Acute pancreatitis in dogs

Objective: To summarize current information regarding severity assessment, diagnostic imaging, and treatment of human and canine acute pancreatitis (AP). Human‐based studies: In humans, scoring systems, advanced imaging methods, and serum markers are used to assess the severity of disease, which allows for optimization of patient management. The extent of pancreatic necrosis and the presence of infected pancreatic necrosis are the most important factors determining the development of multiple organ failure (MOF) and subsequent mortality. Considerable research efforts have focused on the development of inexpensive, easy, and reliable laboratory markers to assess disease severity as early as possible in the course of the disease. The use of prophylactic antibiotics, enteral nutrition, and surgery have been shown to be beneficial in certain patient populations. Veterinary‐based studies: The majority of what is currently known about naturally occurring canine AP has been derived from retrospective evaluations. The identification and development of inexpensive and reliable detection kits of key laboratory markers in dogs with AP could dramatically improve our ability to prognosticate and identify patient populations likely to benefit from treatment interventions. Treatment remains largely supportive and future studies evaluating the efficacy of surgery, nutritional support and other treatment modalities are warranted. Data sources: Current human and veterinary literature. Conclusions: Pancreatitis can lead to a life‐threatening severe systemic inflammatory condition, resulting in MOF and death in both humans and dogs. Given the similarities in the pathophysiology of AP in both humans and dogs, novel concepts used to assess severity and treat people with AP may be applicable to dogs.     

Applied anatomy,pathophysiology and a revised scoring system of bull sheaths

The sheath and prepuce are anatomically simple yet vital parts of the mating apparatus of the bull. They are also susceptible to a range of insults, and pathology of these structures is a common cause of infertility in both Bos taurus and Bos indicus bulls. Significant individual and breed-based variation occurs in the looseness of the skin, the presence and development of preputial muscles, the relative position of the opening to the cranial preputial muscles, the length of the prepuce, and the prominence of the umbilicus. Individual and breed-based susceptibility to different conditions is associated with these anatomical variations. Regardless of the cause, pathology of the prepuce generally results in sepsis, prolapse, stenosis or adhesions or a combination. Clinical examination should be aimed at determining the extent of these processes and the amount of healthy prepuce which would remain following successful treatment. The inclusion of evaluation of sheath conformation in the form of a sheath score is recommended. Current scoring systems do not reflect the diversity of predisposing factors to morbidity and may therefore fail to accurately reflect the risk of morbidity. A more detailed scoring system has been proposed. Further refinement of this system is outlined, consisting of a composite of scores for depth, umbilical skin fold, prepuce eversion, and distance from cranial muscle to opening (the ‘Y’ factor). Validation against actual bull performance is indicated to develop a valid and useful risk-management tool for use in evaluating sheath conformation.     

Determination of plasma lysosomal enzyme activity and its relationship to severity of injury following blunt vehicular trauma in dogs

Objective: To determine plasma β‐d ‐glucuronidase (βG) activity in the first 4 hours following injury in dogs struck by a motor vehicle, and to evaluate whether the degree of enzyme activity is correlated with the severity of injury. Design: A prospective clinical study. Setting: Veterinary Medical Teaching Hospital. Animals: Thirteen client‐owned dogs that were presented to the Veterinary Hospital of the University of Pennsylvania between June and August 1999 for blunt vehicular trauma. Ten healthy student and staff‐owned dogs served as controls. Interventions: None. Measurements: Plasma was analyzed for βG enzyme activity at the time of presentation (n=13), and 1 and 4 hours (n=7) following presentation to the Emergency Service for blunt vehicular trauma. The results were compared with enzyme activity from healthy controls evaluated serially over 4 hours. Fluorometric analysis using 96‐well microtiter plates was used to perform the enzyme assays. The relationships between presentation (n=13) and 4 hours (n=7) of enzyme activity and 3 indices of metabolic and physical disturbance (serum pH, serum lactate and Animal Trauma Triage (ATT) score) at the time of presentation were also investigated. Main results: Of the 13 dogs, 7 fulfilled the inclusion criteria for comparison of enzyme activity of the trauma over time. A statistically significant difference in βG activity was found in the trauma group (mean 75.6±10.4 U) at 4 hours following presentation compared with controls (mean 48.0±6.4 U). This difference was suggested by 1 hour following presentation (trauma group, mean 70.4±10.9 U; control group, mean 49.8±5.5 U), although it did not reach statistical significance. Thirteen dogs fulfilled the inclusion criteria for comparison of only presentation enzyme activity with trauma severity score, serum lactate, and serum pH. No statistically significant relationship was found between the βd ‐glucuronidase activity and the presenting ATT score, serum lactate concentration, or serum pH at either presentation or 4 hours, although the power of these analyses was low. Conclusions: These results demonstrate that the activity of βG, a lysosomal enzyme, increases significantly in the systemic circulation in dogs 4 hours following blunt trauma. Additional research to include more severely injured dogs, a larger number of dogs, and to follow the course of injury for a longer period of time would be beneficial to further characterize βG activity following blunt trauma.     

