Melanie Sidler1 | Daniel Brugger2 | Barbara Riond3 | Matthias Dennler4 | Stefan Unterer1 | Peter H. Kook1

Background:
Acute pancreatitis (AP) in dogs presents with nonspecific signs that overlap with acute gastrointestinal disease (aGId), complicating diagnosis. The study aimed to determine if dogs with suspected AP (sAP), identified by elevated DGGR-lipase activity, differ clinically, biochemically, or ultrasonographically from those with aGId, which show similar symptoms but normal or minimally increased lipase activity. The hypothesis was that clinical severity would not differ, diarrhea would be more frequent in aGId, and ultrasonographic signs of pancreatitis would be uncommon in aGId.

Methods:
This prospective cross-sectional study included client-owned dogs presenting with acute gastrointestinal signs. Dogs were categorized into sAP if their DGGR-lipase activity exceeded 450 U/L and into aGId if lipase levels were within or slightly above the reference interval. Clinical signs were assessed using a modified canine activity index (MCAI). Laboratory tests, including hematology, biochemistry, and CRP, were performed. Ultrasonographic evaluation assessed pancreatic and gastrointestinal features. Statistical analyses included univariate and multivariable logistic regression.

Results:
The study included 26 sAP and 48 aGId dogs. Clinical severity (MCAI) and hospitalization duration did not significantly differ between groups. Diarrhea was more common in aGId. Pancreatic ultrasonographic abnormalities, particularly pancreatic enlargement and echogenic changes, were significantly more frequent in sAP. ALP and bilirubin levels were higher in sAP, suggesting mild cholestasis. No significant differences were observed in CRP levels or inflammatory blood markers. In aGId, ultrasonographic pancreatic abnormalities were rare and mostly represented chronic changes, with some dogs showing residual signs of past pancreatitis.

Limitations:
The study relied on clinical criteria for diagnosing pancreatitis due to the impracticality of histopathological confirmation. The influence of prior pancreatitis episodes on ultrasonographic findings complicates interpretation. Also, lipase and ultrasound data may have been influenced by the timing of disease progression and testing.

Conclusions:
Dogs with sAP and aGId do not differ in clinical severity at presentation. Diarrhea is more frequent in aGId, while sAP is associated with higher lipase activity, ALP, and bilirubin, as well as more frequent pancreatic ultrasonographic abnormalities. The presence of pancreatic enlargement and an ultrasonographic diagnosis of pancreatitis strongly predicts sAP, supporting their diagnostic utility in differentiating from aGId.

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