Acute-onset pancreatitis (AP) is common in dogs and presents diagnostic as well as management challenges. Until recently, the management of AP in dogs was based mainly on supportive and symptomatic care. Identification and management of a possible cause of the disease is important, but the majority of cases are considered to be idiopathic. Fluid therapy that is tailored to the patient's needs is crucial to provide adequate hydration while preventing overhydration. Antiemetics are required to control vomiting and fluid loss and aid in early nutritional support. Recognition and management of complications is also crucial. Furthermore, analgesics for abdominal pain are very important. More recently, pharmaceutical modification of the inflammatory cascade has gained interest and the first specific therapeutic agent for the treatment of AP, fuzapladib sodium, has been shown to have a reasonable expectation of effectiveness in a pilot study. This drug has been licensed for the treatment of clinical signs of AP in dogs in Japan and also has achieved FDA conditional approval in the US. Antibiotics should not be used indiscriminately but are indicated for patients with aspiration pneumonia, gastrointestinal bacterial translocation, or evidence of another bacterial infection. Proton pump inhibitors and plasma are not routinely prescribed in pancreatitis unless specifically indicated. Nonsteroidal anti-inflammatory drugs should be avoided. Corticosteroid therapy, once thought to be contraindicated, may have some beneficial effects, as shown in a single retrospective study. However, further studies are required before their routine use can be recommended. Finally, a surgical approach is rarely indicated.

The intracellular distribution of copper in the liver has been investigated in dogs and humans. However, this has not been reported in cats. This study aimed to assess the intracellular copper distribution in liver specimens from cats with a range of hepatic copper concentrations. Twenty-nine frozen liver specimens from cats were included. Each liver specimen was divided into two pieces for overall copper quantification and tissue fractionation. The copper concentrations in liver specimens and liver fractions were measured by flame atomic absorption spectroscopy. Five specimens had copper concentrations < 100 μg/g dry weight, eight had copper concentrations between 100 and 180 μg/g, 14 had copper concentrations between 181 and 700 μg/g, and two had copper concentrations >700 μg/g. Only one specimen had positive copper staining. Regardless of the overall concentrations, copper was mostly found in the cytosolic fraction followed by the nuclear, large granule, and microsomal fractions. Our findings indicate that similarly to other species, intracellular copper is predominantly found in the cytosolic and nuclear fractions in cats. The distribution in cats with copper-loaded conditions, such as primary copper hepatopathy, was not assessed but warrants evaluation.

AbstractBackgroundCopper associated hepatopathy (CAH) has become an important and prevalent disease since the 1990's, coincidental with changes in copper (Cu) content in commercial dog foods. Knowing the demographic and histopathologic features related to hepatic Cu concentrations might aid in diagnosing CAH in dogs.Hypothesis/ObjectivesThe primary aim was to identify demographic and histopathologic features associated with abnormally high hepatic Cu concentrations.AnimalsDogs that underwent liver histopathology and Cu quantification at a veterinary diagnostic laboratory between July 2010 and February 2020.MethodsData was retrospectively collected from an electronic database. A Gaussian multiple regression model on the log scale was used to evaluate associations between hepatic Cu and a set of demographic and histologic features selected with machine learning methods.ResultsOf 4559 cases meeting criteria, 50% had hepatic Cu > 400 and 19% had Cu > 1000 ppm (parts per million) dry weight (reference range 120‐400). Median hepatic Cu was 391 ppm, range 4.5 to 31500. Age was negatively associated (P < .02), but specific breeds (Doberman pinscher, Labrador retriever, and West Highland white terrier) were positively associated with abnormally high hepatic Cu (P < .001). Severity of inflammation (mild, moderate, and severe) and necrosis/apoptosis were associated with abnormally high hepatic Cu (P < .01).Conclusion and Clinical ImportanceAbnormally high hepatic Cu is prevalent in hepatic biopsies from dogs. Machine learning modeling showed that necroinflammation, not cholestasis or cirrhosis, on hepatic histopathology, is predictive of higher hepatic Cu and might be a reliable histologic predictor of CAH.

