Exocrine pancreatic insufficiency

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Exocrine pancreatic insufficiency (EPI) is the inability to properly digest food due to a lack of digestive enzymes made by the pancreas. This disease is found frequently in dogs. EPI is caused by a progressive loss of the pancreatic cells that make digestive enzymes. Most commonly, this is caused by pancreatic acinar atrophy. The atrophy in turn can be caused by previous infections, a blocked pancreatic duct, or genetics. Chronic pancreatitis is the most common cause of EPI in humans and cats, but it is an uncommon cause in dogs.

Symptoms

Symptoms of EPI are not present until 85 to 90 percent of the pancreas is unable secrete the enzymes. Diabetes mellitus is usually not seen in dogs with EPI, unless there is a congenital underdevelopment of the pancreas.

EPI causes malabsorption of food from the intestines. Symptoms include weight loss, poor hair coat, flatulence, increased appetite, coprophagia, and diarrhea. Feces are often yellow-gray in color with an oily texture. It is most common in young German Shepherd Dogs, and Rough Collies in Finland.

Diagnosis and treatment

The most reliable test for EPI is serum trypsin-like immunoreactivity (TLI). A low number indicates EPI.

The best treatment is to supplement the dog's food with dried pancreatic extracts. There are commercial preparations available, but chopped pork pancreas from the butcher can also be used. Symptoms usually improve within a few days, but lifelong treatment is required in most cases. Because of malabsorption, serum levels of cyanocobalamin (vitamin B12) and tocopherol (vitamin E) may be low. These may also be supplemented. If there is bacterial overgrowth in the intestine, antibiotics should be used, especially if treatment is not working. In dogs failing to gain weight or continuing to show symptoms, modifying the diet to make it low fiber, low fat, and highly digestible may help.

Volvulus or mesenteric torsion is a rare complication of EPI.

References

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