Difference between revisions of "Exocrine Pancreatic Insufficiency"
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| − | {{ | + | {{review}} |
| − | == | + | {{cat}} |
| − | + | {{dog}} | |
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| + | ==Signalment== | ||
| + | *Most common in dog and particularly theses breeds: | ||
| − | + | <gallery> | |
| + | Image:GermanShep.jpg|'''German Shepherd (Alsatian)'''<p>WikiCommons | ||
| + | Image:Rough_Collie.jpg|'''Collie (Rough)'''<p>WikiCommons | ||
| + | </gallery> | ||
| − | + | *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 | |
| − | 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 [[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=== | ||
| + | EPI can be managed with the supplementation of pancreatic enzymes from dried pancreatic extracts. Meals should be fed '''twice a day''' to allow weight gain. Many clinical signs resolve within 5 days. Doses can then be lowered to a minimum effective dose which is different for each animal. Cheaper alternatives include chopped raw cow or pig pancreas. | ||
| + | ===Dietary modification=== | ||
| + | *Diets containing high volumes of non-fermentable fibre should be avoided | ||
| + | *Low fat diets should not be fed | ||
| + | *Certain studies show that: | ||
| + | **animals may do better with a highly digestible diet | ||
| + | **the animals may also benefit from readily hydrolysed and absorbed medium chain triglycerides within the diet | ||
| + | ===Vitamin supplementation=== | ||
| + | Levels of vitamin B12 (cobalamin) and vitamin E (tocopherol) are often found to be low. | ||
| + | *Tocopherol should be supplemented for 1 month | ||
| + | *Cobalamin weekly for several weeks. Long term monitoring should be carried out in cats. | ||
| + | ===Antibiotic therapy=== | ||
| + | Dogs with EPI often have Small Intestinal Bacterial Overgrowth (SIBO). This can be treated with oral oxytetracycline, tylosin or metronidazole. | ||
| + | ===Glucocorticoid therapy=== | ||
| + | This is a last line treatment. | ||
| + | *Oral prednisolone. Long term treatment is usually not needed | ||
| − | + | ==Prognosis== | |
| − | + | EPI is a life-long condition and so is the treatment. However recoveries have been reported. The prognosis is generally good so long as the owner understands the longevity of the disease and the cost involved with treating it. | |
| − | |||
| − | |||
==References== | ==References== | ||
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'' | ||
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Revision as of 11:18, 26 August 2009
 |
This article has been peer reviewed but is awaiting expert review. If you would like to help with this, please see more information about expert reviewing. |
Signalment
- Most common in dog and particularly theses breeds:
German Shepherd (Alsatian)WikiCommons
Collie (Rough)WikiCommons
- 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
EPI can be managed with the supplementation of pancreatic enzymes from dried pancreatic extracts. Meals should be fed twice a day to allow weight gain. Many clinical signs resolve within 5 days. Doses can then be lowered to a minimum effective dose which is different for each animal. Cheaper alternatives include chopped raw cow or pig pancreas.
Dietary modification
- Diets containing high volumes of non-fermentable fibre should be avoided
- Low fat diets should not be fed
- Certain studies show that:
- animals may do better with a highly digestible diet
- the animals may also benefit from readily hydrolysed and absorbed medium chain triglycerides within the diet
Vitamin supplementation
Levels of vitamin B12 (cobalamin) and vitamin E (tocopherol) are often found to be low.
- Tocopherol should be supplemented for 1 month
- Cobalamin weekly for several weeks. Long term monitoring should be carried out in cats.
Antibiotic therapy
Dogs with EPI often have Small Intestinal Bacterial Overgrowth (SIBO). This can be treated with oral oxytetracycline, tylosin or metronidazole.
Glucocorticoid therapy
This is a last line treatment.
- Oral prednisolone. Long term treatment is usually not needed
Prognosis
EPI is a life-long condition and so is the treatment. However recoveries have been reported. The prognosis is generally good so long as the owner understands the longevity of the disease and the cost involved with treating it.
References
Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA