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Ask the Doctor March 2013 Issue

Dear Doctor - A test for feline pancreatitis?

Letter to Tufts Veterinarians

A test for feline pancreatitis?

Q In the December 2012 issue, Catnip published an article titled: “Pancreatitis: Still a Mystery.” Over the years, I have had four cats with pancreatitis, so I’m quite experienced with this difficult disease.

I feel that the article omitted a couple of important issues. There was no mention of nausea, and nausea is a huge problem for cats with pancreatitis. Additionally, there was no mention of the blood test that is specifically used for diagnosing pancreatitis, the Spec fPL.
Linda Yacobucci, via Email

A Dear Ms. Yacobucci: I’m sorry to hear that you have had four cats with pancreatitis, and hopefully I can provide you with some information that will be useful.

First, regarding nausea: In truth, nausea is not universally present in cats with pancreatitis. In one study of 40 cats with pancreatitis, vomiting was seen in one-third of the cats, and abdominal discomfort in 25 percent. Your point is well taken, however, that if nausea is present it must be treated. We have several good medications to treat nausea in the cat to prevent their discomfort.

The blood test that you mention — feline pancreatic lipase (Spec fPL) — is controversial. The majority of reports suggesting its usefulness have been written by the doctors who developed the test.

Independent evaluation of the test has not been performed to my satisfaction. The reason this might be important is that the same authors created a previous test — the feline serum trypsin-like immunoreactivity (TLI), in the late 1990s, which they claimed in publications was an excellent test for the diagnosis of feline pancreatitis. However, when the test was independently investigated (by the University of California), its value proved to be highly questionable.

After the publication of that paper, the makers of the serum trypsin-like immunoreactivity (TLI) acknowledged the TLI test had limited value, and that now they had created a better test, the fPL. The fPL test may indeed be useful, but until it has been independently validated, I and many other experts will remain skeptical. Our experience with the TLI test is a good example of the fact that all tests — including the fPL test — need to be independently evaluated before they can be relied upon in clinical practice.
Michael Stone DVM, ACVIM
Clinical Assistant Professor Cummings School
of Veterinary Medicine at Tufts University

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