18 Diagnosing pancreatic disease

The three enzymes we have historically measured are amylase, lipase and trypsin. Amylase isn’t helpful due to poor sensitivity and sensitivity.

The key point is differentiating pancreatitis (excessive function) from exocrine pancreatic insufficiency (insufficient function).

Pancreatic lipase levels are helpful for diagnosing pancreatitis. We expect to see elevated levels when the pancreas is overactive.  Normal levels are pretty low so can’t use it for diagnosing pancreatic insufficiency.

Trypsin-like levels are already relatively high in normal animals and it can be difficult to determine if an animal has pancreatitis due to challenges with renal clearance etc. However, trypsin-like immunoreactivity can be very useful to detect exocrine pancreatic insufficiency!

Enzyme Normal Pancreatitis (high function) Exocrine pancreatic insufficiency
Pancreatic Lipase low elevated  low
Trypsin (TLIR) moderate moderate or high low

We like measuring pancreatic lipase to diagnose pancreatitis.

We like measuring trypsin-like immunoreactivity to diagnose pancreatic insufficiency

We can also look at indirect markers of pancreatic function in EPI.

Pancreatic function is required to absorb cobalamin. Low cobalamin levels would be expected with EPI. Folate is produced by bacteria. If we don’t have antibacterial protein, the bacteria will expand in numbers and produce more folate.

With EPI, we expect low cobalamin and high folate levels.

Enzyme Normal Pancreatitis (high function) Exocrine pancreatic insufficiency
Pancreatic Lipase low elevated  low
Trypsin (TLIR) moderate moderate or high low
Folate moderate high
Cobalamin moderate low

 

Resources

Diagnosis of pancreatitis in dogs and cats – review article

Chronic pancreatitis in dogs and cats – article

TLI, folate and B12 – lab test explanation

Trypsin like immunoreactivity – lab test explanation

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