Pancreatic Disease - Diagnosis and Testing
Recent advances in diagnosis and testing have lead to an increase in the numbers of reported cases of pancreatitis, particularly in cats.
Lipase is produced and secreted in many different cell types and classical methods of measurement have proved to be lacking in specificity. Elevations in lipase may not relate to pancreatitis but to some other non pancreatic disease. (It must also be remembered that in some cases of pancreatitis amylase and lipase levels are normal).
The measurement of pancreatic lipase is allowing the source of the elevation in lipase to be more accurately assessed. Immunoassays are now available to measure pancreas specific lipase - PLI.
Studies have shown that chronic renal failure can have an effect on levels of cPLI, but in most cases values do not exceed the reference range, and certainly do not reach the level indicative of pancreatitis. Administration of glucocorticoids also does not affect levels. This makes the cPLI test more specific in the diagnosis of pancreatitis in dogs. Sensitivity levels have also been shown to be above 80%.
cPLI can now be assessed in two ways.
- The classical specPLI which will give accurate assessment of levels of PLI, allowing an indication of the severity of the pancreatitis, and also useful for monitoring response to therapy. This test has a 1 day turnaround time.
- In addition there is now a rapid screening test giving a normal or elevated value which correlates well with the specPLI test. This is useful for the ‘yes or no’ question of pancreatitis which is needed in those acute vomiting dogs. Results are available the same day.
It is important you specify on the submission form which of these tests you require. Price implications apply to these tests – prices available on request from the laboratory.
Pancreatitis in cats can be very challenging to diagnose due to the non specific clinical signs which, in one study, included anorexia, lethargy and dehydration as the most common findings. Amylase and lipase activities have very little usefulness in the diagnosis of pancreatitis in cats. In cats both fTLI and fPLI increase with pancreatitis, but fPLI stays elevated far longer than fTLI. The estimation of fPLI is more sensitive, as in the dog, for the diagnosis of feline pancreatitis. Further studies have shown that fPLI was more sensitive and specific for pancreatitis than fTLI and abdominal ultrasound. fPLI is still only available from the GIlab in the USA so turnaround time is a factor when requesting this test, but it will at least answer more accurately the ‘pancreatitis’ question.
Fasting serum samples of at least 0.5ml are required.
Serum TLI remains the test of choice in patients suspected of having exocrine pancreatic insufficiency.
For further details on these tests please contact the laboratory.