Chronic pancreatitis (CP) in dogs is diagnosed by integrating clinical signs, serum pancreatic lipase immunoreactivity (cPLI), and abdominal ultrasonography, with histopathology as the imperfect reference standard that is rarely pursued antemortem. CP prevalence at necropsy ranges from 34% to 64% in all necropsied dogs, confirming it is a common and clinically significant disease rather than a rare incidental finding.Journal of Vete…+1

Diagnosis

The clinical presentation of CP is variable and often subclinical to mild, making a high index of suspicion essential. Common clinical signs in histologically confirmed CP include lethargy (80%), decreased appetite (70%), vomiting (63%), diarrhea (36%), and abdominal pain (27%).Journal of Vete… Acute exacerbations are clinically indistinguishable from acute pancreatitis, and clinical differentiation between the two requires histopathological confirmation.Journal of the…

Serum cPLI — available as the quantitative Spec cPL assay or the semi-quantitative point-of-care SNAP cPL — is the most sensitive and specific clinicopathologic test for pancreatitis in dogs, but its diagnostic sensitivity is reduced in CP specifically. In dogs with concurrent acute and chronic pancreatitis, Spec cPL sensitivity is 71% and specificity ranges from 86% to 100% depending on the cutoff used.Journal of Vete… In dogs with CP alone, the 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) ester (DGGR) lipase assay achieves 100% specificity but only 57% sensitivity.Journal of Vete… Serum cPLI can also be elevated when pancreatitis is not the primary disease process, representing secondary reactive pancreatopathy.Journal of Vete… The Spec cPL and Vcheck cPL quantitative assays show near-perfect agreement (κ = 0.960) and are considered compatible for clinical use in diagnosis and monitoring.Journal of Vete…

Abdominal ultrasonography contributes to diagnosis but has important limitations in CP. The accuracy of ultrasonography for chronic pancreatitis specifically remains unknown.Journal of Vete… Ultrasonographic findings in dogs with acute gastrointestinal signs most commonly reflect chronic changes — hyperechoic (20%) and mixed-echoic (39%) pancreatic echogenicity — and both the ultrasonographic diagnosis of pancreatitis and overall pancreatic scoring correlate positively with age, meaning chronic ultrasonographic changes may be age-related rather than disease-specific.Journal of Vete… Computed tomographic angiography (CTA) offers superior characterization of pancreatic parenchyma and local complications compared to ultrasound, though its routine use in CP has not been established in the veterinary literature.Journal of Vete…

Histopathology remains the reference standard but is imperfect and rarely pursued clinically. Patchy lesion distribution limits biopsy sensitivity for mild or early CP, and the invasive nature of sample collection combined with limited impact on clinical decision-making means biopsies are mostly not acquired in practice.Journal of Vete… There is no validated noninvasive diagnostic system for CP in dogs.Journal of Vete…

Optimal diagnosis is achieved by integrating clinical signs, serum cPLI, and abdominal ultrasonography, while rigorously ruling out concurrent diseases — including inflammatory bowel disease, which shares clinical features with CP — rather than relying on any single test.Journal of Vete…+2

Emerging biomarkers include circulating microRNAs, which are sensitive and specific markers of pancreatitis in humans; small RNA sequencing of canine serum has identified candidate microRNA biomarkers for naturally occurring CP in dogs, though these are not yet available for clinical use.Journal of Vete…

Management

Management of CP is supportive and directed at controlling pain, managing flare-ups, providing nutritional support, and addressing complications such as diabetes mellitus and exocrine pancreatic insufficiency (EPI). CP is a significant cause of chronic pain in dogs and results in progressive impairment of endocrine and exocrine function, with eventual development of diabetes mellitus or EPI, or both, in some dogs at end stage.Topics in Compa…

Fluid therapy, antiemetics, analgesics, and nutritional support are the cornerstones of managing acute flare-ups. Antibiotics, anti-inflammatory agents, gastric acid suppressants, fresh frozen plasma, and pancreatic surgery are not considered standard management and have specific, limited indications.Journal of the…

Fuzapladib sodium is the first specific therapeutic agent approved for treatment of acute-onset pancreatitis in dogs, though its role in the chronic disease context has not been defined in the available veterinary literature.Journal of the…

When CP coexists with diabetes mellitus, insulin requirements are variable and increase during flare-ups, then decrease as pancreatitis improves. Conservative dose adjustments are essential, and home blood glucose monitoring is recommended to detect hypoglycemia when insulin resistance resolves.AAHA Clinical G… Species-specific PLI, trypsin-like immunoreactivity (TLI), and abdominal ultrasound are recommended as second-level diagnostics in diabetic dogs with suspected concurrent pancreatitis.AAHA Clinical G…

Serial monitoring with Spec cPL and C-reactive protein (CRP) is used to track disease progression and treatment response, though CRP has limited prognostic value at hospital admission in dogs with acute-onset pancreatitis.Journal of Vete…+1 The DGGR lipase assay has been evaluated for monitoring CP specifically, given its high specificity in this population.Journal of Vete…

Breed predisposition should inform clinical suspicion, as CP shows increased prevalence in certain breeds; in English Cocker Spaniels, CP appears to be part of a polysystemic immune-mediated disease, and histological and clinical appearances differ across breeds, suggesting differing etiologies.Topics in Compa…

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