The clinical signs of pancreatitis are often variable, and the intensity of the disease will depend on the amount of enzymes that are prematurely activated. The most common clinical signs include nausea, vomiting, fever, lethargy, abdominal pain, diarrhea, and decreased appetite. During an attack, dogs may take a 'praying position', with their rear end up in the air and their front legs and head lowered onto the floor. If the attack is severe, acute shock, severe depression, and even death may occur. Some dogs with pancreatitis, especially chronic pancreatitis, will escape detection with many of these tests. Ultrasound studies often diagnose pancreatic inflammation or local peritonitis caused by this condition. Unfortunately, some dogs with pancreatitis, especially chronic pancreatitis, will escape detection with many of these tests. Consequently, the diagnosis of pancreatitis may be tentative or presumptive in some cases and based solely on clinical signs and medical history.