OBJECTIVE:To increase acidic esophageal lumen pH in dogs that developed gastroesophageal reflux (GER) during anesthesia. We compared water and 2 different bicarbonate concentrations. ANIMALS:112 healthy, nonbrachycephalic dogs presented for ovariectomy. PROCEDURES:Following standard anesthesia and surgery protocols for ovariectomy in all dogs, esophageal lumen impedance and pH were monitored using a dedicated probe. Esophageal impedance indicates the presence of GER whereas pH indicates the acidity level. Dogs with strongly acidic GER and an esophageal lumen pH value < 4.0 were included in the study, and lavage was performed with either tap water, bicarbonate 1%, or bicarbonate 2% until the pH increased to > 4.0. The effect of lavage on esophageal pH was compared using the Kruskal-Wallis and Wilcoxon 2 sample tests. Associations between lavage and pH changes were determined. RESULTS:Of 48/112 dogs with strongly acidic GER, 33% neutralized their esophageal pH during surgery. For the 32 dogs that maintained an esophageal lumen pH value < 4, esophageal lavage with water increased the lumen pH to > 4 in 78.6% of dogs, whereas both bicarbonate concentrations increased it in 100% of the dogs to a more neutral pH (P < .0001). The dogs in the water group were more likely to regurgitate after anesthesia (36% vs 0% in both bicarbonate groups, P = .028). CLINICAL RELEVANCE:Bicarbonate 1% and 2% increased esophageal lumen pH to more than 4 after strongly acidic GER. Lavage with water was mildly effective, but required large volumes and predisposed to further regurgitation after anesthesia.

Abstract In the last 20 years, the diagnosis of pancreatitis has become more frequent as a result of improved diagnostic modalities such as abdominal ultrasound examination, advanced imaging, and immunoassays for the measurement of pancreatic lipase. Our aim is to provide a state‐of‐the‐art overview of the clinical diagnosis of acute pancreatitis (AP) in dogs with a particular focus on pancreatic lipase assay validation and clinical performance, in addition to advanced imaging modalities. We also discuss the potential indications for cytology and histopathology in dogs with suspected AP.

Vetica Labs, Inc., San Diego, California Cabrillo Pet Hospital, San Diego, California Department of Internal Medicine, Blue Pearl Specialty, Scottsdale, Arizona Department of Internal Medicine, West LA Animal Hospital, Los Angeles, California Department of Clinical Studies, West LA Animal Hospital, Los Angeles, California Department of Internal Medicine, Katonah Bedford Veterinary Center, New York, New York

O ver the past 15 to 20 years, we have seen what we believe to be an increased incidence of copper-associated hepatopathy in dogs.The onset of this increase appears to have coincided with a change in the type of copper used in premixes added to commercial dog foods.And, more recently, the increased incidence may have been exacerbated by consumerdriven desire for pet foods formulated with a high content of animal-based ingredients (eg, evolutionary diets), including certain organ meats, that might introduce additional copper and by trends favoring foods containing vegetables with a high copper content (eg, sweet potatoes).In light of the increased incidence of copper-associated hepatopathy in dogs, the association between dietary copper and hepatic injury, and the higher copper content of current commercial dog foods, compared with foods marketed prior to the revised guidelines for dietary copper, we believe that it would be prudent to reexamine dietary copper recommendations for dogs and reconsider current guidelines for copper content in commercial dog foods. Copper Content of Commercial Dog Foods and Hepatic Copper Concentrations in DogsIn agreement with suggestions by several previous authors, 1-7 we suspect that copper contents of many commercial dog foods are greater than the biologic requirement of dogs and exceed the tolerance limit for some of them.Guidelines for the nutrient content of commercial dog foods are overseen by the AAFCO, a voluntary association of local, state, and federal agencies that operates in a watchdog capacity to regulate the sale and distribution of animal feeds and animal drug remedies.The AAFCO guidelines 8 describe minimum and, for some nutrients, maximum Viewpoint

OBJECTIVE To evaluate the feasibility of contrast-enhanced CT for assessment of pancreatic perfusion in healthy dogs. ANIMALS 6 healthy purpose-bred female Treeing Walker Coonhounds. PROCEDURES Contrast-enhanced CT of the cranial part of the abdomen was performed with 3-mm slice thickness. Postprocessing computer software designed for evaluation of human patients was used to calculate perfusion data for the pancreas and liver by use of 3-mm and reformatted 6-mm slices. Differences in perfusion variables between the pancreas and liver and differences in liver-specific data of interest were evaluated with the Friedman test. RESULTS Multiple pancreatic perfusion variables were determined, including perfusion, peak enhancement index, time to peak enhancement, and blood volume. The same variables as well as arterial, portal, and total perfusion and hepatic perfusion index were determined for the liver. Values for 6-mm slices appeared similar to those for 3-mm slices. The liver had significantly greater median perfusion and peak enhancement index, compared with the pancreas. CONCLUSIONS AND CLINICAL RELEVANCE Measurement of pancreatic perfusion with contrast-enhanced CT was feasible in this group of dogs. Hepatic arterial and pancreatic perfusion values were similar to previously published findings for dogs, but hepatic portal and hepatic total perfusion measurements were not. These discrepancies might have been attributable to physiologic differences between dogs and people and related limitations of the CT software intended for evaluation of human patients. Further research is warranted to assess reliability of perfusion variables and applicability of the method for assessment of canine patients with pancreatic abnormalities.

