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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.

ABSTRACT 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.