/Objectives (i) To compare predicted prognosis for death and for prolonged (≥ 5 days) hospitalization across scoring schemes for AP in dogs and (ii) to predict concordance of each scoring scheme with death and for prolonged hospitalization. Animals Five hundred four client‐owned dogs. Methods Multi‐institutional retrospective study. Data extracted from medical records included: signalment, history, physical examination findings, diagnostic results, length of hospitalization, and death. Five prognostic schemes (OS, CSI, APPLEfull, CAPS, MCAI) were calculated for each dog. Results Overall concordance was low. Only APPLEfull (p = 0.004) and MCAI (p = 0.01) scores were significantly different between survivors and non‐survivors. Overall, APPLEfull had the greatest concordance (0.632, 95% CI: 0.592–0.672) with length of hospitalization. Of the other more pancreatitis‐specific schemes, MCAI had the greatest concordance (0.576, 95% CI: 0.567–0.635) with length of hospitalization, while CSI had the lowest concordance with length of hospitalization (0.525, 95% CI: 0.494–0.556). Conclusions and Clinical Importance On a population level, APPLEfull and MCAI had the greatest predictive discrimination between dogs of normal and prolonged hospitalization. If an individual dog has any of the 5 prognostic score schemes above the proposed cut‐off for death, it should be interpreted with caution because of the low case fatality rate.

Background It is unclear if dogs with acute pancreatitis differ clinically from dogs with non‐pancreatic acute gastrointestinal disease (aGId). Objectives Compare clinical findings in dogs with acute gastrointestinal signs suspected of having acute pancreatitis (sAP) based on increased DGGR‐lipase activity versus those with presumptive aGId. Animals Twenty‐six dogs with sAP, 48 dogs with aGId based on acute signs, lipase activity > 450 U/L (RI, 17–156 U/L) and within/minimally (20 U/L) > RI, respectively. Methods Prospective study. Clinical signs were graded using a simplified modified clinical activity index (MCAI). CBC, biochemistry, C‐reactive protein (CRP), pancreatic, and gastrointestinal ultrasonographic findings were compared between groups. Results Median (range) disease duration before presentation (sAP 36 h [3–96 h], aGId 48 h [3–168 h]) did not differ. Diarrhea was significantly more frequent in aGId; MCAI did not differ between groups. Median (range) lipase activities in sAP and aGId dogs were 1280 U/L (451–6712) and 49.5 U/L (14–176), respectively. Alkaline phosphatase activity and bilirubin were significantly higher in sAP. Pancreatic ultrasonographic abnormalities were significantly more common in sAP. In aGId, a mixed‐echoic (17/44, 39%), hyperechoic (9/44, 20%), hypoechoic pancreas (3/44, 7%), and hyperechoic mesentery (4/44, 9%) were found. Only a distended stomach was significantly more common in sAP. Multivariable logistic regression analysis only identified pancreatic enlargement and ultrasonographic diagnosis of pancreatitis to increase the odds of sAP. Hospitalization (median, range) did not differ (sAP 3, 1–8 days; aGId 2.5, 1–5 days). Conclusion and Clinical Importance Both groups do not differ in clinical severity; diarrhea is less prevalent, and mild cholestasis is more common in sAP. Pancreatic ultrasonographic changes suggestive of AP are rare in aGId.

Background Serum feline pancreatic lipase immunoreactivity (fPL) commonly is used in the assessment of sick cats suspected to have pancreatitis but its diagnostic utility is debated. Objectives To evaluate the diagnostic utility of the Spec fPL test and selected serum biochemistry tests in the diagnosis of pancreatitis in cats. Animals Two hundred seventy‐four client‐owned cats presented to a university teaching hospital in the United Kingdom, from April 2013 to May 2017, in which Spec fPL was measured. Methods Cats were classified into 1 of 4 groups based on clinical signs (all cats), ultrasonographic findings (all cats) and histopathological or cytological assessment of the pancreas where available (9 cats) regardless of Spec fPL concentration. The groups were (a) definite pancreatitis (n = 9), (b) probable pancreatitis (n = 49), (c) possible pancreatitis (n = 139), and (d) unlikely pancreatitis (n = 77). Spec fPL and selected serum biochemistry test results were compared among groups. Results Serum fPL concentrations >5.3 μg/L were classified as positive and concentrations <3.5 μg/L were classified as negative. There was a significantly (P = .03) lower proportion of false‐positive results (cats unlikely to have pancreatitis, n = 77, with a positive fPL, n = 8, 10%) than false‐negative results (cats with definite or probable pancreatitis, n = 58, with a negative fPL result, n = 14, 24%). None of the selected biochemical tests were helpful diagnostically. Conclusion and Clinical Importance A positive Spec fPL result indicates that pancreatitis is a probable diagnosis, but the test cannot be used to rule the diagnosis out.