Abstract Background Dogs infected with canine parvovirus (CPV) have compromised intestinal epithelial barrier integrity. Production of D‐lactate by enteric bacteria may directly reflect disease severity or contribute to metabolic acid‐base status in these dogs. Hypothesis Serum D‐lactate concentration will be increased in CPV dogs compared to healthy controls and correlate with markers of disease severity and acid‐base status. Animals Dogs with CPV undergoing treatment (n = 40) and healthy control dogs (n = 9). Methods Prospective observational study. Dogs with CPV had a baseline and daily CBC, venous blood gas with serum electrolyte concentrations, composite clinical severity score, and serum D‐lactate concentration performed. A single serum D‐lactate measurement was obtained from healthy control dogs. Results The CPV dogs had a higher D‐lactate concentration (mean ± SD) of 469 ± 173 μM compared to controls, 306 ± 45 μM (P < .001). There was no difference in baseline D‐lactate concentrations for CPV survivors (474 ± 28 μM), versus nonsurvivors (424 ± 116 μM; P = .70). D‐lactate concentration decreased over the first 4 days of treatment (−9.6 μM/d; P = .46). Dogs hospitalized for <4 days had lower baseline D‐lactate concentrations compared to those hospitalized ≥4 days (400 ± 178 μM versus 520 ± 152 μM; P = .03). No sustained correlation over time between serum D‐lactate concentration and clinical severity score or recorded acid‐base results. Conclusions and Clinical Importance Serum D‐lactate concentrations are higher in dogs with CPV compared to healthy controls but do not appear to be clinically relevant. No relationship identified between serum D‐lactate concentrations and markers of CPV disease severity, acid‐base status, or outcome.

Objectives The aim of this study was to assess hepatic copper concentrations and zonal distribution in cat liver specimens. Methods For this study, 121 archived, formalin-fixed, paraffin-embedded liver specimens from cats were used. Tissue sections were stained for copper with rhodanine and scored from 0 (no copper accumulation) to 5 (panlobular copper accumulation). The tissue specimens were then deparaffinized and hepatic copper concentrations were measured using flame atomic absorption spectroscopy. Results Tissue samples were categorized into four groups based on histopathologic findings: (1) no significant histopathologic hepatic changes (n = 66); (2) hepatic steatosis (n = 18); (3) inflammatory or infectious disease (n = 24); and (4) neoplasia (n = 13). Of the 121 specimens, 13 (11%) stained positive for copper, with three having a score ⩾3. Thirty-seven specimens (31%) had copper concentrations above the reference interval ([RI] <180 µg/g dry weight liver). Copper concentrations in cats with hepatic inflammatory or infectious disease were significantly higher than cats with hepatic steatosis ( P = 0.03). Copper-staining score and concentration were positively correlated (r s = 0.46, P <0.001). Conclusions and relevance Despite the fact that 31% of specimens had copper concentrations above the RI, only 11% showed positive copper staining and only 2.5% had a score ⩾3. Our findings suggest that hepatic copper concentrations greater than the upper limit of the RI are relatively common in cats. Further studies to determine the factors that influence hepatic copper staining in cats and to establish contemporary RIs for hepatic copper in healthy cats are warranted.

Endoscopy is the best minimally invasive method for evaluating the oesophagus for inflammatory disease, strictures, foreign bodies and neoplasia. This chapter covers instrumentation, indications and contraindications, patient preparation and positioning, procedure, normal and pathological findings, and complications. The chapter also includes a video clip.

