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Case Study of Canine Pancreatitis in Shih-Tzu at Cucu K.

Sajuthi DVM and


Associetes, Period of October-December 2016

Titis Setyo Putri (160130100111015)


Veterinary Profession Education, Faculty of Veterinary Medicine, Brawijaya
University

Abstract: Pancreatitis is a condition caused by inflammation, resulted in damage


to the pancreas. A male Shih-tzu aged more than 10 years experienced
pancreatitis. Amannesis and clinical symptoms, the dog has anorexia for three
days, vomiting , lethargy, lots of drinking (polydipsia) and lost of urine (polyuria).
Clinical examination revealed is showed pale mucosa and palpation in the
abdomen in pain. Hematology revealed increased lymphocytes of non-significant
and chemistry revealed increased (ALP, BUN, and creatinin) and drecreased
phosphor of non-significant. So that the need for other investigations such as the
test kit SNAP cPL IDEXX, from the test kit the dog experienced pancreatitis.
There wast treatment is fluid therapy, anti-emetic, antibiotics, anti-ulcer, vitamins,
and supplements. From the result of treatment the dog experienced appetite, not
vomiting, active, not lethargic, and normal mucosa.

Key : pancreatitis, dog, treatment.

INTRODUCTION CASE PRESENTATION


Pancreatitis is often seen in
dogs more than eight aged with
normal weight. Disorders function of
organs and digestive tract such as
pancreas often found in dogs and cats.
So an accurate diagnosis is the right
thing to handle treatment in patients
with disordered pancreatic function.
In a variety of clinical cases treated
by practitioners, cases of pancreatitis
are more difficult to treat. Although Figure 1 : Maurice
studies and research of pancreatic A male Shih-tzu aged more than
dysfunction continue to develop, ten years old was presented with a
there has been not patent treatment to history of anorexia at three days,
completely cure pancreatitis. Therapy vomiting, lethargy, polidypsia and
with optimal results depends on the polyuria. Clinical examination
ability and knowledge of practitioners releaved with palpation abdominal
regarding physiology, pain, lethargy, and mucosa pink pale.
pathophysiology, clinical symptoms, Based on result hematology and
treatment with medication therapy biochemistry is increased (limfosit,
and appropriate surgery techniques in ALP, BUN, and creatinin) not
prancreatitis patients (Schaer, 2010). significant and decreased phosphat.
Examination Result Unit Normal Range
Hematologi:
White Blood Cell (WBC) 12,6 103/uL 6.0 – 17.0
Red Blood Cell (RBC) 6,05 106/uL 5.5 – 8.5
Hemoglobin (Hb) 14,1 g/dL 11.0 – 19.0
Hematocrit (HCT) 42,9 % 39.0 -56.0
Mean Corpuscular Volume
(MCV) 71,0 fL 62.0 – 72.0
Mean Corpuscular Hemoglobin
(MCH) 23,3 pg 20 – 25
Mean Corpuscular Hemoglobin
Concentration (MCHC) 32,8 g/dL 30.0 – 38.0
Trombosit (PLT) 365 103/uL 117 – 460
Limfosit 35,7 ↑ % 12.0 – 30.0
Monosit 2,6 % 2.0 – 9.0
Granulosit 61,7 % 60.0 – 83.0
Limfosit 4,5 103/uL 0.8 – 5.1
Monosit 0,3 103/uL 0.1 – 1.8
Granulosit 7,8 103/uL 5.5 – 8.50
Red Blood Cell Distribution
Width (RDW)-SD 37,2 fL 37.0 – 54.0
Red Blood Cell Distribution
Width (RDW)-CV 16,3 ↑ % 11.0-15.50
Procalcitonin (PCT) 0,31 % 0.1– 9.99
Mean Platelet Volume (MPV) 8,6 fL 7.0 – 12.90
Platelet Disribution Width
(PDW) 11,0 % 0.1 – 30.0
P-LCR 2,3 % 0.1-99.9
Biochemistry:
Albumin 4.0 g/dL 2.5 – 4.4
Alkalin Phosphatase (ALP) 177 ↑ U/L 20-150
Alanin Aminotransferase (ALT) 39 U/L 10– 118
Amilase 1054 U/L 200-1200
Bilirubin total 0,3 mg/dL 0.1-0.6
