EPI Flashcards
Compare the endocrine and exocrine pancreas
Endo - 2% - hormones in blood
Exo - 98% - into the duodenum
What are the possible causes of EPI?
Most common in dogs - pancreatic acinar atrophy (PAA) just exocrine Cats - chronic pancreatitis (can happen in dogs too) (endo and exocrine function) Pancreatic hypoplasia (endo and exocrine function, puppies, v v v rare) Chronic pancreatic duct obstruction (e.g. by neoplasia) - seen in humans, not documented in animals. Can cause pancreatitis or atrophy
What is the likely signalment of PAA?
Mostly dogs
GSDs/ rough coated collies over represented, possibly also chows
Autosomal recessive
What happens in PAA
Possibly auto-immune,
Marked inflammatory infiltrate with T lymphocytes, leading to loss of secretory ability
subclinical then clinical phases
When do signs of EPI appear?
Maldigestion once 90% of secretory ability is lost
What are the signs of EPI due to?
Loss of digestive ability
Low b12/ other vitamins
Changes in SI mucosa/ microflora
How is the mucosa affected in EPI?
Decrease in intrinsic factors to maintain normal GI mucosa
Abnormal activities and impaired function of mucosal enzymes
Reduced degredation of exposed brush border enzymes
Why are there changes in intestinal microflora in EPI?
Loss of the AB properties of pancreatic juice
Increased amount of substrates for bacteria in the SI lumen
Changes in intestinal motility and immune functions
Bacteria may impair absorption by competing for nutrients and changing intraluminal factors
Outline the loss of B12 in EPI
Water soluble vitamin
Absorbed by specific factors in the ileum when bound to intrinsic factor (made by the pancreas)
V common to be low in b12 with EPI, cats seem to get it more frequently/ severely
There can also be a overgrowth of b12 binding bacteria
What can low b12 lead to?
Anorexia/ lethargy/ weight loss poor hair coat anaemia d+ neuro signs lack of response to other Tx
Aside from b12, what other vitamins may be lacking in EPI?
Vitamin A (no associated clinical sings) Vitamin E (Tochopherol) Vit K (rare, more in cats)
What are the clinical signs of EPI
Polyphagia/ possible coprophagia Weight loss Increase volume/ freq of f+ Flatulence/ borborigmus ++ sometimes v+ Loose yellowish f+ Normally less than 4yo at onset (older in CKCS) Poor coat Nervousness possible (expected due to abdo pain)
What would you see on bloods?
Low TLI
Possibly low b12
low lipid/ cholesterol
Possible mild to moderate increase in ALT - may reflect hepatocyte damage due to increased absorption of hepatotoxic metabolites
Outline the TLI test
Pancreatic specific
Not affected by intestinal disease/ oral pancreatic enzymes
Ideally do a fasted sample (as should increase after eating)
Renal dysfunction can cause a rise in TLI
Outline subclinical EPI
No need for tx
Variable progression, some never get clinical signs
How do you treat EPI
Supplementation of pancreatic enzymes (raw pancreas or dried pancreatic extract)
Pancreas - 500-100g per meal per 20-35kg dog
Give lots then find LED
What may affect Tx of EPI?
Low cobalamin -supplement if low
Small intestinal bacterial overgrowth. many will respond to just the enzymes, but if not may need to give ABs
Some may have co-morbidities (DM or other SI dz). Tx as needed. DM v hard to control if present.
There is an arguement for giving antacids to reduce gastric pH and therefore reduce gastric degredation of enzymes but no definitive evidence to say this works
Why do up to 75% of EPI dogs have SIBO?
Increased availability of nutrients in the intestine lumen
Lack of bacteriostactic factors from pancreatic secretions
Change in intestinal motility and immunity
What diet should you provide for EPI?
Unclear evidence for anything
Fibre may impair pancreatic enzymes
Fat restriction questionable
Normally aim for a highly digestible, low firbre, low fat diet.
What is the general outcome for EPI cases?
50% respond well to treatment
Approx 20-30 PTS in first year
Short relapses can occur
If good response, QoL and life expectancy are normal
