Difference between revisions of "Exocrine Pancreatic Insufficiency"

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==Typical Signalment==
 +
*Most common in dog:
 +
**German Shepherd Dogs
 +
**Rough Collie
 +
*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
 +
 +
==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===
  
 +
==Treatment==
 +
===Enzyme replacement===
 +
===Dietary modification===
 +
===Vitamin supplementation===
 +
===Antibiotic therapy===
 +
===Glucocorticoid therapy===
 +
==Prognosis==
  
 +
==References==
  
*'''Exocrine pancreatic insufficiency (EPI)''' is a syndrome caused by insufficient synthesis and secretion of digestive enzymes by the exocrine portion of the pancreas
+
Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
*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
 
*Most common in dog - usually associated with [[Pancreas Degenerative - Pathology|pancreatic atrophy]] or [[Pancreas Inflammatory - Pathology#Chronic Pancreatitis|chronic pancreatitis]]
 
*Occurs occasionally in other species, esp. calves with [[Pancreas Developmental - Pathology#Pancreatic hypoplasia|pancreatic hypoplasia]] and in cats
 
*'''Clinical signs'''
 
**Steatorrhoea
 
**Diarrhoea
 
**Weight loss
 
**Increased appetite
 
  
*In contrast, '''horses''' with very little pancreatic tissue develop '''hypoinsulinism''' but rarely EPI
+
Merck & Co (2008) '''The Merck Veterinary Manual'''

Revision as of 13:03, 7 August 2009



Typical Signalment

  • Most common in dog:
    • German Shepherd Dogs
    • Rough Collie
  • 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

Treatment

Enzyme replacement

Dietary modification

Vitamin supplementation

Antibiotic therapy

Glucocorticoid therapy

Prognosis

References

Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA

Merck & Co (2008) The Merck Veterinary Manual