Pancreatic Atrophy, Exocrine

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AKA Pancreatic Acinar Athropy (PAA)


Pancreatic atrophy (Image sourced from Bristol Biomed Image Archive with permission)
  • Degeneration of acinar cells ccurs as a sequel to
    • Starvation - loss of zymogen granules
    • Maldigestion
    • Obstruction of the pancreatic ducts by
      • Neoplasm
      • Chronic inflammation and associated fibrosis
      • Foreign bodies (parasites, pancreoliths
    • Specific nutritional deficiencies include: essential amino acids, zinc, copper, selenium

Clinical signs

  • By the time clinical signs of exocrine pancreatic insufficiency (EPI) appear, the pancreas is usually almost totally destroyed
  • Chronic diarrhoea with steatorrhoea and undigested muscle fibres. Large quantities of pale faeces are passed (due to dilution of bile pigment and the presence of undigested fats). The faeces have a characteristic rancid or cheesy odour.
  • Loss of condition despite marked increase in appetite

Macroscopic appearance

  • The pancreas is extremely thin and almost lace-like
  • Primarily acinar tissue affected; the ducts and Islets of Langerhans are relatively normal

Microscopic appearance

  • In these cases the parenchyma is replaced by atypical parenchyma and adipose tissue
  • Irregular, shrunken acini composed of cells with little cytoplasm
  • Some cases show a few areas of apparently normal glandular tissue or foci of cellular infiltraton which have been interpreted as suggesting degenerative changes

Aetiology

  • The underlying cause is not known, possibly due to nutritional imbalances
  • Chronic pancreatitis is a rare cause of EPI
  • Possible hereditary EPI in GSDs and rough coated collies

Diagnosis

  • Low serum trypsin-like immunoreactivity is an early, preclinical diagnostic test for EPI