Spec cPL™ Test Case Pancreatitis with suspected
reflux esophagitis
How did a simple lab test
make all the difference
in Rocky’s diagnosis
and recovery?
Rocky
12-year-old male neutered Boston Terrier
Age, sex, breed__________________________________________________
2-week history of vomiting and/or regurgitation
Presenting complaint:_____________________________________________
Began “spitting up” every other day 2 weeks ago; now after
History:_________________________________________________________
every meal. Appetite normal to slightly decreased. Activity level normal.
_______________________________________________________________
Quiet, alert, responsive. 5% dehydrated.
Physical
examination:_____________________________________________
Chest clear. Abdominal palpation normal. Remainder of PE unremarkable.
_______________________________________________________________
IDEXX LaserCyte® CBC, chemistry panel, Spec cPL, UA, chest and Plan:___________________________________________________________
abdominal radiographs. Hospitalize with IV fluid support.
_______________________________________________________________
RIVERTON ANIMAL CLINIC
1234 Snapdragon Avenue
Miami, FL 50500
888-555-1234
Account #5678
1-888-433-9987
Owner:
Patient:
Species:
Breed:
Age:
Gender:
ANDERSON
ROCKY
CANINE
BOST TERR
12 Y
MALE
CHEMISTRY PANEL
TEST
VALUE
REF RANGE
ALK. PHOSPHATASE
102
10 - 150 U/L
ALT (SGPT)
51
5 - 107 U/L
AST (SGOT)
25
5 - 55 U/L
CK
70
10 - 200 U/L
GGT
19
0 - 14 U/L
AMYLASE
942
350 - 1050 U/L
LIPASE
651
100 - 750 U/L
ALBUMIN
3.4
2.5 - 4.0 g/dL
TOTAL PROTEIN
6.9
5.1 - 7.8 g/dL
GLOBULIN
3.5
2.1 - 4.5 g/dL
TOTAL BILIRUBIN
0.1
0.0 - 0.4 mg/dL
BUN
36
7 - 27 mg/dL
CREATININE
1.7
0.4 - 1.8 mg/dL
CHOLESTEROL
274
112 - 328 mg/dL
GLUCOSE
107
60 - 125 mg/dL
CALCIUM
12.3
8.2 - 12.4 mg/dL
PHOSPHORUS
5.8
2.1 - 6.3 mg/dL
TCO2 (BICARBONATE)
23
17 - 24 mEq/L
CHLORIDE
110
105 - 115 mEq/L
POTASSIUM
5.1
4.0 - 5.6 mEq/L
SODIUM
141
141 - 156 mEq/L
FLAGS
BAR GRAPH
HIGH
HIGH
Spec cPL
TEST
Spec cPL
1
VALUE
472
REF RANGE
FLAGS
BAR GRAPH
ug/L
COMMENTS
1.
< 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.
Rocky Anderson Pancreatitis with suspected reflux esophagitis
Hematology
Assessment
Erythrogram: Normal
The elevated Spec cPL indicated that Rocky had
Leukogram: Mild leukocytosis (21,200/uL)
characterized by mild mature neutrophilia (17,384/uL).
Changes consistent with either mild inflammation or
to be caused by reflux esophagitis secondary to
vomiting associated with the pancreatitis. The
esophagitis likely resulted in some regurgitation,
which confused the clinical presentation. Mild
Platelet Evaluation: Normal
cholestasis likely resulted from pancreatitis.
Chemistry
Diagnosis Pancreatitis with suspected
Slightly elevated GGT indicated mild cholestasis. Mild
reflux esophagitis
increase in BUN with concentrated urine was prerenal
secondary to dehydration. Elevated Spec cPL revealed
pancreatitis present.
Urinalysis
Concentrated urine (specific gravity 1.042) and no
significant abnormalities noted.
Treatment IV fluids, injectable antiemetic and antacid
with sucralfate slurry given per os. Elevated feedings
with low-fat, easily digestible diet.
Clinical Case Outcome
Rocky didn’t vomit in the hospital. He only ate a small
amount of food and did regurgitate most of this after
Additional Diagnostics
eating on the first day. From this point on, his appetite
Thoracic radiographs revealed dilated esophagus
improved and regurgitation reduced. Repeat thoracic
consistent with a megaesophagus. Abdominal
radiographs revealed the esophagus was only dilated
radiographs unremarkable.
distally. He was discharged from the hospital after 3
days on oral antacid, sucralfate slurry and a low-fat diet.
He was scheduled for recheck examination, blood work
including Spec cPL and repeat chest radiographs the
following week.