AbstractBackgroundThe etiology of idiopathic chronic hepatitis (ICH) in dogs is poorly understood, but evidence supports an immune‐mediated pathogenesis in some dogs.ObjectivesTo describe a case series of dogs with presumed ICH treated with cyclosporine (CsA) with or without concurrent medications and to document the incidence of biochemical remission and factors associated with failure to attain remission.AnimalsForty‐eight client‐owned dogs diagnosed with presumed ICH, treatment of which included CsA.MethodsTwo‐institution, retrospective case series of dogs between 2010 and 2017. All dogs were treated with CsA with or without concurrent medications for ≥2 weeks. Data were collected from medical records.ResultsBiochemical remission (<1.1 times the upper limit of normal for alanine aminotransferase activity) was attained in 79% of dogs (38/48). Median dose of CsA at remission was 7.9 mg/kg/d (range, 2.5‐12.7 mg/kg/d) and median time to remission was 2.5 months (range, 0.75‐18 months). Concurrent hepatoprotectant treatment was not associated with likelihood of remission. Clinical score, ascites, hypoalbuminemia, hyperbilirubinemia, prolonged coagulation times, dose, and duration of treatment were not associated with the probability of remission or time to remission. Common adverse effects of CsA were gastrointestinal signs in 38% (18/48) and gingival hyperplasia in 25% (12/48) of treated dogs.Conclusion and Clinical ImportanceA treatment regimen including CsA and frequent hepatoprotectant use resulted in biochemical remission of ICH in most dogs. None of the evaluated factors, including hepatoprotectant use, were significantly associated with likelihood of remission. Future prospective studies are indicated to evaluate CsA monotherapy in ICH dogs.

Abstract This consensus statement on chronic hepatitis (CH) in dogs is based on the expert opinion of 7 specialists with extensive experience in diagnosing, treating, and conducting clinical research in hepatology in dogs. It was generated from expert opinion and information gathered from searching of PubMed for manuscripts on CH, the Veterinary Information Network for abstracts and conference proceeding from annual meetings of the American College of Veterinary Medicine and the European College of Veterinary Medicine, and selected manuscripts from the human literature on CH. The panel recognizes that the diagnosis and treatment of CH in the dog is a complex process that requires integration of clinical presentation with clinical pathology, diagnostic imaging, and hepatic biopsy. Essential to this process is an index of suspicion for CH, knowledge of how to best collect tissue samples, access to a pathologist with experience in assessing hepatic histopathology, knowledge of reasonable medical interventions, and a strategy for monitoring treatment response and complications.

The etiology of idiopathic chronic hepatitis (ICH) in dogs is poorly understood, but evidence supports an immune-mediated pathogenesis in some dogs. To describe a case series of dogs with presumed ICH treated with cyclosporine (CsA) with or without concurrent medications and to document the incidence of biochemical remission and factors associated with failure to attain remission. Forty-eight client-owned dogs diagnosed with presumed ICH, treatment of which included CsA. Two-institution, retrospective case series of dogs between 2010 and 2017. All dogs were treated with CsA with or without concurrent medications for ≥2 weeks. Data were collected from medical records. Biochemical remission (<1.1 times the upper limit of normal for alanine aminotransferase activity) was attained in 79% of dogs (38/48). Median dose of CsA at remission was 7.9 mg/kg/d (range, 2.5-12.7 mg/kg/d) and median time to remission was 2.5 months (range, 0.75-18 months). Concurrent hepatoprotectant treatment was not associated with likelihood of remission. Clinical score, ascites, hypoalbuminemia, hyperbilirubinemia, prolonged coagulation times, dose, and duration of treatment were not associated with the probability of remission or time to remission. Common adverse effects of CsA were gastrointestinal signs in 38% (18/48) and gingival hyperplasia in 25% (12/48) of treated dogs. A treatment regimen including CsA and frequent hepatoprotectant use resulted in biochemical remission of ICH in most dogs. None of the evaluated factors, including hepatoprotectant use, were significantly associated with likelihood of remission. Future prospective studies are indicated to evaluate CsA monotherapy in ICH dogs.