Blood concentrations of regenerating island-derived proteins (REG) are high in humans with sepsis, acute pancreatitis, and gastrointestinal diseases. REG3E was recently identified in canine pancreas and blood, but concentrations in dogs with various diseases are unknown. To measure and compare REG3E concentrations in dogs with sepsis, acute pancreatitis, gastrointestinal diseases, and healthy dogs. Cross-sectional study measuring plasma REG3E concentrations using an in-house developed ELISA in stored convenience samples from client-owned dogs with naturally occurring sepsis (n = 44), acute pancreatitis (n = 42), acute (n = 25) and chronic gastrointestinal diseases (n = 23), and healthy controls (n = 80). Concentrations of REG3E are compared among groups and between survivors and non-survivors to discharge using the Kruskal-Wallis test with post-hoc Conover analysis and independent samples t-tests. REG3E concentrations differed significantly among all groups (P < 0.005), except between sepsis and acute pancreatitis (P = 0.936). Median concentrations (interquartile range [ng/mL]) were 36.5 (30-89) in healthy dogs, 200 (103.5-361.5) in dogs with chronic gastrointestinal diseases, 634 (257-1060) in dogs with acute gastrointestinal diseases, 1644.5 (710 - 4122) in dogs with acute pancreatitis, and 1736 (480.5-3416) in septic dogs. Non-survivors (n = 33) had significantly higher REG3E concentrations than survivors when compared across all clinically ill dogs (P < 0.001) and within the sepsis group (n = 20; P = 0.0133), but not within the acute pancreatitis group (n = 13; P = 0.248). Plasma REG3E concentrations are higher in dogs of all disease categories, particularly in dogs with sepsis and acute pancreatitis, but with considerable overlap between different diseases. High REG3E concentrations may be associated with poor prognosis in septic dogs. Thus, REG3E is likely to reflect inflammation and merits further investigations to refine its potential as a diagnostic and decision-making biomarker in this species.

While most cases of pancreatitis in dogs are thought to be idiopathic, potential risk factors are identified. In this article we provide a state‐of‐the‐art overview of suspected risk factors for pancreatitis in dogs, allowing for improved awareness and detection of potential dog‐specific risk factors, which might guide the development of disease prevention strategies. Additionally, we review important advances in our understanding of the pathophysiology of pancreatitis and potential areas for therapeutic manipulation based thereof. The outcome of pathophysiologic mechanisms and the development of clinical disease is dependent on the balance between stressors and protective mechanisms, which can be evaluated using the critical threshold theory.

Background No data after hospitalization for acute pancreatitis (AP) in dogs comparing clinical signs to lipase results exists. Objectives Evaluate disease severity, lipase activity, and pancreatic lipase immunoreactivity (PLI) after hospitalization for suspected AP. Animals One hundred and six client‐owned dogs with a minimum of one re‐check 2 weeks after hospitalization for AP. Methods Combined retrospective and prospective study. Clinical signs graded using a clinical disease activity score (CDAS = CIBDAI complemented by abdominal pain) were compared to DGGR‐lipase activity (LIPC Roche) and PLI (SpecPL) at 2 weeks (t2, n = 106) after discharge. Additional re‐checks were available 6 weeks (t3, n = 56), 12 weeks (t4, n = 24), and 24 weeks (t5, n = 13) after discharge. Results Lipase activity and PLI correlated strongly at all time points (rs 0.863–0.937, p < 0.0001). Discordant results in regard to published reference intervals (RI) were rare (2.8% at t2, 1.7% at t3, 4.2% at t4, 0% at t5) and seemed clinically irrelevant. Dogs with still elevated lipase activity and PLI at t2 (24/106.22.6%) and t3 (21/56.37.5%) were significantly older compared to dogs with lipase within RI. Weak and moderate correlation between CDAS and lipase activity/PLI was found only at t2 (rs 0.391, p = 0.0009; rs 0.279, p = 0.004) and t5 (rs 0.603, p = 0.032; rs 0.57 p = 0.045). Most dogs (79.2%) with still elevated lipase at t2 had no or minimal clinical signs (CDAS 0–3). The same applied to all later re‐checks. Conclusion and Clinical Importance Both lipase assays did not differ when compared to clinical status. Most dogs with hyperlipasemia after hospitalization for AP have no or minimal clinical signs.

