New directions in diagnosis and treatment of canine acute pancreatitis
Mansfield, Caroline S. (2011) New directions in diagnosis and treatment of canine acute pancreatitis. PhD thesis, Murdoch University.
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Acute pancreatitis is an important disease in companion animal medicine, and diagnostic methodology available to veterinary practitioners is often limited. Evidence based principles for the management of this common disease are also lacking. This thesis explores the current diagnostics of canine pancreatitis and management of this condition, reviewing the literature across both the veterinary and human medical fields.
Assessment of the specificity of canine pancreatic-specific lipase (cPL) was made in a post-mortem study and calculated to be 82-92%, with a correlating sensitivity of 45-55%. A multi-centre study of dogs presenting with clinical signs consistent with acute pancreatitis to assess a new laboratory test, serum canine pancreatic elastase-1 (cPE-1) was also performed. This test had a sensitivity ranging from 66-79%, with a specificity of 92%. The sensitivity of both laboratory tests was greater in dogs with severe disease.
To assess potential treatment options, a clinical severity score was established, with gut health, respiratory complications, cardiac complications, and blood pressure determining the final score. Retrospectively, plasma administration did not appear to be associated with treatment success, but this conclusion was limited by the retrospective nature of the study and small numbers of dogs. Out of the other factors, fasting for 3 or more days was the one most significantly associated with mortality. To begin assessment of nutritional modalities, pancreatic responses in healthy dogs to varying dietary fat composition (ranging from 4%DW to 16% DW) was assessed, with no statistical difference determined. On the basis of this, a pilot study of 10 dogs with severe pancreatitis was undertaken, with 5 dogs fed enterally and another 5 dogs were given total parenteral nutrition (TPN). No differences in mortality or days of hospitalisation between the two were found, but there were significantly less episodes of vomiting or regurgitation in the dogs given food (p < 0.001). There were also more severe complications (4/5) in the TPN group compared to the enteral feeding group (2/5).
In all, this thesis supports the new premise of enteral feeding of dogs with acute pancreatitis early in the course of disease, determines the sensitivity and specificity of two diagnostic tests and has established an objective marker of disease severity.
|Publication Type:||Thesis (PhD)|
|Murdoch Affiliation:||School of Veterinary and Biomedical Sciences|
|Supervisor:||Robertson, Ian and Phillips, Jacqueline|
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