Background Acute pancreatitis in dogs is an under‐diagnosed disease. Current diagnostic methods are insufficient at identifying sequelae and lack prognostic capability. Computed tomographic angiography (CTA) is accurate for diagnosis and prognostication of pancreatitis in humans. Objectives In comparison to ultrasound (US), CTA will (1) better diagnose more severe pancreatitis and sequelae and (2) provide assessment of patient outcome by identification of pancreatic contrast enhancement patterns. Animals Twenty‐six client‐owned dogs suspected to have acute pancreatitis. Methods US and CTA examinations performed at time of admission were compared to determine the detection of pancreatic changes and sequelae. CTA findings also were compared to outcome indicators for prognosis of dogs with acute pancreatitis. Specific canine pancreatic lipase (cPL) samples were obtained and compared with CTA findings. Results Ten of 26 dogs had heterogeneous contrast enhancement of the pancreas. Compared to US, CTA better identified portal vein thrombosis ( P = .003). Patients with heterogeneous contrast enhancement had longer hospitalization ( P = .01), including hospital stays for >5 days ( P = .02), had more relapses, and were more likely to have portal vein thrombosis ( P = .002). Patients with heterogeneous contrast enhancement had increased spec cPL ( P = .006). Conclusions and Clinical Importance In comparison to US, CTA better identified dogs with more severe acute pancreatitis and those with portal vein thrombosis, factors that may predict longer hospitalization and increased risk of relapse. The presence of heterogeneous contrast enhancement and portal vein thrombosis may change therapy for patients with acute pancreatitis.

Background Idiopathic chronic hepatitis (CH) in dogs is a prevalent hepatic disorder. The etiology is poorly understood; however, there is evidence to support an immune-mediated pathogenesis. No literature exists investigating the efficacy of cyclosporine (CsA) therapy for CH in dogs. Objectives To retrospectively evaluate the efficacy and adverse side effects of CsA in the treatment of CH in dogs, and to identify factors that impact response to CsA therapy. Animals 48 client-owned dogs diagnosed with CH treated with CsA for at least 2 weeks. Methods Retrospective review of medical records between the years 2010-2017. Results Twenty-two breeds of dogs were included of which 54% were spayed females, 42% neutered males and 4% intact males. Median age was 8.5 years (range, 0.7-14 years). Complete remission (normalization of alanine aminotransferase [ALT]) in response to CsA was attained in 79% of dogs (38/48). Median dose of CsA at the time of remission was 7.9 mg/kg/day (range, 2.5-12.7mg/kg/day) and median time to remission was 2.5 months (range, 0.75-18 months). None of the factors evaluated including clinical score, presence of ascites, hypoalbuminemia, hyperbilirubinemia, prolonged coagulation times, dose, or duration of therapy influenced remission. Common side effects were gastrointestinal signs in 38% (18/48) and gingival hyperplasia in 25% (12/48) of dogs. Conclusion and Clinical Importance CsA proved to be a tolerated and effective medication in attaining remission in dogs with idiopathic CH based on normalization of serum ALT. None of the evaluated factors were shown to negatively impact response to CsA or remission of disease.

Introduction: Maropitant is an antiemetic also known to improve postoperative appetite. Omeprazole is a proton pump inhibitor blocking gastric acid production. This study evaluated the effect of oral maropitant and omeprazole on preoperative emesis, appetite and recovery quality in dogs.

Antiemetics are commonly prescribed during the treatment of canine parvoviral enteritis. This blinded, randomized prospective study compared the quality of clinical recovery and duration of hospitalization in canine parvoviral dogs receiving either maropitant (1 mg/kg [0.45 mg/lb] IV q 24 hr, n = 11) or ondansetron (0.5 mg/kg [0.23 mg/lb] IV q 8 hr, n = 11). All dogs were treated with IV fluids, cefoxitin, and enteral nutrition. Frequency of vomiting and pain scoring were recorded twice daily. Rescue analgesics and antiemetics were administered as dictated by specific pain and vomiting criteria. Clinical severity scoring, body weight, and caloric intake were monitored daily. When comparing dogs receiving maropitant versus ondansetron, respectively, there were no differences in duration of hospitalization (3.36 ± 0.56 versus 2.73 ± 0.38 days, P = .36), requirement of rescue antiemetic (3/11 versus 5/11 dogs, P = .66), duration of vomiting (5 versus 4 days, P = .65), or days to voluntary food intake (2 versus 1.5 days, P = 1.0). Results of this study suggest that maropitant and ondansetron are equally effective in controlling clinical signs associated with parvoviral enteritis.

Introduction: Gastroesophageal reflux (GER) during anesthesia can lead to esophagitis and esophageal stricture. We evaluated the effect of oral maropitant and maropitant with omeprazole on the incidence and pH of GER. We reported the effect of esophageal lavage with tap water on GER pH.