State-of-the-art review
Journal of Veterinary Emergency and Critical Care 13(4) 2003, pp 201^213
Acute pancreatitis in dogs Jennifer L. Holm, DVM, Daniel L. Chan, DVM and Elizabeth A. Rozanski, DVM, DACVECC, DACVIM
Abstract Objective: To summarize current information regarding severity assessment, diagnostic imaging, and treatment of human and canine acute pancreatitis (AP). Human-based studies: In humans, scoring systems, advanced imaging methods, and serum markers are used to assess the severity of disease, which allows for optimization of patient management. The extent of pancreatic necrosis and the presence of infected pancreatic necrosis are the most important factors determining the development of multiple organ failure (MOF) and subsequent mortality. Considerable research efforts have focused on the development of inexpensive, easy, and reliable laboratory markers to assess disease severity as early as possible in the course of the disease. The use of prophylactic antibiotics, enteral nutrition, and surgery have been shown to be beneficial in certain patient populations. Veterinary-based studies: The majority of what is currently known about naturally occurring canine AP has been derived from retrospective evaluations. The identification and development of inexpensive and reliable detection kits of key laboratory markers in dogs with AP could dramatically improve our ability to prognosticate and identify patient populations likely to benefit from treatment interventions. Treatment remains largely supportive and future studies evaluating the efficacy of surgery, nutritional support and other treatment modalities are warranted. Data sources: Current human and veterinary literature. Conclusions: Pancreatitis can lead to a life-threatening severe systemic inflammatory condition, resulting in MOF and death in both humans and dogs. Given the similarities in the pathophysiology of AP in both humans and dogs, novel concepts used to assess severity and treat people with AP may be applicable to dogs. (J Vet Emerg Crit Care 2003; 13(4): 201–213)
Keywords: canine, diagnostic imaging, illness severity markers, scoring schemes, therapy
Introduction Acute pancreatitis (AP) is a mild, self-limiting disease in the majority of affected humans. However, 10–20% of human patients develop a more severe form of the disease characterized by sepsis and multiple organ failure (MOF), with mortality rates approaching 30%.1,2 In 1992, the International Symposium on Acute Pancreatitis proposed a consensus statement outlining From the Department of Clinical Sciences, Tufts University School of Veterinary Medicine, North Grafton, MA. Address correspondence and reprint requests to: Dr. Elizabeth A. Rozanski, Department of Clinical Sciences, Tufts University School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536. Fax: (508) 839-7922. E-mail: Elizabeth.rozanski@tufts.edu & Veterinary Emergency and Critical Care Society 2003
the criteria defining severe AP. Severe AP was defined as the development of systemic complications such as organ failure and/or local complications such as pancreatic necrosis, pseudocyst, or abscess.3 The extent of pancreatic necrosis and the presence of infected pancreatic necrosis are the most important factors determining the development of MOF and subsequent mortality.4,5 Considerable efforts have been directed toward early identification of patients at risk for developing severe AP. Several methods of severity determination have been developed in humans, and include clinical scoring systems, serum markers, and evaluation by contrast-enhanced computed tomography (CECT). The utility of objective criteria for patient stratification includes identification of subjects eligible for clinical trials and guides for treatment decisions, 201