Exocrine Pancreatic Insufficiency - Cat
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Description
Exocrine Pancreatic Insufficiency is a rare disease in cats but can occur following chronic pancreatitis.
Diagnosis
History
Cats with EPI have a history of chronic small bowel diarrhoea and weight loss combined with a ravenous appetite.
Clinical signs
Weight loss and muscle wastage are usually seen in assosiation with EPI. Diarrhoea and steatorrhoea are also common. Cats may present with a wet, greasy looking body coat particularly around the perineal area, this may be a result of fatty soiling or secondary to cobalamin deficiency.
Laboratory Tests
Routine hamatology and biochemistry are often unremarkable in cats with EPI. Serum concentrations of cobalamin are often decreased. Serum folate concentrations may also be decreased due to concurrent Inflammatory bowel disease or Intestinal lymphoma. The most sensitive and specific test for the diagnosis of feline EPI is the feline trypsin-like immunoreactivity assay(fTLI). The values are greatly reduced as compared to normal animals. Values <8µg/l in cats are considered diagnostic. This test must be carried out after withdrawing food for several hours. Unfortunatley the fTLI assay is only available from specialist laboratories, other tests are available but are often inconvenient and expensive. Due to the pathophysiology of the disease Cats with EPI may also have concurrent Diabetes mellitus.
Other
Atrophy of the pancreas seen via exploratory laparotomy or laparoscopy
Treatment
Enzyme replacement
Pancreatic enzyme replacement, raw pancreas (10-20g/feed is generally more effective than dried enzyme replacment and can be stored frozen for at least three months). Clinical signs often resolve within four to five days.
Dietary modification
A fat restricted diet is advised.
Vitamin supplementation
In cats Cobalamin absorption depends on adequate secretion of intrinsic factor, in cats 99% of intrinsic factor is released from the exocrine pancreas and subsequently cats with EPI are frequently cobalamin deficient. Cats diagnosed with EPI should be supplemented every two weeks to maintain normal serum cobalamin levels. Long term monitoring of serum cobalamin is advised. Similarly cats with EPI may also have subnormal Vitamin E levels which should be measured and corrected. A Vitamin K responsive coagulopathy has been reported in cats and hence it is sensible to examine the vitamin K status of cats with EPI.
Glucocorticoid therapy
Oral prednisolone may be useful in animals that do not respond to the above treatment. This is normally only required for a short period.
Cats that do not respond well to the treatment listed above may have small intestinal disease causing malabsorption despite adequate pancreatic enzyme replacement. These cases usually require further investigation of the small intestine.
Prognosis
EPI is generally irreversible and hence life-long treatment is needed. The prognosis is generally good as long the owner is aware of 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
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.