Veterinary Medicine - November 2008 - (Page DM8)

and other test results. Williams: You have to ask yourself when you do an ultrasound what you’re likely to nd. What ndings would change what we are going to do? If everything ts with pancreatitis and fPLI is elevated, ultrasonographic ndings are not going to change your approach in most cases. If more severe pancreatitis exists, you can identify that with ultrasound, whereas you cannot establish severity from the degree of the fPLI elevation. Forman: The ultrasound might give you some information about concurrent diseases, such as a possible intestinal foreign body or a concern for hepatic lipidosis. Robertson: So when would you recommend a veterinarian run an fPLI test on a cat? Williams: I would run it on any cat with unexplained lethargy, decreased appetite, vomiting, diarrhea, or weight loss. Even if you have another diagnosis, some cats could have concurrent pancreatitis. With the feline pancreas speci c lipase Spec fPL™ test now being widely available through IDEXX Laboratories, veterinarians have good reason to run this test in many cases. Steiner: Ten to 20 years from now, we won’t be able to afford not to look at the pancreas. When I went to veterinary school 15 years ago, we had to justify why we wanted to run an ALT and ALP test. Today students want to run a full serum chemistry pro le. I’m happy with that because I want to know what the liver and kidneys are doing. We almost automatically perform a full pro le, including measurement of serum hepatic enzyme activities, to get a complete picture of the patient. I think that sometime in the future, we will perform pancreatic screening automatically. Twedt: That’s probably true. An example is T4 measurement. I used to perform a minimum database on sick cats that did not include a T4. If that didn’t give me a diagnosis, then I would request a T4, which is now routinely included in our feline minimum database. Robertson: Dr. Steiner and Dr. Williams have worked with IDEXX Laboratories during the past few years to develop the Spec fPL test, which is a modi cation of the fPLI test. Dr. Steiner, do you think that now this test is more routinely available to practitioners, it will change the way we look at the pancreas? Steiner: Absolutely. The pancreas is an organ that we need to evaluate in every patient on whom we perform routine blood work. Williams: The fPLI, now the Spec fPL test, is an emerging gold standard for pancreatic in ammation. A corollary would be the TLI, which is effectively a gold standard for pancreatic mass. When it rst came out and we saw animals with slightly subnormal TLI, 8 I thought that was a failing of the test. It was not as good as I had hoped it would be; however, time has shown that when patients have a subnormal TLI, they have reduced pancreatic mass even if it is subclinical. I think we are on that path with the Spec fPL test. It is going to become the gold standard. The histologic de nition is limited and impractical because you can rarely do histopathologic examination of the whole pancreas. Ultrasonography cannot detect pancreatitis in the more mildly affected patients. Robertson: So an elevated Spec fPL test in a cat with compatible clinical signs will help you diagnose pancreatitis. In an animal without compatible clinical signs, the test still tells us something is wrong with the pancreas. Williams: Yes. An elevated Spec fPL indicates a pancreatic abnormality, most likely pancreatitis, even if the animal is asymptomatic. Steiner: If a cat has a creatinine level of 3.5 mg/dl and is not dehydrated or obstructed, it doesn’t matter whether it has any clinical signs. I have no doubt this cat has renal insuf ciency. If you have a cat with a Spec fPL that is above the cut-off value for pancreatitis, there is no question that the cat has pancreatic in ammation. However, I can’t tell you whether that is the primary disease process in this cat—it may also have gastric or intestinal disease. Knowing that the cat has an elevated Spec fPL may change how I approach the case. For example, I normally would put a diabetic cat on a lowcarbohydrate diet, which is also high in fat. But if the cat also has pancreatitis, I certainly wouldn’t do that. If a cat just has IBD, I am likely to perform a dietary trial. But if the cat has IBD and pancreatitis, I’m more likely to prescribe steroids. In other words, I will treat a cat differently if I know complicating pancreatitis exists. Robertson: Other than ultrasonography, do you use any other imaging in cats with pancreatitis? Steiner: Radiography is important for ruling out other diseases, such as a foreign body, which would be more of a differential diagnosis in cats with acute clinical signs. Twedt: You may see evidence of effusion or a pancreatic mass, but those aren’t very common. But ruling out other diseases is important. Robertson: What are the speci c changes that you look for on ultrasound in a cat with pancreatitis? Forman: No one abnormality on ultrasound has been identi ed that is pathognomonic for pancreatitis in the cat. A change in the size and echogenicity of the pancreas is a common nding. The pancreas will be larger than normal and hypoechoic with a hyperechoic surrounding mesentery. Other ndings include a change in the echotexture or peripancreatic uid. An irregular

Table of Contents Feed for the Digital Edition of Veterinary Medicine - November 2008

Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

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