Background The sensitivity, specificity, and agreement of 4 diagnostic assays (SNAP canine pancreatic lipase (cPL), specific cPL (Spec cPL), VetScan cPL Rapid Test, and Precision PSL) for pancreatitis in dogs have not been directly compared. Hypothesis/Objectives To determine the level of agreement among each of the 4 assays and a clinical suspicion score, level of agreement among the assays, and sensitivity and specificity of each assay in a clinically relevant patient group. Animals Fifty client‐owned dogs with clinical signs of gastrointestinal disease. Methods Prospective study. History, physical examination, complete blood count, serum biochemistry, abdominal ultrasound examination, and the 4 diagnostic assays for pancreatitis were performed. Intraclass correlation coefficients (ICC) were used to determine the level of agreement between each assay and a clinical suspicion score determined by a panel of 5 board‐certified veterinary internists. Results The ICC between the clinical suspicion score and the 4 assays were SNAP cPL, 0.61; Spec cPL, 0.68; VetScan cPL Rapid Test, 0.68; and Precision PSL, 0.60. The sensitivities of the assays ranged from 73.9 to 100.0%, whereas the specificities were SNAP cPL, 71.1–77.8%; Spec cPL, 74.1–81.1%; VetScan cPL Rapid Test, 76.9–83.8%; and Precision PSL, 64.0–74.3%. Conclusions and Clinical Importance A good to excellent level of agreement was demonstrated among the 4 assays. The previously unreported sensitivity and specificity of the VetScan cPL Rapid Test were 73.9–83.3% and 76.9–83.8%, respectively. Results of any of the 4 diagnostic assays alone, in the absence of supporting clinical findings, are insufficient to establish a diagnosis of clinical pancreatitis in dogs.

Background A clinical diagnosis (CDx) of pancreatitis includes evaluation of clinical signs, abdominal ultrasound (AUS), and pancreatic lipase. However, practitioners are using AUS to diagnose pancreatitis and are using AUS severity to guide decisions. The validity of this is unknown. Objectives To determine whether (1) there is a correlation between AUS, specific canine pancreatic lipase (Spec cPL) assay, and CDx; (2) individual AUS abnormalities correlate more closely with CDx than others; (3) AUS severity mirrors clinical severity indices; (4) changes in AUS can be used as a marker for changes in Spec cPL or CDx; and (5) the sensitivity and specificity of AUS for pancreatitis. Animals One hundred fifty‐seven dogs. Methods In this retrospective case study, inclusion criteria were signs of gastrointestinal, pancreatic disease, or both, in addition to having a Spec cPL and AUS performed within 30 hours. Information extracted from the records included bloodwork, Spec cPL, AUS images/clips, and severity of ultrasonographic findings. Results AUS was weakly correlated with Spec cPL (rs = .0178, P = .03) and moderately correlated with CDx (rs = .379, P = <.001). Pancreatic size (rs = .285, P = <.001), echogenicity (rs = .365, P = <.001), and mesenteric echogenicity (rs = .343, P = <.001) were correlated with CDx. Change in AUS was not correlated with Spec cPL or CDx changes. When pancreatic enlargement, echogenicity, or altered mesenteric echogenicity were required for a diagnosis, the sensitivity and specificity were 89% (95% confidence interval [CI] 71.8, 97.7) and 43% (95% CI 34.0, 51.6). When all 3 criteria were required, the sensitivity and specificity were 43% (95% CI 24.5, 62.8) and 92% (95% CI 85.3, 95.7). Conclusions AUS should not be used in isolation to diagnose pancreatitis and is a poor indicator of severity.