Exocrine Pancreatic Insufficiency

Also known as: EPI — Pancreatic Exocrine Insufficiency

Introduction

Exocrine pancreatic insufficiency (EPI) is a syndrome characterised by insufficient secretion of digestive enzymes by the exocrine portion of the pancreas. Most commonly EPI occurs following the progressive reduction in pancreatic mass caused by pancreatic acinar atrophy or chronic pancreatitis. EPI may also occur secondary to excessive gastric acid secretion (excess acid affects the activity and production of the pancreatic enzymes) or severe protein malnutrition (decreased synthesis of pancreatic enzymes). Concurrent diabetes mellitus and pancreatic hypoplasia have also been documented as causes in the dog.

The Pancreas has a considerable functional reserve and a large proportion needs to be non-functional to show signs of EPI. In the dog EPI is mostly caused by Exocrine Pancreatic Atrophy or Pancreatic Acinar Atrophy (PAA). In the cat EPI is usually associated with chronic pancreatitis.

Signalment

EPI is most common in the dog, German Shepherd dogs and rough collies are over-represented. Many other breeds however can also be affected by EPI.

EPI can occur in cats as a result of chronic pancreatitis and also occasionally in calves with pancreatic hypoplasia. In contrast, horses with very little pancreatic tissue develop hypoinsulinism but rarely EPI.

Exocrine Pancreatic Insufficiency in the dog

Exocrine Pancreatic Insufficiency in the cat

TLI (Trypsin-Like Immunoreactivity)

Serum TLI is the test of choice for exocrine pancreatic insufficiency (EPI) in both the dog and the cat. Serum is essential and the patient should be fasted for at least 6 hours but preferably, overnight. Acute pancreatitis produces marked increases, but it is important to sample the patient as early as possible, since serum activities decline as the disease progresses. TLI is excreted by the kidneys and activity may be increased 2-3 fold in azotaemic patients. This is not a definitive test for pancreatitis as the sensitivity of this test is low. Pancreatic lipase immunoreactivity is recommended for diagnosis of pancreatitis.

Increased TLI activity

• Pancreatitis (CPLi and FPLi are used for diagnosis)
• Reduced renal excretion

Decreased activity

• Exocrine pancreatic insufficiency

Complementary tests

DGGR lipase, PLI, urea, creatinine and urine SG. In cats, triaditis (concurrent inflammation of pancreas, liver and small intestine) is more common than primary pancreatitis and in this species, vitamin B12 and folate may be appropriate.

Test Codes - Please visit www.nwlabs.co.uk or see our current price list for more information

Exocrine Pancreatic Insufficiency Learning Resources
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References

Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA

Ettinger, S.J, Feldman, E.C. (2005) Textbook of Veterinary Internal Medicine (6th edition, volume 2)

Sturgess, K. (2003) Notes on Feline Internal Medicine Blackwell Publishing.

Tams, T.R. (2003) Handbook of Small Animal Gastroenterology (2nd edition) Saunders.

TLI: NationWide Laboratories

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