Caroline S. Mansfield

Development of a clinical severity index for dogs with acute pancreatitis

OBJECTIVE To establish a clinical severity index that correlates severity of body system abnormalities with outcome in dogs with acute pancreatitis (AP) and determine the usefulness of serum C-reactive protein (C-RP) concentration as an objective measure of AP severity. DESIGN Retrospective cohort study. ANIMALS 61 client-owned dogs with ultrasonographically or histologically confirmed AP. PROCEDURES Medical records of AP-affected dogs were reviewed, and signalment, physical examination findings, clinicopathologic data, and outcome (death or discharge from the hospital) were evaluated. The correlation of specific abnormalities in endocrine, hepatic, renal, hematopoietic, cardiovascular, and respiratory systems; local pancreatic complications; and intestinal integrity were evaluated, and a clinical severity index was developed for AP in dogs. The severity index score was compared with outcome and, for 12 dogs, with serum C-RP concentration. RESULTS The clinical severity index had a good correlation with outcome and interval from hospital admission until end point (days until outcome), but there was no difference in days until outcome between survivors and nonsurvivors. All 12 dogs evaluated had high serum C-RP concentration, but this variable was not related to outcome; however, within a 2-day period after onset of clinical signs, serum C-RP concentration in survivors and nonsurvivors differed significantly. CONCLUSIONS AND CLINICAL RELEVANCE Among AP-affected dogs, the clinical severity index may be useful for treatment comparisons and prediction of intensive management requirements. Serum C-RP concentration was best related to AP severity within a 2-day period after onset of clinical signs, but daily measurement may be more useful for monitoring progress.

Acute Pancreatitis in Dogs: Advances in Understanding, Diagnostics, and Treatment

Acute pancreatitis in dogs is a potentially reversible condition, but in severe forms it can cause systemic and local complications. These complications are driven by the cytokine, complement, and kinin systems, with the roles of these systems along with other substances such as nitric oxide being increasingly studied. The intestinal tract and altered pancreatic microcirculation also contribute greatly to the perpetuation of disease. Diagnosis remains difficult, because the true diagnostic utility of the current tests available is problematic to establish. Further understanding of the pathophysiology of this disease has opened up new areas of research into optimal treatments. In particular, the role of enteral nutrition has been the focus of much attention, and current recommendations are to feed earlier in the disease than previously thought.

Observed occurrence of Tritrichomonas foetus and other enteric parasites in Australian cattery and shelter cats

Cattery-housed pedigree cats, located mostly within the USA, have the highest reported prevalence of Tritrichomonas foetus (T foetus) to date. This prospective, multi-institutional, cross sectional study examines the occurrence of T foetus and other enteric parasites in cattery-housed and shelter cats within Australia, where T foetus has only recently been identified. Faecal specimens were collected from 134 cats, including 82 cattery-housed pedigree cats and 52 shelter cats. Faecal examinations performed for most cats included concentration techniques, Snap Giardia test, culture in InPouch medium, and polymerase chain reaction (PCR) amplification of T foetus ribosomal ribonucleic acid (rRNA) genes using species-specific primers. Observed occurrence of T foetus, Giardia species, Isospora species and Toxascaris leonina for cattery-housed cats (and catteries) were 0%, 7.4 (13.8)%, 10.9 (22.6)% and 1.6 (3.2)%, respectively. Observed occurrence of T foetus, Giardia species, Isospora species and hookworms for shelter cats were 0%, 11.5%, 9.8% and 4.9%, respectively. These results suggest the prevalence of T foetus in cattery-housed cats is currently much lower in Australia than in the USA, while Isospora and Giardia species infections are common.

Pathophysiology of Acute Pancreatitis: Potential Application from Experimental Models and Human Medicine to Dogs

The cellular events leading to pancreatitis have been studied extensively in experimental models. Understanding the cellular events and inciting causes of the multisystem inflammatory cascades that are activated with this disease is of vital importance to advance diagnosis and treatment of this condition. Unfortunately, the pathophysiology of pancreatitis in dogs is not well understood, and extrapolation from experimental and human medicine is necessary. The interplay of the inflammatory cascades (kinin, complement, cytokine) is extremely complex in both initiating leukocyte migration and perpetuating disease. Recently, nitric oxide (NO) and altered microcirculation of the pancreas have been proposed as major initiators of inflammation. In addition, the role of the gut is becoming increasingly explored as a cause of oxidative stress and potentiation of systemic inflammation in pancreatitis.

