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Exocrine Pancreatic Insufficiency
In this condition the exocrine (outer) part of the pancreas may lose its ability to make digestive enzymes. This is usually caused by irreversible atrophy of the pancreas which subsequently requires life-long therapy. Exocrine pancreatic insufficiency (EPI)is a particular problem in families of German Shepherd Dogs, in which it is an inherited condition. EPI results in small intestinal bacterial overgrowth that can be reversed by pancreatic replacement therapy, indicating that pancreatic secretions can have an important influence on the small intestinal bacterial flora of dogs. Affected dogs eat voraciously but lose weight. They pass large quantities of gray stool.
Pancreatic Acinar Atrophy
Pancreatic acinar atrophy (PAA) is a degenerative disease of the exocrine pancreas and is the most common cause of exocrine pancreatic insufficiency in the German Shepherd Dog. In pancreatic acinar atrophy a destruction of digestive enzyme-producing acinar cells leads to poor digestion. Chronic pancreatitis is a common cause of exocrine pancreatic insufficiency (EPI) in humans and cats but is rarely recognised in dogs in which pancreatic acinar atrophy is reportedly more common. Chronic pancreatitis may be a more common cause of EPI in dogs than previously assumed and may be under-recognised because of difficulties in diagnosis. Evaluation of data by complex analysis is strongly suggestive of an autosomal recessive mode of inheritance for EPI in German Shepherds in the United States.
Signs
Diagnosis of exocrine pancreatic insufficiency is based on signs and laboratory tests. Blood tests show low levels of digestive enzymes. Pancreatic disorders in dogs and cats are recognized with increasing frequency, and abdominal ultrasonography has assumed an important role in their diagnosis.
Treatment
The primary treatment of EPI is supplementing each meal with pancreatic enzymes. Dogs are given commercially produced dry pancreatic extract. Dogs also should be fed supplements of fat-soluble vitamins, especially vitamin E. Antibiotics and corticosteroids are used in some cases. Response to long-term enzyme treatment in dogs with EPI varies considerably, making it difficult to determine prognosis for individual patients. Response to initial treatment and survival are affected by signs and therapeutic methods employed. Long-term prognosis in canine EPI is favorable for dogs that survive the initial treatment period. Although it is possible to predict the long-term survival, severe cobalamin deficiency is associated with shorter survival. Therefore, cobalamin supplementation may be considered in some cases.
References
- Caring for Your Dog by Bruce Fogle, DVM, MRCVS
- Sonographic evaluation of the normal and abnormal pancreas.Hecht S, Henry G.
Department of Small Animal Clinical Sciences, The University of Tennessee College of Veterinary Medicine, Knoxville, TN 37996-4544, USA.
- Prognostic factors in canine exocrine pancreatic insufficiency: prolonged survival is likely if clinical remission is achieved.Batchelor DJ, Noble PJ, Taylor RH, Cripps PJ, German AJ. Small Animal Hospital, Department of Veterinary Clinical Science, University of Liverpool, UK.
- Effects of diet on clinical signs of exocrine pancreatic insufficiency in dogs.Westermarck E, Wiberg ME. Department of Clinical Veterinary Sciences, Faculty of Veterinary Medicine, University of Helsinki, Finland.
- Exocrine pancreatic insufficiency as an end stage of pancreatitis in four dogs.Watson PJ. Department of Clinical Veterinary Medicine, University of Cambridge
- Effects of exocrine pancreatic insufficiency and replacement therapy on the bacterial flora of the duodenum in dogs.Simpson KW, Batt RM, Jones D, Morton DB.
Department of Biomedical Services, University of Leicester, UK.
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