Use of Ultrasound to Diagnose &

Evaluate the Severity of Pancreatitis

in Dogs
Micah A. Bishop, DVM, PhD, DACVIM (SAIM), WAVE Veterinary Internal Medicine, Naples, Florida

INTERNAL MEDICINE | APRIL/MAY 2021

Print/View PDF

In the Literature
Cridge H, Sullivant AM, Willis RW, Lee AM. Association between abdominal
ultrasound findings, the specific canine pancreatic lipase assay, clinical
severity indices, and clinical diagnosis in dogs with pancreatitis. J Vet
Intern Med. 2020;34(2):636-643.

FROM THE PAGE …

Abdominal ultrasonography (AUS) is frequently used to diagnosis pancreatitis, and it is believed
that pancreatic ultrasonography can be used to assess severity and possibly help guide clinical
treatment. Although it can be challenging to perform ultrasonography on the pancreas, improved
training and technology has made this use more common.

The objectives of this retrospective study were to determine whether a correlation exists among
AUS findings, specific canine pancreatic lipase assay, and a clinical diagnosis of pancreatitis;
whether certain individual AUS abnormalities correlate with a clinical diagnosis of pancreatitis
more than others; whether ultrasonographic assessment of pancreatitis severity mirrors clinical
severity indexes; whether ultrasonographic assessment of severity over time can be a marker of
change in specific canine pancreatic lipase concentration or clinical diagnosis; and the sensitivity
and specificity of AUS for diagnosis of canine pancreatitis.
The results suggest that AUS should not be used for determining the severity of pancreatitis.
Ultrasound severity indexes were a poor indicator of clinical disease severity; although some
findings were associated with pancreatitis, the pancreatic scoring system was poorly correlated
with clinical disease indexes of pancreatitis. Ultrasound severity scoring was also poorly
correlated with clinical diagnosis (compatible clinical findings, laboratory parameters, and
specific canine pancreatic lipase). In addition, changes over time based on ultrasonographic
appearance were not correlated with clinical diagnosis.

Although the power of the study was low, the results did not support using ultrasonography to
guide pancreatitis treatment and monitoring; however, repeated scans may be useful for
determining other causes of worsening abdominal pain (eg, previously unfound foreign body
causing secondary pancreatitis) or lack of clinical improvement in a patient that is not responding
to therapy.

AUS was of value in detecting decreased echogenicity of the pancreas, pancreatic enlargement,
and increased or altered echogenicity of the surrounding mesentery. In isolation, one of these
findings is sensitive for clinical diagnosis of pancreatitis but is poorly specific. Specificity
increases if 2 or all 3 of these findings are present, but there is decreased sensitivity. These
findings may be generally supportive of pancreatitis but should not be used in isolation (ie,
without compatible history, physical examination findings, laboratory parameters, and increased
specific canine pancreatic lipase concentrations).

… TO YOUR PATIENTS
Key pearls to put into practice:

1 Pancreatic ultrasonography should not be used to assess clinical severity of pancreatitis.

2 Serial ultrasonography should not be used to monitor or guide treatment of pancreatitis;

however, in patients not responding to therapy, rechecks are important to look for
complications or pathology that can cause secondary pancreatitis.

3 Decreased echogenicity of the pancreas, pancreatic enlargement, or

alterations/increased echogenicity of the surrounding mesentery can be supportive of a
diagnosis of pancreatitis, but none of these findings should be used in isolation to make a
diagnosis.

4 A diagnosis of pancreatitis should be based on compatible history, physical

examination findings, supportive laboratory parameters, and an increased specific
canine pancreatic lipase concentration.

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can
be found here.
All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content
may not reflect recent developments in research and practice.
Material from Clinician's Brief may not be reproduced, distributed, or used in whole or in part without prior
permission of Educational Concepts, LLC. For questions or inquiries please contact us.