A Pilot Study to Assess Tolerability of Early Enteral Nutrition via Esophagostomy Tube Feeding in Dogs with Severe Acute Pancreatitis

BACKGROUND The putative role of the gut in amplification of systemic inflammation in acute pancreatitis is gaining credence, and intraluminal nutrition has been shown to decrease inflammation in experimental models of pancreatitis. Prepyloric feeding often is used in people with acute pancreatitis, but has not been evaluated in dogs. HYPOTHESIS Early intervention with enteral nutrition (EN) delivered proximal to the pylorus will be well tolerated in dogs with acute pancreatitis and provide justification for further larger trials. ANIMALS Ten dogs with severe acute pancreatitis in an open-label, prospective pilot study. METHODS Dogs were treated with plasma transfusion and standard care, and then consecutively assigned to receive either EN via esophagostomy tube feeding or parenteral nutrition (PN). Outcome was used to determine optimal study size for future studies, and complications were compared between the 2 groups. RESULTS A significantly greater number of vomiting or regurgitating episodes occurred in dogs receiving PN. The dogs receiving EN did not demonstrate any noticeable postprandial pain. There were more catheter-related complications in the PN group. There was no difference in outcome between the 2 treatments, and 43 dogs for each treatment would be required in future studies to determine a difference in outcome. CONCLUSIONS AND CLINICAL RELEVANCE Early EN delivered proximal to the pylorus is well tolerated in dogs with severe pancreatitis and resulted in fewer complications than PN. Prospective trials in a larger cohort are justified to fully establish the potential benefit of early EN, preferably compared with minimal enteral nutrition.

Sinonasal aspergillosis in dogs: a review

Sinonasal aspergillosis is an uncommon, yet debilitating and often frustrating condition to treat in dogs despite years of research evaluating pathogenesis, diagnosis and treatment. The disease is most commonly caused by non-invasive fungal infection, thought to be secondary to altered innate and/or adaptive immune responses. Attempts to confirm this have however failed. A variety of conflicting opinions regarding the diagnosis and treatment of sinonasal aspergillosis exist. Often the use of a particular treatment protocol is based upon personal or regional preference. Evaluation of the veterinary literature demonstrates that the evidence base in support of individual treatment recommendations is weak. A number of recent publications have helped to expand the current knowledge base and therefore our understanding of important practicalities for both diagnostic options and treatment protocols. The following review examines the current evidence for the pathogenesis of sinonasal aspergillosis in dogs, as well as the various diagnostic options. The available evidence for frequently utilised -therapeutic options and their likely outcomes is also explored.

Review of Feline Pancreatitis Part Two: Clinical Signs, Diagnosis and Treatment:

In the past decade pancreatitis has become recognised as a significant disease in the cat. Chronic, mild pancreatitis is often associated with more commonly diagnosed diseases such as inflammatory bowel disease or cholangitis/cholangiohepatitis. Furthermore, acute pancreatitis with similar complications to those seen in dogs is now diagnosed more frequently in cats. Unfortunately, the clinical signs and clinicopathological findings in cats with pancreatitis are often non-specific and vague. The lack of specific signs often results in a diagnosis being made only when the veterinary surgeon has a strong index of suspicion for pancreatitis and vigorously pursues that diagnosis. Pancreatitis is an important disease in cats, has been implicated as a potential cause of diabetes mellitus, and when present complicates the treatment of diabetes and other intra-abdominal diseases in cats.