IDEXX Spec cPL™ Test
Results PLUS™
difference
Rocky’s blood work was overall pretty unremarkable, and his amylase and lipase were
within reference range limits. Without the Spec cPL™ Test, Rocky’s pancreatitis would
have likely been missed, and a primary megaesophagus may have been suspected
based on clinical signs and radiographic findings. Diagnosis of a megaesophagus
leads to performing additional diagnostics to determine if there is an underlying cause.
Megaesophagus can be difficult to manage and euthanasia is not uncommon.
Knowing that Rocky had pancreatitis made the diagnosis of a reflux
esophagitis more likely than true megaesophagus. Reflux esophagitis
carries a good prognosis with appropriate management.
Spec cPL
possible glucocorticoid effect (“stress”).
pancreatitis. The esophageal dilation was suspected
The Spec cPL™ (canine pancreas-specific lipase) Test reveals important
clues for diagnosing pancreatitis in a variety of cases
Overview
IDEXX Reference Laboratories has introduced a new test to measure canine pancreas-specific lipase, Spec cPL,
allowing practitioners to more immediately and accurately diagnose pancreatitis in dogs.
Until now, pancreatitis has been difficult to diagnose and monitor for two reasons. First, clinical signs are nonspecific and
include vomiting, abdominal pain, anorexia, weakness and dehydration.1 Second, routine CBC and serum chemistry results
are generally nonspecific in dogs with pancreatitis.
IDEXX Reference Laboratories has collaborated with Dr. Jörg Steiner and Dr. David Williams at the Gastrointestinal Laboratory
at the Texas A&M to refine their cPLI assay by using a recombinant antigen and monoclonal antibodies. The result: the Spec cPL
Test, which measures pancreas-specific lipase concentrations in the bloodstream. With accurate results to you in just 12 to 24
hours, it provides you with the timely information you need to manage your cases appropriately, resulting in more positive
patient outcomes.
Consider Spec cPL to measure pancreas-specific lipase concentrations in the following scenarios:
Case type
Presenting signs
Acute/severe emergency cases
Severe vomiting, anorexia, lethargy and/or abdominal pain
Mild to moderate acute cases
Mild or moderate vomiting, anorexia, lethargy and/or abdominal pain
Nonspecific and chronic cases
Intermittent or ongoing chronic vomiting or inappetence
Recovering from pancreatitis
May be nonclinical or clinical
Monitoring for recurrence or after management
(e.g., diet) change
Nonclinical
Miniature schnauzer with familial hyperlipidemia
Overtly clinical, intermittently showing signs or nonclinical
Dogs on potassium bromide
Usually nonclinical but predisposed to developing pancreatitis
Dogs on other medications including: some
chemotherapeutics (e.g., azathioprine), furosemide,
tetracycline, aspirin, sulfa antibiotics
Usually nonclinical but may be predisposed to developing pancreatitis
Unique Diagnostic Advantages of Using Spec cPL with These Cases:
Diagnosing a dog with pancreatitis using Spec cPL lets you:
A normal Spec cPL lets you:
•Confidently take your next treatment steps (hospitalization,
fluid therapy, anti-vomiting medication, pain control, diet)
•Explore alternative causes for the presenting signs (e.g.,
gastrointestinal obstruction or neoplasia) because a
normal Spec cPL is very unlikely in a dog with pancreatitis.
•Differentiate between pancreatitis and gastritis, letting you focus on
addressing complications associated with pancreatitis
•Avoid performing unnecessary or invasive diagnostics (e.g., exploratory
laparotomy) to determine the cause of the clinical signs
•Prescribe the appropriate diet for pancreatitis and monitor outcome—
accurate treatment and monitoring of pancreatitis will positively affect initial
outcome and possibly long-term quality of life
•Save the pet owner and your practice the added
worry and expense of diagnosing pancreatitis (e.g.,
ultrasound). You can focus, instead, on diagnosing and
treating the true cause of the clinical signs.
•Identify cases of pancreatitis that enzymatic amylase/lipase would miss
•Establish a baseline for testing and ongoing monitoring during
hospitalization and on follow-up visits
To order Spec cPL, use Test Code 1849.
Specimen Requirements: 1 mL serum – RT or SST
Turn around time: results in 12–24 hours
For more information about the Spec cPL Test,
call IDEXX Reference Laboratories at 1-888-433-9987
or visit www.idexx.com/speccpl
1. Hess RS, Saunders HM, Van Winkle TJ, et al. Clinical, clinicopathologic, radiographic,
and ultrasonographic abnormalities in dogs with fatal acute pancreatitis: 70 cases
(1986–1995). J Am Vet Med Assoc 1998;213:665–670. September 2006
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