Tuesday, February 18, 2014

Pancreatitis: Cookie’s Blood Work

Cookie is recovering from pancreatitis. She isn't obese and she didn't get any fatty table scraps. The hypothesis is that she got it from eating horse feed, based on what was found in her runny stool.


How is pancreatitis diagnosed?

Cookie was lethargic, then she threw up twice without feeling better afterward and she had diarrhea. That's a combination of symptoms I didn't like at all, so we took her to the vet right away.

The vet also noted a painful belly and we decided to run blood work. While we were waiting for the results, Cookie got antibiotics, antiemetics and was to fast for the day. She had no interest in food anyway.

Typical clinical signs associated with pancreatitis are abdominal pain, anorexia, vomiting, diarrhea, dehydration, weakness and lethargy, but these are not all present in every case.

Because Cookie only got a change to throw up twice and we got her to the veterinarian so quickly, she was only mildly dehydrated. When I was examining her gums, they didn't look right but I couldn't put my finger on it. They didn't really look pale or gray but didn't seem to have the normal pink color either.

The original plan was to take x-rays or ultrasound of Cookie's abdomen, but based on the examination and description of events, Cookie's vet decided that we'll run the blood first and go from there.



In the old days, amylase and lipase (enzymes made by the pancreas that help digest starch and fats) were used when diagnosing pancreatitis.

They are not accurate criteria, though. There was one time when Jasmine's lipase was very high and yet further testing confirmed she did not have pancreatitis. And as you can see, Cookie's amylase and lipase are perfectly normal.

Further reading: Your Pet's Serum Lipase Level


Fortunately, better testing is available now. The spec cPL (specific canine pancreatic lipase) test does a better job in diagnosing acute pancreatitis and has come to be the test of choice.

It’s not perfect, however. Sometimes abdominal ultrasound or even exploratory surgery is necessary to definitively diagnose pancreatitis.

Idexx Laboratories provides a guideline on how to interpret spec cPLvalues.

  • < or = 200 ug/L - Serum Spec cPL concentration is in the normal range
  • 201 - 399 ug/L - Serum Spec cPL concentration is in the questionable range. The patient may have pancreatitis and serum Spec cPL should be re-evaluated. If clinical signs are present, treat appropriately and perform additional diagnostics to investigate other differential diagnoses. Repeat the Spec cPL in 1-2 weeks. If no clinical signs are present, recommend retesting in 3-4 weeks.
  • > or = 400 ug/L - Serum Spec cPL concentration is consistent with pancreatitis.


One interesting point to be made is about Cookie’s free T4 (thyroid hormone).

It does not make sense to run this test on a sick dog, but it was part of the package. As you can see it is low. What does that mean? In a case such as this it means just one thing - sick dog. This would most certainly not be the way to diagnose hypothyroidism in a dog.

Further reading: Thyroid Function in Dogs


Cookie's bilirubin was elevated.

Bilirubin is a yellow colored pigment that is a waste product of normal breakdown of red blood cells. It is processed by the liver. Elevated blood levels indicate either an unhappy liver, obstruction of the biliary system or red blood cell damage.


Alanine aminotransferase (ALT) is one of the liver enzymes. Elevated ALT also indicates an unhappy liver. However, it doesn't automatically mean permanent liver damage has occurred, and it does not really reflect liver function. The liver can get angry for a number of reasons. Pancreatitis is one of the reasons for ALT levels to rise.

Further reading: What's In The Blood? Blood Testing And Interpretation

Cookie's blood text also showed low globulin and lymphocytes.

According to our vet this is a result of immune response to the inflammation. Such changes can also happen as a result of a stress response (particularly low lymphocyte count). Our vet felt these abnormalities were not clinically significant.


Related articles:
The Perplexities of Pancreatitis 
The House Is On Fire! Bridget's Pancreatitis
Holistic Look At Pancreatitis
Dog With Pancreatitis In Critical Condition
The Project That Is Cookie: Pancreatitis Up Close And Personal 

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