Effect of hematocrit on accuracy of two point-of-care glucometers for use in dogs

OBJECTIVE To determine the effect of Hct on blood glucose readings of dogs obtained by use of 2 point-of-care (POC) blood glucometers and a laboratory analyzer. ANIMALS 184 dogs, including 139 Greyhounds. PROCEDURES Venous blood samples collected from 184 dogs with a range of Hcts (measured in EDTA-anticoagulated blood) were immediately analyzed with a handheld glucometer specifically developed for veterinary use and a glucometer developed for use in humans. The remainder of each blood sample was placed in fluoride oxalate tubes, and plasma glucose concentration was measured with a laboratory analyzer. Agreement between results for the POC glucometers and laboratory analyzer and effect of Hct on glucometer accuracy was assessed via regression analysis. RESULTS Significant differences were detected between results of the glucometers and the reference laboratory analyzer. The Hct affected the correlation between results for the glucometers and the laboratory analyzer. Deviations of the glucometers from the reference interval varied with Hct. The glucometer for veterinary use more closely correlated with the glucose concentration when Hct was within or above its reference interval. The glucometer for use in humans more closely approximated laboratory reference glucose concentrations in anemic dogs. CONCLUSIONS AND CLINICAL RELEVANCE Hct had a relevant impact on the correlation between whole blood and plasma glucose concentrations in dogs. Significant variations between results obtained with the 2 glucometers could be critical when interpreting blood glucose measurements or selecting a POC glucometer for an intensive care setting and precise glycemic control in critically ill dogs.

Association between canine pancreatic-specific lipase and histologic exocrine pancreatic inflammation in dogs: assessing specificity

The current study aimed to determine the specificity, and to a lesser extent the sensitivity, of canine pancreatic-specific lipase (cPL) concentration in dogs with various disease conditions. Dogs were presented for postmortem examination and had serum collected for cPL concentration within 6 hr preceding death or immediately postmortem. Pancreatic tissue was collected postmortem, and sections from the left lobe, right lobe, and body of the pancreas were examined histologically. Inflammation and fibrosis in each section were assessed to determine a total pancreatic inflammatory score and pancreatic fibrosis score in each dog. Correlations between these scores and the cPL concentration were made, as well as determination of specificity. A total of 32 dogs were included in the analysis, 20 of whom had no to minimal pancreatic inflammation. The specificity of cPL with a cutoff value of 200 µg/l was 80% (95% confidence interval [CI]: 56–94%), while with a cutoff of 400 µg/l, the specificity was 90% (95% CI: 68–99%). There was a significant but rather low correlation between cPL concentration and the pancreatic inflammation score, but not with the fibrosis score. Canine pancreatic-specific lipase concentration has good specificity overall in dogs without pancreatitis. This test is less useful in dogs with milder pancreatitis, and both false-positive and false-negative results occur. Results indicated that dogs with clinical signs suggestive of pancreatitis would require abdominal imaging in addition to serum cPL testing to evaluate the cause (or causes) of clinical signs.

Pancreatic response in healthy dogs fed diets of various fat compositions

OBJECTIVE To indirectly assess the pancreatic response in healthy dogs that were fed diets of different fat compositions with or without supplemental pancreatic enzymes and medium-chain triglycerides (MCTs). ANIMALS 10 healthy adult dogs. PROCEDURES Dogs were fed 4 diets once in random order at 1-week intervals; food was withheld from the dogs for > or = 12 hours prior to the feeding of each diet. Diets A and B contained 16% and 5% crude fat, respectively; diet C was composed of diet A with pancreatic enzymes; and diet D was composed of diet B with pancreatic enzymes and MCTs. Serum canine trypsin-like immunoreactivity (cTLI) and canine pancreatic lipase immunoreactivity (cPLI) concentrations were measured before (0 hours) and at 1 to 2 and 6 hours after feeding. Serum gastrin concentration was measured at 0 hours and at 5 to 10 minutes and 1 to 2 hours after feeding. A gastrin assay validation study was performed to confirm accuracy of test results in dogs. Data were analyzed by use of a repeated-measures general ANOVA. RESULTS Serum cTLI, cPLI, or gastrin concentrations in the dogs did not differ among the different diets fed, among dogs, or over time. When multiple comparisons were analyzed, diet D caused the least amount of measurable pancreatic response, although this difference was not significant. CONCLUSIONS AND CLINICAL RELEVANCE Results did not indicate a significant effect of dietary fat content or addition of supplemental MCT oil or pancreatic enzymes in diets on serum cTLI, cPLI, or gastrin concentrations in healthy dogs.