MAKING THE DIAGNOSIS
A reliable blood test has been lacking for this disease until recently. Traditionally, blood levels of amylase and lipase (two pancreatic digestive enzymes) have been used. When their levels are especially high, this has been felt to be a reasonable sign that these enzymes have leaked out of the pancreas and pancreatitis is present but, still, these tests are not as sensitive or specific as we would prefer. Amylase and lipase can elevate dramatically with corticosteroid use, with intestinal perforation, kidney disease, or even dehydration. Some experts advocate measuring lipase and amylase on fluid from the belly rather than on blood but this has not been fully investigated and is somewhat invasive.
A newer test called the “PLI” or “pancreatic lipase immunoreactivity” test has come to be important. As mentioned, lipase is one of the pancreatic digestive enzymes and only small traces are normally present in the circulation. These levels jump dramatically in pancreatitis and the diagnosis can be confirmed with a less expensive and non-invasive test. A regular lipase level measures all forms of lipase, not just those of a pancreatic source; this is test is specific for pancreatic lipase. The problem is that technology n eeded to run this test is unique and the test can only been run in certain facilities on certain days. Results are not necessarily available rapidly enough to help a very sick patient.
More recently a new test called the SPEC cPL (“specific canine pancreatic lipase”) test has come to be the test of choice. This test is a newer generation immunological test for canine pancreatic lipase and can be run overnight by a reference lab. This test is able to detect 83% of pancreatitis cases (the test is 83% sensitive) and excludes other possible diseases in 98% of cases (i.e. the test is 98% specific for pancreatitis). There is no comparable test for the cat at this time.
Radiographs can show a widening of the angle of the duodenum against the stomach which indicates a swelling of the pancreas. Most veterinary hospitals have the ability to take radiographs but this type of imaging is not very sensitive in detecting pancreatitis and only is able to find 24% of cases.
Ultrasound, on the other hand, detected 68% of cases and provides the opportunity to image other organs and even collect fluid from the belly easily. Since pancreatitis can be accompanied by a tumor in the vicinity of the p ancreas, ultrasound provide the opportunity to catch complicating factors such as this.
In some cases, surgical exploration is the only way to make the correct diagnosis.
Canine Pancreatitis