A novel clinical scoring system for outcome prediction in dogs with acute kidney injury managed by hemodialysis

BACKGROUND: No reliable tool to predict outcome of acute kidney injury (AKI) exists. HYPOTHESIS: A statistically derived scoring system can accurately predict outcome in dogs with AKI managed with hemodialysis. ANIMALS: One hundred and eighty-two client-owned dogs with AKI. METHODS: Logistic regression analyses were performed initially on clinical variables available on the 1st day of hospitalization for relevance to outcome. Variables with P< or = .1 were considered for further analyses. Continuous variables outside the reference range were divided into quartiles to yield quartile-specific odds ratios (ORs) for survival. Models were developed by incorporating weighting factors assigned to each quartile based on the OR, using either the integer value of the OR (Model A) or the exact OR (Models B or C, when the etiology was known). A predictive score for each model was calculated for each dog by summing all weighting factors. In Model D, actual values for continuous variables were used in a logistic regression model. Receiver-operating curve analyses were performed to assess sensitivities, specificities, and optimal cutoff points for all models. RESULTS: Higher scores were associated with decreased probability of survival (P < .001). Models A, B, C, and D correctly classified outcomes in 81, 83, 87, and 76% of cases, respectively, and optimal sensitivities/specificities were 77/85, 81/85, 83/90 and 92/61%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: The models allowed outcome prediction that corresponded with actual outcome in our cohort. However, each model should be validated further in independent cohorts. The models may also be useful to assess AKI severity.     

The Feline Acute Patient Physiologic and Laboratory Evaluation (Feline APPLE) Score: a severity of illness stratification system for hospitalized cats

Background: Scores allowing objective stratification of illness severity are available for dogs and horses, but not cats. Validated illness severity scores facilitate the risk‐adjusted analysis of results in clinical research, and also have applications in triage and therapeutic protocols. Objective: To develop and validate an accurate, user‐friendly score to stratify illness severity in hospitalized cats. Animals: Six hundred cats admitted consecutively to a teaching hospital intensive care unit. Methods: This observational cohort study enrolled all cats admitted over a 32‐month period. Data on interventional, physiological, and biochemical variables were collected over 24 hours after admission. Patient mortality outcome at hospital discharge was recorded. After random division, 450 cats were used for logistic regression model construction, and data from 150 cats for validation. Results: Patient mortality was 25.8%. Five‐ and 8‐variable scores were developed. The 8‐variable score contained mentation score, temperature, mean arterial pressure (MAP), lactate, PCV, urea, chloride, and body cavity fluid score. Area under the receiver operator characteristic curve (AUROC) on the construction cohort was 0.91 (95% CI, 0.87–0.94), and 0.88 (95% CI, 0.84–0.96) on the validation cohort. The 5‐variable score contained mentation score, temperature, MAP, lactate, and PCV. AUROC on the construction cohort was 0.83 (95% CI, 0.79–0.86), and 0.76 (95% CI, 0.72–0.84) on the validation cohort. Conclusions and Clinical Importance: Two scores are presented enabling allocation of an accurate and user‐friendly illness severity measure to hospitalized cats. Scores are calculated from data obtained over the 1st 24 hours after admission, and are diagnosis‐independent. The 8‐variable score predicts outcome significantly better than does the 5‐variable score.