Case Study of Canine Pancreatitis in Shih-Tzu at Cucu K.

Sajuthi DVM and

Associetes, Period of October-December 2016

Titis Setyo Putri (160130100111015)

Veterinary Profession Education, Faculty of Veterinary Medicine, Brawijaya
University

Abstract: Pancreatitis is a condition caused by inflammation, resulted in damage

to the pancreas. A male Shih-tzu aged more than 10 years experienced
pancreatitis. Amannesis and clinical symptoms, the dog has anorexia for three
days, vomiting , lethargy, lots of drinking (polydipsia) and lost of urine (polyuria).
Clinical examination revealed is showed pale mucosa and palpation in the
abdomen in pain. Hematology revealed increased lymphocytes of non-significant
and chemistry revealed increased (ALP, BUN, and creatinin) and drecreased
phosphor of non-significant. So that the need for other investigations such as the
test kit SNAP cPL IDEXX, from the test kit the dog experienced pancreatitis.
There wast treatment is fluid therapy, anti-emetic, antibiotics, anti-ulcer, vitamins,
and supplements. From the result of treatment the dog experienced appetite, not
vomiting, active, not lethargic, and normal mucosa.

Key : pancreatitis, dog, treatment.

INTRODUCTION CASE PRESENTATION

Pancreatitis is often seen in
dogs more than eight aged with
normal weight. Disorders function of
organs and digestive tract such as
pancreas often found in dogs and cats.
So an accurate diagnosis is the right
thing to handle treatment in patients
with disordered pancreatic function.
In a variety of clinical cases treated
by practitioners, cases of pancreatitis
are more difficult to treat. Although Figure 1 : Maurice
studies and research of pancreatic A male Shih-tzu aged more than
dysfunction continue to develop, ten years old was presented with a
there has been not patent treatment to history of anorexia at three days,
completely cure pancreatitis. Therapy vomiting, lethargy, polidypsia and
with optimal results depends on the polyuria. Clinical examination
ability and knowledge of practitioners releaved with palpation abdominal
regarding physiology, pain, lethargy, and mucosa pink pale.
pathophysiology, clinical symptoms, Based on result hematology and
treatment with medication therapy biochemistry is increased (limfosit,
and appropriate surgery techniques in ALP, BUN, and creatinin) not
prancreatitis patients (Schaer, 2010). significant and decreased phosphat.
 Examination Result Unit Normal Range
Hematologi:
White Blood Cell (WBC) 12,6 103/uL 6.0 – 17.0
Red Blood Cell (RBC) 6,05 106/uL 5.5 – 8.5
Hemoglobin (Hb) 14,1 g/dL 11.0 – 19.0
Hematocrit (HCT) 42,9 % 39.0 -56.0
Mean Corpuscular Volume
(MCV) 71,0 fL 62.0 – 72.0
Mean Corpuscular Hemoglobin
(MCH) 23,3 pg 20 – 25
Mean Corpuscular Hemoglobin
Concentration (MCHC) 32,8 g/dL 30.0 – 38.0
Trombosit (PLT) 365 103/uL 117 – 460
Limfosit 35,7 ↑ % 12.0 – 30.0
Monosit 2,6 % 2.0 – 9.0
Granulosit 61,7 % 60.0 – 83.0
Limfosit 4,5 103/uL 0.8 – 5.1
Monosit 0,3 103/uL 0.1 – 1.8
Granulosit 7,8 103/uL 5.5 – 8.50
Red Blood Cell Distribution
Width (RDW)-SD 37,2 fL 37.0 – 54.0
Red Blood Cell Distribution
Width (RDW)-CV 16,3 ↑ % 11.0-15.50
Procalcitonin (PCT) 0,31 % 0.1– 9.99
Mean Platelet Volume (MPV) 8,6 fL 7.0 – 12.90
Platelet Disribution Width
(PDW) 11,0 % 0.1 – 30.0
P-LCR 2,3 % 0.1-99.9
Biochemistry:
Albumin 4.0 g/dL 2.5 – 4.4
Alkalin Phosphatase (ALP) 177 ↑ U/L 20-150
Alanin Aminotransferase (ALT) 39 U/L 10– 118
Amilase 1054 U/L 200-1200
Bilirubin total 0,3 mg/dL 0.1-0.6
Blood Urea Nitrogen (BUN) 37.0 ↑ mg/dL 7 – 25
