Exocrine Pancreatic Insufficiency

Question 1

What’s the most common cause of exocrine pancreatic insufficiency in cats and dogs?

Answer 1

chronic pancreatitis (100% of cats, 50% of dogs)
- the other 50% of dogs = pancreatic acinar atrophy –> German Shepherds, rough-coated Collies, Eurasians

Question 2

How much pancreatic function needs to be lost before EPI becomes clinical?

Answer 2

90%

Question 3

What are some of the causes of clinical signs noted with EPI?

Answer 3

both maldigestion –> diarrhea, SI microbiota proliferation, weight loss
and malabsorption –> due to lack to trophic factor normally secreted by the pancreas to maintain normal GI mucosa
- lack intrinsic factor –> hypocobalaminemia

Question 4

What are some common clinical signs of EPI?

Answer 4

• weight loss
• loose stool (watery diarrhea is actually uncommon)
• borborygmus
• increased flatulence
• increased appetite

Question 5

How is EPI diagnosed?

Answer 5

trypsin like immunoreactivity, highly sensitive and specific for EPI in dogs and cats

Question 6

What’s the treatment for EPI?

Answer 6

digestive enzyme replacement therapy –> usually with dried up porcine pancreatic powder
- fresh/frozen possible too if cannot do powder

Question 7

What’s the diet recommendation for pets with EPI?

Answer 7

high quality maintenance diet, no fat restriction, but should avoid high fiber
- cobalamin supplement

Question 8

What other supportive therapy can be added if the patient doesn’t respond to digestive enzyme replacement therapy?

Answer 8

• can try tylosin in case of SI diysbiosis
• can try an antacid to decrease destruction of pancreatic lipase in the stomach (but will also decrease the gastric lipase)

Question 9

What’s the prognosis of EPI?

Answer 9

generally will do well – most can be managed successfully and have a normal life
- hypocobalaminemia = negative prognostic factor