Exocrine Pancreatic Insufficiency - Dog
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This article is still under construction. |
Diagnosis
History
Dogs usually have a history of small bowel diarrhoea with weight loss whilst maintaining a normal or increased appetite. There may be a history of vomiting, borborygmus, Coprohagia and flatulence with signs of abdominal discomfort.
Clinical signs
Weight loss and muscle wastage are usually seen in assosiation with EPI.Diarrhoea and steatorrhoea are also common. Hair coat is often in a poor condition and animals may be associated with a foul smell due to haircoat soiling with fatty faecal material.
Laboratory Tests
Modest increases in Serum alanine aminotransferase (ALT) and a decrease in cholesterol concentration are seen on routine biochemical studies in some dogs. Serum concentrations of cobalamin may be low whilst serum folate concentrations may be high. Low serum concentrations of Vitamin E are also frequently documented in dogs with EPI. 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 are considered diagnostic. This test must be carried out after withdrawing food for several hours.
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 and 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.