THE pancreas is a vital organ which lies on the right side of the abdomen. It has two functions - to produce enzymes to help in food digestion, and to produce hormones, such as insulin. When the pancreas becomes inflamed, the disorder is called pancreatitis - a disease that is quite common in the dog. It can happen at any age, to either sex, and in any breed.
Pancreatitis can affect the canine as an acute disease causing severe abdominal pain and vomiting; or it can also show in a more chronic form where the animal fails to digest its food properly. It is more common in overweight dogs or can occur in animals that are fed well after being malnourished. Meals containing a high level of fat may also be associated with the disease.
Acute pancreatitis is serious and can be fatal. Dogs who recover - as well as those who have the chronic form - often have permanent damage and loss of pancreas function.
Recently a study was held at the Brisbane University to devise a way for veterinarians in general practice to more accurately assess the severity of their canine patients with spontaneous canine acute pancreatitis.
Score points were assigned for the extent of hyperamylasaemia and hyperlipasaemia, and for the number of organ systems other than the pancreas that had become compromised.
It was found that the assessment of severity of the disease using pancreatic enzyme activities as a gauge was potentially inaccurate. Use of a score based on organ system compromise was found to be more accurate in determining the likelihood of mortality.
This was compatible with the theory that severe canine acute pancreatitis is a multiple organ failure syndrome rather than a single organ failure.
In veterinary medicine, it is the perception of the veterinarian as to the severity of the dog's illness that will determine how the case is managed. The prognosis given to owners will be based on the expected costs faced by the owner, the willingness of the vet to treat the case, and the likelihood that the dog will recover.
Dogs taking part in the research were assessed and assigned to groups on the basis of the number of organ systems affected, and it was found that no dog survived where four or more organ systems had been compromised. Also, no dog died with a zero organ score (no organs other than the pancreas involved). The interaction between organ score and mortality rate was found to be significant.
Severe electrolyte disturbances were also apparent in dogs with an organ score of four. While there was no significant difference in amylase activity between the organ score groups, dogs with an organ score of four showed a large increase in lipase activity.
With current understandings of the disease, the assessment of the possibility of the patient's death is difficult. One possible approach, then, would be to use such severity scoring systems, which would allow vets to give a prognosis based on the organ score.
Most current diagnoses are given in pathological terms - oedematous pancreatitis or necrotising, haemorrhagic pancreatitis. Necrotising or haemorrhagic forms have a higher expected death rate. But in general veterinary practice the pathological diagnosis is not readily available and while multiple organ failure does often cause or contribute to the dog's death, pathological tissue changes often do not reveal multiple organ failure.
The 'organ score' is therefore an attempt to diagnose more accurately canine acute pancreatitis patients on the basis of organ system failure.
Amylase activity was found to be a poor indicator of the disease's outcome, but lipase activity showed a parallel increase in death of the patient with the increased activity. However, most cases of canine acute pancreatitis are not severe and these dogs recover without complications.
The normal amylase activity range seems to indicate a physiological connection with the increased activity and canine acute pancreatitis but that was not shown to be the case in dogs with hyperamylasaemia alone, which can show a high activity rate in dogs with an organ score of 0.
However, hyperlipasaemia (increased lipase activity) was more accurately an indicator of a high organ score and a lesser chance of recovery.