Kalsium 11,3 mg/dL 8.6-11.8
Phospat 2,5 ↓ mg/dL 2.9-6.6
Creatinin 1.9 ↑ mg/dL 0.3 – 1.4
Glucosa 112/68 mg/dL 60-110
Na+ 140 mmol/L 138-160
K+ 5.0 mmol/L 3.7-5.8
Protein Total 7,1 g/dL 5.4 – 8.2
Globulin 3,1 g/dL 2.3 – 5.2
normality. At October 2016
Result hematology at Maurice increased glucose caused the dog
increased limfosit of presentage after eat. The others result
value, but absolute value is normal, biochemistry is increased ALP,
and increased (RDW-CV) not BUN, and creatinin not significant.
significant. Result biochemistry From examination hematology
examination is increased glucose and biochemistry the result not
level at 10 October 2016, but at 13 significant so needed the others
October 2016 result glucose test is examination. Based on amanesa and
physical examintaion indicated
aexistence gastrointestinal disorders.
Supporting diagnoses used further in
PDHB 24 Jam Sunter Jakarta Utara
Veterinary Hospital, the dog of the
patient affected by pancreatitis is
with the IDEXX® SNAP cPL test
kit. This SNPL test kit IDEXX® is
used to measure the increased lipase
enzyme present in serum.
The principle of the test kit is
to use the accepted 95% with
principle Enzyme - Linked
Immunosorbent Assay (ELISA) (Mix
and Jones, 2008). The IDEXX®
SNAP cPL test kit is one of the in
vitro tests to determine the increased
pancreatic lipase in dog serum. The
normal level of lipase in dogs is
≤200 mg / L, if the lipase content of
201-399 mg / L requires the
evaluation of diagnosis and retesting
of the IDEXX® SNPL cPL test kit,
and while the lipase content of> 400
mg / L dog can be said to be positive
for pancreatitis . How this test kit
works is that antibodies in the kit
will bind to the antigen in the form of
lipase enzyme from the sample and
will form antigen-antibody complex.
Figure 2 : Interpretation Test Kit SNAP
cPL IDEXX.
Figure 3. Result SNAP cPL IDEXX Test
Kit at Maurice.
From the test results showed
the blue color is clearly visible and
older at the sample point than the
control point of the SNPL test kit
IDEXX®, so it can be concluded that
Maurice's dog have pancreatitis.
Treatment given to Maurice is
fluid therapy was given with Lactate
ringer’s using intravena 40-60 cc/
kg/day. During the observation
treatment using ondansentron 0,5
mg/kg/ q12-14h/IV, antibiotic with
ampicilin using 10-20 mg/kg/IM,
ornipural using 2-5 cc IM, Neurobion
0,15 cc/IM, and Inpepsa using 3-5
cc/2x/day. Outpatient therapy using
administration per oral with
ondansentron, methycobalt,
spuradyn, enzyplex, curcuma, TF
plus, clavamox and Weight/Diet
Hills®.
DISSCUSION
Pancreatitis is a condition
caused by pancreatic inflammation
called pancreatitis. Pancreatitis is
most common in older dog that are
often overweight. Dogs with
pancreatitis usually have anoreksia,
vomiting, abdominal pain,
depression and sometimes fever and
diarrhea. The dog called Maurice
have anamnesa anoreksia, vomiting,
lethargy, and abdominal pain. This
showed that Maurice experience
pancreatitis. The ethiology an
pathogenesis of spontaneous
pancreatitis is poorly understood
(Andrew, 2013).
From result hematology is
increased limfosit and biochemistry
increased (ALP,BUN, and creatinin).
Based studies Troy (2007),
pancreatitis marked by increased
ALP, GGT, ALT, and AST). This is
consistent with the presumption
Maurice experiencing pancreatitis.
And also confirmation with test kit
SNAP cPL IDEXX showed positive
result.
Treatment of cases of
pancreatitis in dog patients in PDHB
24 Jam Sunter Jakarta Utara using
