The pancreas

Abstract

The most promising recent development in diagnostic methods for pancreatic disease is the indication for expanded use of the H IVGTT as a screening test in veterinary medicine. Exocrine endocrine interdependency in the pancreas is such that glucose tolerance becomes abnormal in inflammation, degeneration and neoplasia. The H IVGTT is well suited as a screening test, requiring relatively little time, not being influenced by gastric or intestinal motility, and physically easier on the patient. As further experience with the H IVGTT is gained, it may be possible to reduce the number of samples (eg 0, 5, 15, and 60 minute values may be adequate to estimate the k value in clinical practice). The H IVGTT may prove useful as a prognostic tool in dogs and cats with obesity, abnormal heat cycles, and unexplained fasting hyperlipidemia. Whether or not it will be possible to characterize and recognize prediabetes in dogs and cats, as in man, awaits further study. In any event, rather than being the last test run in a diagnostic workup, the H IVGTT may move to the second rank after urinalysis, CBC, and BUN. The oral glucose tolerance test (OGTT) will continue to be used where intestinal pancreatic interactions are of interest. It has the advantage of a physiological route of administration. Parallel changes in serum amylase and lipase noted in experimental pancreatitis in dogs need to be confirmed in clinical cases by serial analysis during the course of illness. The azo casein method for fecal trypsin determination may improve the sensitivity of the test for pancreatic exocrine insufficiency, although fecal fat determinations seem more reliable. Cost favors the fecal trypsin test. Several innovations in treatment of pancreatitis in man may find application in veterinary practice. Use of glucagon to reduce pancreatic exocrine secretion may prove useful, although it is obvious that therapeutic effectiveness depends greatly on very early diagnosis of acute pancreatitis. The same is true of fibrinolysin or heparin, although lysis of thrombi or prevention of blood clotting should be useful during more advanced stages of acute pancreatitis also. Further study should determine if ADH is useful in clinical cases of pancreatitis. The deleterious influence of dietary fat on pancreatic cells, described by Haig, supports the clinical observation that a fat meal may trigger the onset of pancreatitis in dogs. Client education on the deleterious influence of dietary fat should continue to be emphasized.