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History

History. Not sensitive Not specific. Signalment Diet Vomiting Prior episodes Diarrhea. Identify diseases that MIMIC pancreatitis. History. Signalment Diet Vomiting Prior episodes Diarrhea. Physical Examination. Not sensitive Not specific. Anterior abdominal pain Icterus

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History

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  1. History Not sensitive Not specific • Signalment • Diet • Vomiting • Prior episodes • Diarrhea

  2. Identify diseases that MIMIC pancreatitis History • Signalment • Diet • Vomiting • Prior episodes • Diarrhea

  3. Physical Examination Not sensitive Not specific • Anterior abdominal pain • Icterus • Profuse ascites • Fever • SQ abscesses

  4. Identify diseases that MIMIC pancreatitis Physical Examination • Anterior abdominal pain • Icterus • Profuse ascites • Fever • SQ abscesses

  5. WHICH CBC(S) IS/ARE FROM DOG(S) WITH ACUTE PANCREATITIS?

  6. 147033147198 90524 159796 Non-discriminatory PCV 28.528.830 40 WBC 30,00045,5009,800 11,500 Segs 26,10033,6704,606 9,890 Bands 9002,7302,450 0 Plat 87,000407,000679,000 470,000 Toxic modmodnone none

  7. Clinical Pathology • An anorexic, vomiting dog with fasting hyperlipidemia probably has acute pancreatitis

  8. Clinical Pathology • An anorexic, vomiting dog with fasting hyperlipidemia probably has acute pancreatitis • Most dogs with pancreatitis DO NOT have fasting hyperlipidemia

  9. Clinical Pathology Garbage • Amylase/Lipase • Sensitivity ~ 50% • Specificity ~ 50% • TLI • Sensitivity ~ 35%

  10. Clinical Pathology • cPLI • Sensitivity ~ 80-85%

  11. Sig: 7 yr M Boxer X CC: Anorexia/Vomiting HPI: Started 1 week ago snap PLI = pancreatitis Dog died despite therapy: Everything normal on gross necropsy

  12. PANCREATITIS versus CLINICALLY IMPORTANT PANCREATITIS

  13. Diagnostics • cPLI • Sensitivity ~ 80% • Abdominal ultrasound • Sensitivity probably ranges from 40% to about 65%

  14. Diagnostics • cPLI • Sensitivity ~ 80% • Abdominal ultrasound • Sensitivity probably ranges from 40% to about 65% because clinicians rarely repeat the ultrasound

  15. Diagnostics • cPLI • Sensitivity ~ 80% • Abdominal ultrasound • Sensitivity probably ranges from 40% to about 65% • Findings can change within hours ...

  16. WHAT IS THE BEST WAY TO DIAGNOSE CANINE ACUTE PANCREATITIS?

  17. All things being equal, try to avoid surgery

  18. THE REAL PROBLEM IS THAT ACUTE PANCREATITIS CAN PRESENT IN SO MANY DIFFERENT WAYS THAT YOU DON’T EVEN SUSPECT IT INITIALLY

  19. TAMU #88267 Sig: 7 yr M Sheltie CC: Vomiting HPI: Began 5 weeks ago Partial anorexia, vomits phlegm or bile once daily Dog otherwise pretty healthy PE: No significant abnormalities

  20. TAMU #88267 PCV = 37% (35-55) WBC = 21,800/ul (6,-16,000) Segs = 20,274/ul (4,-14,000) Lymphs = 840/ul (1,000 - 4,000) Platelets = 255,000/ul (200, - 500,000)

  21. TAMU #88267 Creatinine = 2.0 mg/dl (< 2.0) BUN = 36 mg/dl (8-29) Total protein = 4.7 gm/dl (5.5-7.5) Albumin = 1.7 gm/dl (2.5-4.4) ALT = 10 U/L (< 130) SAP = 31 U/L (< 147) Bilirubin = 0.4 mg/dl (< 1.0) Urine: 1.015 with 4+ protein

  22. TAMU #159796 Sig: 9 yr M(c) Pug CC: Vomiting, yellow scleras HPI: Feeling bad 12 days ago Started vomiting, responded to fluid therapy, but became ill again when started feeding it Dog’s eyes turned yellow PE: Scleras yellow

  23. TAMU #159796 PCV = 40% (35-55) WBC = 11,500/ul (6,-14,000) Segs = 9,890/ul (4,-12,000) Lymphs = 460/ul (1,-4,000) Eos = 230/ul (100-1,250) Platelets = 470,000/ul (200,-500,000)

  24. TAMU #159796 BUN = 4 mg/dl (8-29) Creatinine = 0.7 mg/dl (< 2.0) Glucose = 95 mg/dl (75-133) Potassium = 3.6 mEq/L (3.8-5.1) Cholesterol = 597 mg/dl (120-247) Albumin = 2.9 gm/dl (2.5-4.4) ALT = 1,691 IU/L (< 130) SAP = 3,134 IU/L (< 147) Bilirubin = 4.5 mg/dl (0-0.8)

  25. TAMU #159796 4/9 4/11 4/13 4/15 4/16 ALT 1,691 2,108 1,275 SAP 3,134 3,753 3,633 Bili 4.5 4.5 4.8 2.6 1.2

  26. TAMU #152494 Sig: 9 yr F(s) Dalmation CC: Vomiting/diarrhea HPI: Vomiting food/bile 6-8X in 2 weeks Diarrhea constantly for 2 weeks Decreased appetite for 10 days, anorexia for 5 days PE: T = 102.5 F, HR = 102/min

  27. TAMU #152494 PCV = 35.5% (35-55) WBC = 21,700/ul (6,-14,000) Segs = 15,200/ul (4,-12,000) Bands = 630/ul (< 500) Lymphs = 1,400/ul (1,-4,000) Platelets = 568,000/ul (200,-500,000)

  28. TAMU #152494 Sodium = 152 mEq/L (138-148) Potassium = 4.1 mEq/L (3.5-5.0) Glucose = 107 mg/dl (60-120) Albumin = 2.7 gm/dl (2.5-4.4) ALT = 123 IU/L (< 110) SAP = 2,174 IU/L (< 130) Creatinine = 1.3 mg/dl (< 2.0)

  29. TAMU #152494 Abdominal ultrasound: “… Small amount of anechoic effusion between liver lobes and around urinary bladder. Fine Needle Aspirate reveals turbid yellow tan fluid.”

  30. TAMU #152494 Abdominal fluid: WBC = 153,000/ul RBC = 0/ul Total protein = 4.6 gm/dl 90% nondegenerate neutrophils 8% macrophages, vaculated “Suppurative exudate”

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