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==Introduction==

==signalment==

The most common cause of [[Exocrine Pancreatic Insufficiency|Exocrine Pancreatic Insufficiency (EPI)]] in the dog is reported to be [[Pancreatic Atrophy, Exocrine| Pancreatic Acinar Atrophy (PAA)]].

German Shepherd dogs and rough collies are over-represented. Many other breeds however can also be affected by EPI.

==Diagnosis==

==Diagnosis==

===History===

===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.

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===

===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 soiled with fatty faecal material.

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 hair coat soiled with fatty faecal material.

===Laboratory Tests===

===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.

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.

The most sensitive and specific test for the diagnosis of EPI is the '''[[Exocrine Pancreatic Insufficiency|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===

===Other===

Atrophy of the pancreas seen via exploratory laparotomy or laparoscopy

Atrophy of the pancreas seen via exploratory laparotomy or laparoscopy.

==Treatment==

==Treatment==

===Vitamin supplementation===

===Vitamin supplementation===

Levels of vitamin B12 (cobalamin) and vitamin E (tocopherol) are often found to be low and hence should be supplemented. Similarly Cobalamin supplementation is often required.

Levels of vitamin B12 (cobalamin) and vitamin E (tocopherol) are often found to be low and hence should be supplemented.

===Antibiotic therapy===

===Antibiotic therapy===

Dogs with EPI often have Small Intestinal Bacterial Overgrowth (SIBO). This can be treated with oral oxytetracycline, tylosin or metronidazole.

Dogs with EPI often have [[Antibiotic Responsive Diarrhoea|Small Intestinal Bacterial Overgrowth (SIBO)]]. This can be treated with oral oxytetracycline, tylosin or metronidazole.

===Glucocorticoid therapy===

===Glucocorticoid therapy===

Oral prednisolone may be useful in animals that do not respond to the above treatment.  

Oral prednisolone may be useful in animals that do not respond to the above treatment.  

==Prognosis==

==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.

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.