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Exocrine pancreatic insufficiency in dogs
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Exocrine pancreatic insufficiency is a debilitating disease which is underdiagnosed in dogs; María-Dolores Tabar Rodríguez discusses the condition, its diagnosis and treatment.
María-Dolores Tabar Rodríguez
DVM, Dipl. ECVIM-CA, Acred. AVEPA Internal Medicine, Hospital Veterinario San Vicente, San Vicente del Raspeig-Alicante, Spain.
Dr. Tabar Rodríguez qualified from the University of Zaragoza in 2001 and undertook a small animal internship and a European Residency in Internal Medicine at the Hospital Clínic Universitari with the Autonomous University of Barcelona (UAB). She became a Diplomate of the European College of Veterinary Internal Medicine (specialty in small animals) in 2010 and is currently in charge of the internal medicine department at the Hospital Veterinario San Vicente in Alicante.
Key Points:
- Exocrine pancreatic insufficiency (EPI) must be considered in any dog showing one or more of the appropriate clinical signs, but especially if there is small intestinal diarrhea and weight loss.
- EPI diagnosis is essentially functional and is based on assessment of pancreatic function by measurement of serum trypsin-like immunoreactivity (TLI).
- Therapy for these patients focuses on the administration of pancreatic enzymes, adequate nutrition, and cobalamin supplementation.
- Although not all patients show an optimal response to treatment, the prognosis is generally good but requires ongoing treatment and regular monitoring.
Introduction
Exocrine pancreatic insufficiency (EPI) in dogs can cause poor absorption and digestion of food, with affected animals showing a progressive and serious deterioration in their health status. The veterinarian must know which breeds are predisposed to the problem and should be familiar with the clinical presentation, as well as being aware that concomitant disease may also be present. The clinician should, therefore, be alerted to the possibility of EPI when presented with a dog that shows one or more of the signs typically encountered with the disease, which will allow appropriate diagnostic tests to be instigated.
EPI – an overview
Exocrine pancreatic diseases have a significant prevalence in small animals yet are often underdiagnosed. Diagnosis can sometimes be complicated due to the presence of non-specific clinical signs, the possibility of concomitant disease, and difficulties in interpreting laboratory results and imaging tests. The most common disease processes of the exocrine pancreas are pancreatitis and exocrine pancreatic insufficiency; however, the exocrine pancreas can also be affected by neoplastic processes that, although rare in small animals, can be confused with other lesions such as cysts, pseudocysts, or pancreatic abscesses.
The exocrine pancreas is responsible for the secretion of various substances that contribute to several important functions, including digestion of proteins, carbohydrates, and lipids (via digestive enzymes); helping to neutralize the duodenum (via bicarbonate, chlorine and water); intervening in the absorption of cobalamin (via intrinsic factor); and regulating the bacterial flora of the small intestine (via antibacterial proteins). EPI is a disorder of the gastrointestinal tract characterized by insufficient production of digestive enzymes by the pancreatic acinar cells; clinical signs will appear when over 90% of exocrine pancreatic function is lost.[...]
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