Difference between revisions of "Exocrine Pancreatic Insufficiency"

Revision as of 13:03, 7 August 2009

Typical Signalment

Most common in dog:
- German Shepherd Dogs
- Rough Collie
Occurs occasionally in other species including calves with pancreatic hypoplasia and in cats (chronic pancreatitis)
In contrast, horses with very little pancreatic tissue develop hypoinsulinism but rarely EPI

Description

Exocrine pancreatic insufficiency (EPI) is a syndrome caused by insufficient synthesis and secretion of digestive enzymes by the exocrine portion of the pancreas

Leading to insufficient activity of digestive enzymes in the lumen of the small intestine
Pancreas has considerable functional reserve, large proportion needs to be non-functional to show signs of EPI
In dog it is mostly caused by pancreatic atrophy or Pancreatic Acinar Atrophy (PAA)
In the cat it is usually associated with chronic pancreatitis

Diagnosis

History

Weight loss with or without polyphagia (usually ravenous with scavenging)
Coprophagia and pica
Polyuria and polydipsia due to Diabetes Mellitus
Varible diarrhoea (large volumes of semi-formed faeces)
Vomiting
Borborygmus and flatulance

Clinical Signs

Steatorrhoea
Diarrhoea
Mild to marked weight loss
Muscle wastage
Polyphagia
Poor haircoat
Flatulance

Laboratory Tests

Treatment

Enzyme replacement

Dietary modification

Vitamin supplementation

Antibiotic therapy

Glucocorticoid therapy

Prognosis

References

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

Merck & Co (2008) The Merck Veterinary Manual

@@ Line 1: / Line 1: @@
-{{OpenPagesTop}}Also known as: '''''EPI — Pancreatic Exocrine Insufficiency'''''
+{{unfinished}}
+==Typical Signalment==
+*Most common in dog:
+**German Shepherd Dogs
+**Rough Collie
+*Occurs occasionally in other species including calves with [[Pancreas Developmental - Pathology#Pancreatic hypoplasia|pancreatic hypoplasia]] and in cats ([[Pancreas Inflammatory - Pathology#Chronic Pancreatitis|chronic pancreatitis]])
+*In contrast, '''horses''' with very little pancreatic tissue develop '''hypoinsulinism''' but rarely EPI
-==Introduction==
+==Description==
-'''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.
+'''Exocrine pancreatic insufficiency (EPI)''' is a syndrome caused by insufficient synthesis and secretion of digestive enzymes by the exocrine portion of the pancreas
+*Leading to insufficient activity of digestive enzymes in the lumen of the small intestine
+*Pancreas has considerable functional reserve, large proportion needs to be non-functional to show signs of EPI
+*In dog it is mostly caused by [[Pancreas Degenerative - Pathology|pancreatic atrophy]] or Pancreatic Acinar Atrophy (PAA)
+*In the cat it is usually associated with [[Pancreas Inflammatory - Pathology#Chronic Pancreatitis|chronic pancreatitis]]
-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 [[Pancreatic Atrophy, Exocrine| Exocrine Pancreatic Atrophy]] or [[Pancreatic Atrophy, Exocrine|Pancreatic Acinar Atrophy (PAA)]]. In the cat EPI is usually associated with [[Pancreatitis|chronic pancreatitis]].
+==Diagnosis==
+===History===
+*Weight loss with or without polyphagia (usually ravenous with scavenging)
+*Coprophagia and pica
+*Polyuria and polydipsia due to Diabetes Mellitus
+*Varible diarrhoea (large volumes of semi-formed faeces)
+*Vomiting
+*Borborygmus and flatulance
+===Clinical Signs===
+*Steatorrhoea
+*Diarrhoea
+*Mild to marked weight loss
+*Muscle wastage
+*Polyphagia
+*Poor haircoat
+*Flatulance
+===Laboratory Tests===
-==Signalment==
+==Treatment==
-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.
+===Enzyme replacement===
+===Dietary modification===
-EPI can occur in cats as a result of [[Pancreatitis|chronic pancreatitis]] and also occasionally in calves with [[Pancreatic Hypoplasia|pancreatic hypoplasia]]. In contrast, '''horses''' with very little pancreatic tissue develop '''hypoinsulinism''' but rarely EPI.
+===Vitamin supplementation===
+===Antibiotic therapy===
-<big>'''[[Exocrine Pancreatic Insufficiency - Dog|Exocrine Pancreatic Insufficiency in the dog]]
+===Glucocorticoid therapy===
+==Prognosis==
-'''[[Exocrine Pancreatic Insufficiency - Cat|Exocrine Pancreatic Insufficiency in the cat]]</big>
-{{Learning
-|Vetstream = [https://www.vetstream.com/felis/search?s=exocrine Exocrine pancreatic insufficiency (EPI)]
-|literature search = [http://www.cabdirect.org/search.html?rowId=1&options1=AND&q1=%22Exocrine+Pancreatic+Insufficiency%22&occuring1=title&rowId=2&options2=AND&q2=&occuring2=freetext&rowId=3&options3=AND&q3=&occuring3=freetext&x=37&y=15&publishedstart=yyyy&publishedend=yyyy&calendarInput=yyyy-mm-dd&la=any&it=any&show=all Exocrine pancreatic insufficiency publications]
-}}
 ==References==
@@ Line 27: / Line 44: @@
 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)
+Merck & Co (2008) '''The Merck Veterinary Manual'''
-Sturgess, K. (2003) '''Notes on Feline Internal Medicine''' Blackwell Publishing.
-Tams, T.R. (2003) '''Handbook of Small Animal Gastroenterology''' (2nd edition) Saunders.
-{{review}}
-{{OpenPages}}
-[[Category:Pancreas_-_Pathology]]
-[[Category:Pancreatic Diseases - Cattle]]
-[[Category:Expert_Review]]