Blood Urea Nitrogen (BUN) 37.0 ↑ mg/dL 7 – 25
Kalsium 11,3 mg/dL 8.6-11.8
Phospat 2,5 ↓ mg/dL 2.9-6.6
Creatinin 1.9 ↑ mg/dL 0.3 – 1.4
Glucosa 112/68 mg/dL 60-110
Na+ 140 mmol/L 138-160
K+ 5.0 mmol/L 3.7-5.8
Protein Total 7,1 g/dL 5.4 – 8.2
Globulin 3,1 g/dL 2.3 – 5.2
normality. At October 2016
Result hematology at Maurice increased glucose caused the dog
increased limfosit of presentage after eat. The others result
value, but absolute value is normal, biochemistry is increased ALP,
and increased (RDW-CV) not BUN, and creatinin not significant.
significant. Result biochemistry From examination hematology
examination is increased glucose and biochemistry the result not
level at 10 October 2016, but at 13 significant so needed the others
October 2016 result glucose test is examination. Based on amanesa and
physical examintaion indicated
aexistence gastrointestinal disorders.
Supporting diagnoses used further in
PDHB 24 Jam Sunter Jakarta Utara
Veterinary Hospital, the dog of the
patient affected by pancreatitis is
with the IDEXX® SNAP cPL test
kit. This SNPL test kit IDEXX® is
used to measure the increased lipase
enzyme present in serum.
The principle of the test kit is
to use the accepted 95% with
principle Enzyme - Linked Figure 3. Result SNAP cPL IDEXX Test
Immunosorbent Assay (ELISA) (Mix Kit at Maurice.
and Jones, 2008). The IDEXX®
SNAP cPL test kit is one of the in From the test results showed
vitro tests to determine the increased the blue color is clearly visible and
pancreatic lipase in dog serum. The older at the sample point than the
normal level of lipase in dogs is control point of the SNPL test kit
≤200 mg / L, if the lipase content of IDEXX®, so it can be concluded that
201-399 mg / L requires the Maurice's dog have pancreatitis.
evaluation of diagnosis and retesting Treatment given to Maurice is
of the IDEXX® SNPL cPL test kit, fluid therapy was given with Lactate
and while the lipase content of> 400 ringer’s using intravena 40-60 cc/
mg / L dog can be said to be positive kg/day. During the observation
for pancreatitis . How this test kit treatment using ondansentron 0,5
works is that antibodies in the kit mg/kg/ q12-14h/IV, antibiotic with
will bind to the antigen in the form of ampicilin using 10-20 mg/kg/IM,
lipase enzyme from the sample and ornipural using 2-5 cc IM, Neurobion
will form antigen-antibody complex. 0,15 cc/IM, and Inpepsa using 3-5
cc/2x/day. Outpatient therapy using
administration per oral with
ondansentron, methycobalt,
spuradyn, enzyplex, curcuma, TF
plus, clavamox and Weight/Diet
Hills®.
Figure 2 : Interpretation Test Kit SNAP
cPL IDEXX. DISSCUSION
Pancreatitis is a condition
caused by pancreatic inflammation
called pancreatitis. Pancreatitis is
most common in older dog that are
often overweight. Dogs with
pancreatitis usually have anoreksia,
vomiting, abdominal pain,
depression and sometimes fever and
diarrhea. The dog called Maurice lactam antibiotics including
have anamnesa anoreksia, vomiting, penisillinum families that have broad
lethargy, and abdominal pain. This spectrum, are active against gram
showed that Maurice experience negative and positive bacteria.
pancreatitis. The ethiology an Ampicillin is a bakterocidal that acts
pathogenesis of spontaneous in an irreversibly inhibiting activity
pancreatitis is poorly understood of transpeptidase enzyme needed for
(Andrew, 2013). the synthesis of bacterial cell walls.
From result hematology is Clavamox® antibiotics are a
increased limfosit and biochemistry formulation of broad-spectrum
