Idexx CspecPL

Re: Idexx CspecPL

crazedndazed — Fri, 14 Dec 2012 23:01:35 GMT

But I would think it was then sent to Idexx then...

Re: Idexx CspecPL

crazedndazed — Fri, 14 Dec 2012 22:59:33 GMT

We use Axiom[quote user="Martin Atkinson"]

[quote user="crazedndazed"]Had a phone call from the lab saying this was the highest result they'd ever had and so they were sending it to another lab for corroboration in case there was an error. Came back as definitely high (>600) but dog was clinically well although O said could occasionally be disinterested in food. [/quote] What lab do you use? I've had an Idexx specCPL back as >1000 ugm/l and its SNAP test was only just equal to the control. The only abnormalities on biochem/CBC were a low BUN, marginal hyperglycaemia and very mild anaemia. Signlament was a large turkey meal a few hours beforehand, only symptoms were acute onset and very severe abdominal pain, a couple of hours on a drip and shed load of Vetergesic and it was better in 12 hours. This was a nurse's dog so was well monitored.

[/quote]

Re: Idexx CspecPL

Graham Bilbrough — Mon, 10 Dec 2012 05:54:02 GMT

Normal 0 false false false EN-GB X-NONE X-NONE MicrosoftInternetExplorer4

Chronic pancreatitis is a challenge by comparison to acute pancreatitis. Again, I turn to my liver enzymes analogy. You would expect a dog with a cirrhotic liver to have low/normal liver enzyme activity despite even profound hepatitis. Likewise, we encounter plenty of dogs, after years of chronic pancreatitis, with a “withered pancreas”: severe inflammation in what little tissue remains does not cause an elevation above our 400unit threshold. That said, if you look at the trend, you can usually spot it.

After reaching the diagnosis at PM, referral clinicians—seeing the more tricky cases—tend to suggest that this shows the test is not as sensitive as they would wish. They forget to mention that their ultrasound probe struggled too.

@crazedndazed

I find this a little odd. There is only one lab (IDEXX) that runs Spec cPL. Any lab offering the test passes it to us (even if they erroneously refer to it as "cPLI" or similar).

@Michael

The iPad is back in the cupboard.

Re: Idexx CspecPL

Martin Atkinson — Fri, 07 Dec 2012 16:35:47 GMT

Re: Idexx CspecPL

Stephen Courtney — Fri, 07 Dec 2012 14:43:00 GMT

It is my experience that specialists in referral practice are not nearly as enamoured of speciifc pancreatic lipase as GP vets tend to be.

this may be because they see a different population of awkward cases i suppose - our classical pancreatitis cases are not usually referred on as we can manage them well, in most cases, with supportive care.

Re: Idexx CspecPL

crazedndazed — Fri, 07 Dec 2012 13:56:49 GMT

I had a geriatric Lakeland Terrier with PU/PD and weight gain. Changes on bloods and urine suggestive of CKD but also the amylase and lipase suggestive of pancreatitis so ran a CPLi. Had a phone call from the lab saying this was the highest result they'd ever had and so they were sending it to another lab for corroboration in case there was an error. Came back as definitely high (>600) but dog was clinically well although O said could occasionally be disinterested in food. The dog was referred and the specialist said that CPLi wasn't particularly specific or sensitive(?) - I forget which... but they basically said it was meaningless in a dog that didn't have signs of pancreatitis.

Re: Idexx CspecPL

ashvetenry — Fri, 07 Dec 2012 11:55:43 GMT

[quote user="Christopher Saul"]

My advice would be to repeat the pli at a later stage and if it does not start to normalise then I would suggest getting a radiologist to perform a pancreatic FNA.....

[/quote]

This latest, highest value is 1 month after the first, how much later do you feel "at a later stage" is?

Cheers,

Ash.

Re: Idexx CspecPL

J G Wray — Fri, 07 Dec 2012 07:21:00 GMT

Observational study of 14 cases of chronic pancreatitis in dogs

P. J. Watson, MA, VetMD, CertVR, DSAM, DipECVIM, MRCVS1,
J. Archer, VMD, MS, PhD, FRCPath, DipECVCP, MRCVS1,
A. J. Roulois, DMV, PhD, FRCPath, MRCVS2,
T. J. Scase, BSc, BVM&S, PhD, DipACVP, MRCVS3 and
M. E. Herrtage, MA, BVSc, DVSc, DVR, DVD, DSAM, DECVIM, DECVDI, MRCVS1

This study reports the clinical, clinicopathological and ultrasonographic findings from dogs with chronic pancreatitis (CP). Fourteen dogs with clinical signs consistent with CP and histological confirmation of the disease were evaluated. Abdominal ultrasound and clinical pathology results were recorded. Sensitivities of pancreatic enzymes for diagnosis of CP were calculated with two different cut-off values. The mean age of affected dogs was 9.1 years. Spaniels were the most common breed with CP, representing seven of the 14 dogs in this study. CP was histologically severe in nine cases. Most dogs showed chronic low-grade gastrointestinal signs and abdominal pain. Five dogs had exocrine pancreatic insufficiency and five dogs had diabetes mellitus. The sensitivity of elevated trypsin-like immunoreactivity for CP was 17 per cent. The sensitivities of canine pancreatic lipase immunoreactivity, lipase and amylase for CP were 44 to 67 per cent or 14 to 28 per cent depending on the cut-off value used. Cholesterol was elevated in 58 per cent of samples. Liver enzymes were often elevated. The pancreas appeared abnormal on 56 per cent of ultrasound examinations. Ten dogs had died by the end of the study period; only one case was due to CP.

