Difference between revisions of "Exocrine Pancreatic Insufficiency"
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| − | {{ | + | {{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 | ||
| − | == | + | ==Description== |
| − | '''Exocrine pancreatic insufficiency (EPI)''' is a syndrome | + | '''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]] | ||
| − | + | ==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=== | |
| − | + | Routine tests are generally unhelpful. Serum alanine aminotransferase (ALT) can have mild to moderate elevations. Other biochemical results include reductions in total lipid, polyunsaturated fatty acid concentraions and cholesterol. | |
| + | The most sensitive and specific test for the diagnosis of EPI is the TLI serum assay. The values are greatly reduced as compared to normal animals. Values <2µg/l in dogs and <8µg/l in cats are considered diagnostic. This test must be carried out after withdrawing food for several hours. Serum fTLI is only available from specialist laboratories. | ||
| + | Other tests are available but are often inconvenient and expensive. | ||
| + | ===Other=== | ||
| + | Atrophy of the pancreas seen via exploratory laparotomy or laparoscopy | ||
| + | ==Treatment== | ||
| + | ===Enzyme replacement=== | ||
| + | ===Dietary modification=== | ||
| + | ===Vitamin supplementation=== | ||
| + | ===Antibiotic therapy=== | ||
| + | ===Glucocorticoid therapy=== | ||
| + | ==Prognosis== | ||
==References== | ==References== | ||
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Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA'' | 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''' | |
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Revision as of 13:17, 7 August 2009
 |
This article is still under construction. |
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
Routine tests are generally unhelpful. Serum alanine aminotransferase (ALT) can have mild to moderate elevations. Other biochemical results include reductions in total lipid, polyunsaturated fatty acid concentraions and cholesterol. The most sensitive and specific test for the diagnosis of EPI is the TLI serum assay. The values are greatly reduced as compared to normal animals. Values <2µg/l in dogs and <8µg/l in cats are considered diagnostic. This test must be carried out after withdrawing food for several hours. Serum fTLI is only available from specialist laboratories. Other tests are available but are often inconvenient and expensive.
Other
Atrophy of the pancreas seen via exploratory laparotomy or laparoscopy
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