increased (ALP,BUN, and creatinin). antibiotics amoxicillin trihydrate and
Based studies Troy (2007), clavulanate acid (an antibiotic of the
pancreatitis marked by increased β-lactam inhibitor group).
ALP, GGT, ALT, and AST). This is Amoxicillin acts as an antibacterial
consistent with the presumption by inhibiting the formation of
Maurice experiencing pancreatitis. bacterial walls, clavulanate acid
And also confirmation with test kit increases the coverage of the
SNAP cPL IDEXX showed positive antibacterial spectrum of amoxicillin.
result. Neorobion has a composition of
Treatment of cases of several vitamin B1, B6, and B12.
pancreatitis in dog patients in PDHB Neurobion is used to improve
24 Jam Sunter Jakarta Utara using metabolism and meet the daily needs
fluid therapy, antibiotics, and of vitamin B complex. Vitamin B6
supportive therapy. The first fluid and B12 are the vitamins needed in
achieved by intravenous fluid the formation and maturation of red
therapy is Ringer Lactat®, which blood cells. Methycobalt® contains
acts as a replacement for lost body mecobalamine which is a type of
electrolytes and is used as a coenzyme B-12. Mecobalamin plays
alkalizing. A special dietary diet for a role in transmetilasi as a
gastrointestinal disorders is assisted methionine coenzyme. Mecobalamin
in the metabolism of fat and is transported to nerve cells to
maintaining muscle (the presence of increase protein synthesis and
L-carnitine), helps maintain weight nucleic acids. Ornipural using to
(the presence of fiber), improves stimulate hepatodigestive activity in
urinary tract health (low fat and renal and digestive disorders.
calories), and boosts immunity Supradyn is a supplement that
antioxidants). The feed given to contains vitamins A, B, C, and D,
Dogs is Digestive / Weight / Glucose this vitamin is used multivitamin, as
Management W / D Hills® that can a mineral, and microelement that
help prankreas repair due to serves to maintainance eye,
inflammation, because it contains metabolism,, prevent infection and
antioxidants and low fat (low fat) maintainance bone. Enzyplex used to
(John and David, 2014). balance digestive enzyms. TF plus
Ondansetron is a drug used to used to anti-plasmic, anti-histamine,
using treatment nausea and vomiting anti inflamation, and maintain
in patient. Ampicillin is a class of β- endurance. From the result of
treatment the dog experienced
appetite, not vomiting, active, not
lethargic, and normal mucosa after
observation and therapy in PDHB
veterinary hospital at six days.

CONCLUSION
Based on anamnesa, clinical
symptom examination, and supported
by hematological examination, blood
chemistry, and IDEXX® SNAP cPL
test kit, it can be concluded that dog
Shih-Tzu patients have pancreatitis..
Therapy is given to the patient's dog,
which is by gradually recovering the
condition by providing medication
that serves to reduce visible clinical
symptoms and is supported by the
feeding and supplement quality to
improve nutrition and endurance

REFERENCES
Andrew, L. 2013. Canine
Pancreatitis.
http//www.clinicianbrief.co
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Desember 2016].
John, K. And L. David. 2014.
Diagnosis of Pancreatitis in
Dogs and Cats. J Small
Anim Pract Vol (56): 13-26.
Mix, K. and C. Jones. 2006.
Diagnosing Acute
Pancreatitis in Dogs. Com
Cont Edition Pract Vet Vol
29 : 226-234.
Schaer M. 2010. Clinical Medicine
of the Dog and Cat. Second
Edition. Manson
Troy Schlines. 2007. Diagnosing
Canine Pancreatitis. Banfeld
Vol 1107. Page 024-035.