Difference between revisions of "Exocrine Pancreatic Insufficiency"

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{{OpenPagesTop}}Also known as: '''''EPI — Pancreatic Exocrine Insufficiency'''''
  
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==Introduction==  
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| Also known as:
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'''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.
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| '''EPI
 
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<br>
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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]].
  
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==Description==
 
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'''Exocrine pancreatic insufficiency (EPI)''' is a syndrome caused by insufficient synthesis and secretion of digestive enzymes by the exocrine portion of the pancreas
 
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*Leading to insufficient activity of digestive enzymes in the lumen of the small intestine
 
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*Pancreas has considerable functional reserve, large proportion needs to be non-functional to show signs of EPI
 
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*In dog it is mostly caused by [[Pancreatic Atrophy, Exocrine]] or Pancreatic Acinar Atrophy (PAA)
 
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*In the cat it is usually associated with [[Pancreatitis, Chronic Interstitial|chronic pancreatitis]]
 
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For EPI in the dog see [[Exocrine Pancreatic Insufficiency - Dog| here]]
 
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For EPI in the cat see [[Exocrine Pancreatic Insufficiency - Cat| here]]
 
 
==Signalment==
 
==Signalment==
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*Most common in dog and particularly theses breeds:
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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.
  
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<gallery>
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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.
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Image:GermanShep.jpg|'''German Shepherd (Alsatian)'''<p>Copyright
 
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Image:Rough_Collie.jpg|'''Collie (Rough)'''<p>Copyright Sannse 2003
 
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</gallery>
 
  
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*Occurs occasionally in other species including calves with [[Pancreatic Hypoplasia|pancreatic hypoplasia]] and in cats ([[Pancreatitis, Chronic Interstitial|chronic pancreatitis]])
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<big>'''[[Exocrine Pancreatic Insufficiency - Dog|Exocrine Pancreatic Insufficiency in the dog]]
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*In contrast, '''horses''' with very little pancreatic tissue develop '''hypoinsulinism''' but rarely EPI
 
  
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'''[[Exocrine Pancreatic Insufficiency - Cat|Exocrine Pancreatic Insufficiency in the cat]]</big>
  
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==Diagnosis==
 
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===History===
 
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*Weight loss with or without polyphagia (usually ravenous with scavenging)
 
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*Coprophagia and pica
 
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*Polyuria and polydipsia due to Diabetes Mellitus
 
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*Varible diarrhoea (large volumes of semi-formed faeces)
 
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*Vomiting
 
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*Borborygmus and flatulance
 
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===Clinical Signs===
 
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*Steatorrhoea
 
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*Diarrhoea
 
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*Mild to marked weight loss
 
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*Muscle wastage
 
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*Polyphagia
 
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*Poor haircoat
 
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*Flatulance
 
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===Laboratory Tests===
 
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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.
 
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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.
 
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Other tests are available but are often inconvenient and expensive.
 
  
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===Other===
 
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Atrophy of the pancreas seen via exploratory laparotomy or laparoscopy
 
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==Treatment==
 
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===Enzyme replacement===
 
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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.
 
  
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===Dietary modification===
 
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*Diets containing high volumes of non-fermentable fibre should be avoided
 
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*Low fat diets should not be fed
 
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*Certain studies show that:
 
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**animals may do better with a highly digestible diet
 
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**the animals may also benefit from readily hydrolysed and absorbed medium chain triglycerides within the diet
 
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===Vitamin supplementation===
 
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Levels of vitamin B12 (cobalamin) and vitamin E (tocopherol) are often found to be low.
 
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*Tocopherol should be supplemented for 1 month
 
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*Cobalamin weekly for several weeks. Long term monitoring should be carried out in cats.
 
  
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===Antibiotic therapy===
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{{Learning
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Dogs with EPI often have Small Intestinal Bacterial Overgrowth (SIBO). This can be treated with oral oxytetracycline, tylosin or metronidazole.
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|Vetstream = [https://www.vetstream.com/felis/search?s=exocrine Exocrine pancreatic insufficiency (EPI)]
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|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]
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}}
  
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===Glucocorticoid therapy===
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==References==
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This is a last line treatment.
 
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*Oral prednisolone. Long term treatment is usually not needed
 
  
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==Prognosis==
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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''
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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.
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Ettinger, S.J, Feldman, E.C. (2005) '''Textbook of Veterinary Internal Medicine''' (6th edition, volume 2)
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Sturgess, K. (2003) '''Notes on Feline Internal Medicine''' Blackwell Publishing.
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Tams, T.R. (2003) '''Handbook of Small Animal Gastroenterology''' (2nd edition) Saunders.
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==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''
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{{review}}
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[[Category:Pancreas_-_Pathology]][[Category:To_Do_-_Clinical]]
 
  
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[[Category:To Do - Caz]]
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{{OpenPages}}
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[[Category:Pancreas_-_Pathology]]
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[[Category:Pancreatic Diseases - Cattle]]
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[[Category:Expert_Review]]

Latest revision as of 19:05, 12 April 2022


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




Exocrine Pancreatic Insufficiency Learning Resources
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(CABI log in required) 		Exocrine pancreatic insufficiency publications


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.



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.



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