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SA DX & TX II > Exam 3 - Exocrine Pancreatic Insufficiency > Flashcards

Exam 3 - Exocrine Pancreatic Insufficiency Flashcards

1
Q

what is exocrine pancreatic insufficiency?

A

syndrome caused by an insufficient amount of pancreatic digestive enzymes in the small intestines

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2
Q

what are some mechanisms that result in EPI due to insufficient pancreatic enzymes?

A

decreased synthesis & secretion from the exocrine pancreas

blockage of pancreatic duct

due to decreased activation of enzymes

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3
Q

EPI is diagnosed more commonly in dogs than cats, but these numbers are misleading - why?

A

fTLI test is only available at the GI lab at TAMU

where as over 90% of cTLI tests are done outside of the TAMU gi lab

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4
Q

T/F: rate of occurrence of EPI in cats has increased in diagnosis over the last few years

A

true

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5
Q

what are the percentages of dogs affected by EPI by age range?

A

under 1 year of age - 3.4%

under 2 years of age - 30.3%

over 2 years of age - 66.4%

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6
Q

what dog breed is most commonly affected by EPI?

A

GSD - 42.1%

other breeds - 57.9%

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7
Q

what cat breeds are most commonly affected by EPI?

A

DSH & persian

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8
Q

why is it important to consider the functional reserve of the exocrine pancreas?

A

the exocrine pancreas has an exceptional functional reserve

so clinical signs do not develop until more than 90% of the exocrine function has been lost

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9
Q

what is the most common etiology of EPI in german shepherd dogs?

A

pancreatic acinar atrophy

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10
Q

is there a breed predilection for EPI in cats?

A

no - higher occurrence in DSH/DLH only because it is the most common cats we encounter

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11
Q

what is the most common cause of EPI in humans & cats?

A

sequelae to chronic pancreatitis

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12
Q

what was the initial suggested causes of pancreatic acinar atrophy?

A

autosomal recessive trait - HAS BEEN DISPROVEN

genetic marker hasn’t been identified - certain haplotypes of MHC class I & II are associated with pancreatic acinar atrophy - autoimmunity

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13
Q

what are the 4 suggested underlying etiologies of exocrine pancreatic insufficiency?

A
  1. pancreatic acinar atrophy
  2. sequela to chronic pancreatitis
  3. sequela to obstruction of the pancreatic duct by pancreatic adenocarcinoma
  4. pancreatic aplasia/hypoplasia
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14
Q

what enzyme appears to be the limiting factor of pancreatic function?

A

pancreatic lipase - rate limiting enzyme for pancreatic digestion

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15
Q

what is the pathogenesis of exocrine pancreatic insufficiency?

A

lack of digestive enzymes in the intestinal lumen causing maldigestion

malabsorption

malassimilation - steatorrhea, increased fecal volume, weight loss, hypovitaminosis

potentially concurrent diabetes mellitus

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16
Q

what is the typical history reported for a patient with EPI?

A

polyphagia - sometimes with corprophagia/pica

weight loss

soft pale voluminous stools

steatorrhea, borborygmus, & flatulence

greasy hair coat in some cats

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17
Q

what are some signs of EPI seen on physical exam?

A

weight loss, poor hair coat, greasy soiling of the hair coat in some cats

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18
Q

what is steatorrhea?

A

fat stays in the feces

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19
Q

what clinical pathology is seen on patients with EPI?

A

normal CBC, hyperglycemia sometimes, slight elevation of SAP in some cases, normal urinalysis

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20
Q

what do you expect serum cobalamin concentrations to be in a dog with EPI?

A

decreased!!!!

21
Q

T/F: hypocobalaminemia when left untreated was shown to be associated with a shorter survival time

A

true

22
Q

what do you expect serum cobalamin concentrations to be in a cat with EPI?

A

decreased in almost all cases

23
Q

what do you expect for results on trypsin-like immunoreactivity in dogs & cats with EPI? what values?

A

severely decreased

dogs cTLI < 2.5ug/l, 100% sensitive & specific
cats fTLI < 8 ug/l, highly specific but unknown sensitivity

24
Q

serum cTLI concentration is specific for what?

A

exocrine pancreatic function

25
Q

what is the most common clinical sign of EPI across all companion animal species?

