Changes

===Clinical signs===

===Clinical signs===

Weight loss and muscle wastage are usually seen in assosiation with EPI. Diarrhoea and steatorrhoea are also common. Cats may present with a wet, greasy looking body coat particularly around the perineal area this may be a result of fatty soiling or secondary to cobalamin deficiency. Cats with EPI may also have concurrent Diabetes mellitus.   

Weight loss and muscle wastage are usually seen in assosiation with EPI. Diarrhoea and steatorrhoea are also common. Cats may present with a wet, greasy looking body coat particularly around the perineal area, this may be a result of fatty soiling or secondary to cobalamin deficiency. Cats with EPI may also have concurrent Diabetes mellitus.   

===Laboratory Tests===

===Laboratory Tests===

Routine hamatology and biochemistry are often unremarkable in cats with EPI.

Routine hamatology and biochemistry are often unremarkable in cats with EPI.

Serum concentrations of cobalamin are often decreased. Serum folate concentrations may also be decreased due to concurrent [[Inflammatory Bowel Disease|Inflammatory bowel disease]] or Intestinal lymphoma.

Serum concentrations of cobalamin are often decreased. Serum folate concentrations may also be decreased due to concurrent [[Inflammatory Bowel Disease|Inflammatory bowel disease]] or Intestinal lymphoma.

The most sensitive and specific test for the diagnosis for feline EPI is the feline trypsin-like immunoreactivity assay('''fTLI'''). The values are greatly reduced as compared to normal animals. Values '''<8µg/l''' in cats are considered diagnostic. This test must be carried out after withdrawing food for several hours.

The most sensitive and specific test for the diagnosis of feline EPI is the feline trypsin-like immunoreactivity assay('''fTLI'''). The values are greatly reduced as compared to normal animals. Values '''<8µg/l''' in cats are considered diagnostic. This test must be carried out after withdrawing food for several hours. Unfortunatley the fTLI assay is only available from specialist laboratories, other tests are available but are often inconvenient and expensive.

===Other===

===Other===

==Treatment==

==Treatment==

===Enzyme replacement===

===Enzyme replacement===

Pancreatic enzyme replacement, raw pancreas (10-20g/feed is generally more effective than dried enzyme replacment and can be stored frozen for at least three months.  

Pancreatic enzyme replacement, raw pancreas (10-20g/feed is generally more effective than dried enzyme replacment and can be stored frozen for at least three months).

Clinical signs often resolve within four to five days.

===Dietary modification===

===Dietary modification===

===Vitamin supplementation===

===Vitamin supplementation===

Levels of vitamin B12 (cobalamin) and vitamin E (tocopherol) are often found to be low and hence should be supplemented. Similarly Cobalamin supplementation is often required.

Cats are particularly susceptible to deveelopment of severe cobalamin deficiency and hence should be supplemented every two weeks to maintain normal serum cobalamin levels. Long term monitoring of serum cobalamin is advised. Similarly cats with EPI may also have subnormal Vitamin E levels which should be measured and corrected. A vitamin K- responsive coagulopathy has been reported in cats and hence it is sensible to examine the vitamin K status of cats with EPI.  

 

Dogs with EPI often have Small Intestinal Bacterial Overgrowth (SIBO). This can be treated with oral oxytetracycline, tylosin or metronidazole.

===Glucocorticoid therapy===

===Glucocorticoid therapy===

Oral prednisolone may be useful in animals that do not respond to the above treatment.  

Oral prednisolone may be useful in animals that do not respond to the above treatment. This is normally only required for a short period.

 

==Prognosis==

==Prognosis==

EPI is generally irreversible and hence life-long treatment is needed. The prognosis is generally good as long the owner is aware of the longevity of the disease and the cost involved with treating it.

EPI is generally irreversible and hence life-long treatment is needed. The prognosis is generally good as long the owner is aware of the longevity of the disease and the cost involved with treating it.