CLINICAL PATHOLOGY
at the 200-400g/L range, and 7 had values >400g/L.
Yet none of the “positive” animals had clinical signs
consistent with pancreatitis.5 However, as it has been
reported that low grade pancreatitis can be present
as a post mortem histopathological diagnosis it is unknown if these dogs had low grade clinical pancreatitis (no biopsies were performed) or if something else
was causing the elevation in the lipase.3
acute pancreatitis in a group of dogs presenting with
acute abdomen, the sensitivity of the SNAP cPL was
82% (18% chance of false negative result) and specificity 59% (41% false positive results).1 The false positive
result dogs may have had pancreatic inflammation
due to diffuse abdominal inflammation due to the
underlying disease process such as septic peritonitis,
conditions causing hypo-perfusion or reperfusion injury, acute gastroenteritis, duodenal reflux and intestinal foreign bodies. In that study, the Spec cPL had a
sensitivity of 70% and a specificity of 77% (23% false
positives) with the accuracy of the SNAP and Spec
cPL in animals with clinically diagnosed pancreatitis
calculated at 65% and 75%, respectively.
Miniature Schnauzers with severe hypertriglyceridaemia (> 9mmol/L, 900mg/dL) were 4.5x more likely
to have a Spec cPL value consistent with pancreatitis
(≥200 µg/L)4; however, these dogs did not show any
obvious clinical signs of pancreatitis.6
Pending further study, SNAP and Spec cPL test results
should be interpreted cautiously in dogs with Cushing’s disease and hypertriglyceridaemia to avoid a
false diagnosis of concurrent pancreatitis.
It is thus evident that is it important to have a positive
SNAP confirmed by the Spec CPL test at a laboratory.
Other conditions where Spec cPL is elevated include
Babesia rossi where 28% of hospitalised cases had a
level >400ug/L, patients with more advanced mitral
valve disease and heart failure had minor increases
(200 – 400 ug/L) and in and a small percentage of
dogs on phenobarbitone and potassium bromide
treatment which had increases between 200-400ug/
L in 13/310 cases and increases >400ug/L in 9/310
dogs.7,8,9
In one study4, dogs were enrolled based on clinical
signs of pancreatitis and the study showed that the
SNAP test had a sensitivity of 91-94% and specificity
of 71 – 77%. Using a cutoff of 400ug/L the Spec cPL
had a sensitivity of 71-77% and a specificity of 80 –
85%.4 Another study also using a clinical diagnosis
(clinical, serum chemistry, abdominal ultrasound) of
!
Take Home Message
• A negative SNAP test makes pancreatitis highly unlikely and thus consider other causes for the
clinical presentation.
• The Spec cPL and SNAP tests are more sensitive and specific in acute pancreatitis.
• Even if it is a true positive result and the dog does have pancreatitis, it does not mean that it is the
only condition present. Pancreatitis can be both primary and secondary and neither the SNAP
nor the Spec cPL can differentiate between the two. Secondary causes of pancreatitis such as
septic peritonitis or intestinal foreign body will need to be specifically addressed. These tests are
meant to be PART of the diagnostic evaluation and not the initial test to place the patient into a
pancreatitis positive/negative group.
Th
e
• There are some other disease conditions which appear to cause false positive results and thus
decrease the specificity of the test. Cushing’s disease, chronic glucocorticoid treatment and
elevated triglycerides in Miniature Schnauzers have been shown to cause increased numbers of
positive Snap and Spec cPL results in the absence of clinical pancreatitis. Thus a positive SNAP
and Spec CPL is not diagnostic for pancreatitis.
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Contact Royal Canin Customer Services 0860 630 063 or email [email protected] Reg No: V22688. Act 36 (1947)
.co.za
Issue 02 | APRIL 2016 | 39
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2016/03/24 2:24 PM