A

weight loss

26
Q

when do dogs with subclinical EPI require treatment?

A

only when they develop clinical signs

27
Q

what is occult EPI in dogs?

A

dogs that have a moderately decreased serum cTLI concentration (2.5-5.6 ug/l) but have clinical signs compatible with EPI

most of these dogs have small intestinal disease & need further diagnostics, but some of these dogs will have EPI & require therapy (trial therapy if no other diarrhea cause can be identified, & re-evaluate serum cTLI 1 month later)

28
Q

when may a fecal elastase concentration test be useful in a patient with EPI?

A

diagnosing EPI due to an obstruction of the pancreatic duct because these patients would be expected to have normal/elevated serum cTLI concentrations

29
Q

is fecal elastase concentration a better diagnostic test than cTLI for EPI in dogs?

A

no - less sensitive & specific than cTLI, only 60% PPV

30
Q

what is fecal elastase concentration?

A

ELISA test available in united states/europe for measuring fecal elastase

31
Q

what is the pathophysiology behind EPI?

A

in dogs with EPI, there is a lack of the acinar cells & a lack of the zymogen granules

so when CCK is released, very little of these granules are released (granules have the pre-form, which isn’t dangerous to the cells)

in turn, the intestines have a lack of enzymes leading to maldigestion & associated clinical signs

32
Q

what is the mainstay of treatment for EPI?

A

pancreatic enzyme replacement therapy

33
Q

how are pancreatic extracts used for treating EPI?

A

dried extracts from porcine/bovine - 1 tsp/10 kg with each meal, sprinkled over the food

34
Q

how is raw porcine/bovine/other pancreas used to treat EPI?

A

can be stored or frozen for many months - 1-2 ounces per 10 kg with each meal

35
Q

T/F: dose of pancreatic enzyme supplements can be gradually decreased after the patient has a complete response to treatment

A

true

36
Q

what is an adverse effect that has been reported with pancreatic extract supplementation?

A

pancreatic enzyme supplements can cause ulcerations of the oral mucosa & cause oral bleeding - most cases respond quickly to a decrease in dose

37
Q

what are the 2 ways that cobalamin can be administrated for supplementation?

A

oral or parenteral

oral is effacacious in both dogs/cats with cobalamin deficiency

38
Q

what are the advantages of using micro-encapsulated enzymatic products for EPI? what about disadvantages?

A

you can protect pancreatic lipase from destruction by gastric acid

may not release pancreatic enzymes in an efficient manner

39
Q

T/F: products containing microbial lipases are not commonly used & are acid-resistant

A

true

40
Q

what kind of diet should be given to an animal with EPI?

A

premium pet food that is not fat restricted - assimilation of fat doesn’t normalize with enzyme supplementation & restricting fat can cause deficiencies in essential fatty acids & fat soluble vitamins

41
Q

what kind of diet should be avoided for a dog with EPI?

A

high fiber diets - don’t feed

42
Q

T/F: there is not one specific diet that is recommended for dogs with EPI because some patients may do better on whatever diet & not one optimal choice has been described

A

true

43
Q

if you see an EPI patient with a suspected coagulopathy, what drug will you give them?

A

vitamin K

44
Q

T/F: patients with EPI are often vitamin deficient

A

true

45
Q

what vitamin may you need to supplement for patients with EPI?

A

vitamin E - 250-500mg daily per dog for one month

46
Q

what is the prognosis of EPI?

A

most patients require lifelong therapy - few recover

diabetes mellitus may complicate treatment

most treated patients will have a normal life expectancy & quality of life

47
Q

how do you approach patients that don’t respond to treatment for EPI?

A

work up for concurrent conditions

antacids/proton pump inhibitor - decrease gastric acid production, may decrease destruction of supplemented pancreatic lipase

fat restriction as a last resort

48
Q

why do we commonly see small intestinal dysbiosis in patients with EPI?

A

lack of antimicrobial factors in pancreatic juice & maldigestion/malabsorption provides nutrients for small intestinal bacterial proliferation

49
Q

how is small intestinal dysbiosis handled in patients with EPI?

A

usually resolves when patients receive pancreatic enzyme supplementation - if clinical signs don’t improve, put on abx

tylosin at 25mg/kg every 12 hours for 6 weeks

SA DX & TX II (62 decks)

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