Ho Hum

JGW

Re: Idexx CspecPL

Christopher Saul — Thu, 06 Dec 2012 23:26:38 GMT

This dog may well have had an episode of pancreatitis; though of course I would second the 'treat the patient not the numbers' point . Pancreatitis represents a huge spectrum of disease from very mild and self limiting to life threatening.

Sorry to air the neoplasm thing again but we've had 2 cases recently of patients who had pancreatitis but later turned out to have pancreatic cancer

My advice would be to repeat the pli at a later stage and if it does not start to normalise then I would suggest getting a radiologist to perform a pancreatic FNA.....

hope this helps

Chris

Re: Idexx CspecPL

Michael Woodhouse — Thu, 06 Dec 2012 19:16:14 GMT

[quote user="Graham Bilbrough"]Arlo, I've lost my paragraphs :( please help :)

[/quote]

Stop using your Ipad/Iphone!

Re: Idexx CspecPL

Graham Bilbrough — Thu, 06 Dec 2012 16:11:08 GMT

Arlo, I've lost my paragraphs :( please help :)

Re: Idexx CspecPL

Graham Bilbrough — Thu, 06 Dec 2012 16:04:10 GMT

I agree: it is always a good idea to look at the patient first, numbers second. But--yes, I am partisan here--I really think Spec cPL is a good test. I have seen many examples of an elevated Spec cPL, an abdominal US (by a diplomat in imaging) that claimed to exclude pancreatitis, and a PM that later showed Spec cPL to be the correct one. That said, I view cPL in a similar fashion to some of the liver enzymes. I've seen plenty of GIT foreign bodies where the resulting hypovolaemia causes some mild pancreatic ischaemia. The cPL concentration will be increased. The trap to be avoided is that just because the dog has pancreatitis doesn't mean it doesn't have another problem. Compare that with ALT and the hyperthyroid cat! On the other hand, I've also seen cases where the dog had no symptoms (that I could find), a cPL concentration in the range 400 to 1000 units and a US or PM later confirmed pancreatitis. Is the patient generally stoical? What would I do? If the owner is sensible, I'd send it home with bland food and use SNAP cPL in a few weeks. If it is normal, then any inflammation is resolved. If it is elevated, the SNAP gets you a large price reduction for the quantification at IDEXX Reference Lab--you can only save money by that route. I hope the case goes well. g

Re: Idexx CspecPL

Michael Woodhouse — Thu, 06 Dec 2012 13:12:47 GMT

[quote user="ashvetenry"]

Certainly is confusing me- not certain what to tell the client now, especially after the mention of neoplastic disease processes!

[/quote]

Tell them its good the dog is getting better. Ask them to bring the dog back if it gets worse. Pat yourself on the back. Stop worrying.

Re: Idexx CspecPL

ashvetenry — Thu, 06 Dec 2012 12:02:41 GMT

Certainly is confusing me- not certain what to tell the client now, especially after the mention of neoplastic disease processes!

Re: Idexx CspecPL

Rajat — Wed, 05 Dec 2012 23:11:48 GMT

[quote user="ashvetenry"]

This may be another "treat the patient, not the numbers" scenario, but is curious.

A suspected case of pancreatitis, which responded to supportative treatment- IV fluids/ analgeisa (vetergesic) and ranitidine, and dietary modifcation ie feeding Hills ID low fat. However it's CspecPL values have continued to rise- the dog is currently very well but its latest value last night is 860 (idexx <200). The initial value at presentation on 12/11/12 was 394 (200-399 being the "gray zone" for pancreatitis) and then 694 on 21/11/12.

Idexx advised the initial sample may have been before the peak and a subsequnet 2 wk sample should see the value normalising- but this further rise is odd, epsecially as the dog is clinically normal.

Does anyone have any ideas / had similar values returned?

[/quote]

The test is known to be more sensitive than specific - the dog may or may not have had pancreatitis, but if it is doing well I would ignore the values. In fact I wouldn't have repeated the test if the dog was improving -because the value does not dictate my choice of 'next step' as it were. I.e if the dog is comfy eating not puking hydrated and generally well, I'd be sending it home regardless of Cpli levels. So personally I don't see the value here in re-checking the levels, it would confuse me like it is confusing you

Re: Idexx CspecPL

Stephen Courtney — Wed, 05 Dec 2012 18:54:38 GMT

The last dog i saw with spec PL > 1000 yet was in no pain and normal scan, turned out to have a Gastro Intestinal Stromal tumour (GIST) on the lesser curvature of the stomach. This was only picked up by a CT which was ordered for other reasons.

I'm not suggesting your case has one of these, simply that there may be another reason for the PL to be up. i think it is not nearly as precise a test as we were initially promised....