fluid therapy, antibiotics, and
supportive therapy. The first fluid
achieved by intravenous fluid
therapy is Ringer Lactat®, which
acts as a replacement for lost body
electrolytes and is used as a
alkalizing. A special dietary diet for
gastrointestinal disorders is assisted
in the metabolism of fat and
maintaining muscle (the presence of
L-carnitine), helps maintain weight
(the presence of fiber), improves
urinary tract health (low fat and
calories), and boosts immunity
antioxidants). The feed given to
Dogs is Digestive / Weight / Glucose
Management W / D Hills® that can
help prankreas repair due to
inflammation, because it contains
antioxidants and low fat (low fat)
(John and David, 2014).
Ondansetron is a drug used to
using treatment nausea and vomiting
in patient. Ampicillin is a class of β-
lactam antibiotics including
penisillinum families that have broad
spectrum, are active against gram
negative and positive bacteria.
Ampicillin is a bakterocidal that acts
in an irreversibly inhibiting activity
of transpeptidase enzyme needed for
the synthesis of bacterial cell walls.
Clavamox® antibiotics are a
formulation of broad-spectrum
antibiotics amoxicillin trihydrate and
clavulanate acid (an antibiotic of the
β-lactam inhibitor group).
Amoxicillin acts as an antibacterial
by inhibiting the formation of
bacterial walls, clavulanate acid
increases the coverage of the
antibacterial spectrum of amoxicillin.
Neorobion has a composition of
several vitamin B1, B6, and B12.
Neurobion is used to improve
metabolism and meet the daily needs
of vitamin B complex. Vitamin B6
and B12 are the vitamins needed in
the formation and maturation of red
blood cells. Methycobalt® contains
mecobalamine which is a type of
coenzyme B-12. Mecobalamin plays
a role in transmetilasi as a
methionine coenzyme. Mecobalamin
is transported to nerve cells to
increase protein synthesis and
nucleic acids. Ornipural using to
stimulate hepatodigestive activity in
renal and digestive disorders.
Supradyn is a supplement that
contains vitamins A, B, C, and D,
this vitamin is used multivitamin, as
a mineral, and microelement that
serves to maintainance eye,
metabolism,, prevent infection and
maintainance bone. Enzyplex used to
balance digestive enzyms. TF plus
used to anti-plasmic, anti-histamine,
anti inflamation, and maintain
endurance. From the result of
treatment the dog experienced
appetite, not vomiting, active, not
lethargic, and normal mucosa after
observation and therapy in PDHB
veterinary hospital at six days.

CONCLUSION
Based on anamnesa, clinical
symptom examination, and supported
by hematological examination, blood
chemistry, and IDEXX® SNAP cPL
test kit, it can be concluded that dog
Shih-Tzu patients have pancreatitis..
Therapy is given to the patient's dog,
which is by gradually recovering the
condition by providing medication
that serves to reduce visible clinical
symptoms and is supported by the
feeding and supplement quality to
improve nutrition and endurance

REFERENCES
Andrew, L. 2013. Canine
Pancreatitis.
http//www.clinicianbrief.co
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John, K. And L. David. 2014.
Diagnosis of Pancreatitis in
Dogs and Cats. J Small
Anim Pract Vol (56): 13-26.
Mix, K. and C. Jones. 2006.
Diagnosing Acute
Pancreatitis in Dogs. Com
Cont Edition Pract Vet Vol
29 : 226-234.
Schaer M. 2010. Clinical Medicine
of the Dog and Cat. Second
Edition. Manson
Troy Schlines. 2007. Diagnosing
Canine Pancreatitis. Banfeld
Vol 1107. Page 024-035.