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Exocrine Pancreatic Insufficiency - Ladue News: Special Features

Exocrine Pancreatic Insufficiency

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Posted: Thursday, January 27, 2011 12:00 am | Updated: 10:54 pm, Tue Aug 9, 2011.

At the behest of a friend of mine, I decided to help her spread the word about a medical problem that she has become passionate about since she lost her dog Wolf. That problem is called Exocrine Pancreatic Insufficiency, or, EPI.

The pancreas is a pretty remarkable organ in that it controls a lot more than one function. It has an endocrine function (hormonal) and an exocrine function, aiding the digestive process. Two sets of cells in one gland regulating separate but related functions. Pretty cool gland, that pancreas.

The endocrine portion of the pancreas has to do with insulin production and therefore, blood sugar control. When this part gets damaged, it can result in a diabetic dog or cat. The exocrine portion, or acinar cells, secrete digestive enzymes near the exit of the stomach into the small intestine. These enzymes become activated in the intestinal tract. I could get all chemically complicated and completely confuse you, but that is not how I practice. Suffice it to say, there are different enzymes for different digestive purposes: this one’s for fats, that one’s for proteins and the other one is for carbohydrates. There are other players in the mix, like vitamin absorbers, for example. It truly is an amazing cascade of events that allow food to be transformed from a meal into the things the body needs.

Why the overview of pancreatic anatomy and physiology? As they said in vet school, “You must understand the normal before you can discern the abnormal.” There are two main ways to get exocrine pancreatic insufficiency (EPI). Either you destroy the exocrine part or you never had a good one to begin with.

Pancreatitis is the most common destroyer of the organ itself. “Itis” refers to inflammation in any sense of the part of the word preceding it. Pancreatitis is inflammation of the pancreas, a particularly painful process the damages the pancreas with scar tissue as it heals. Repeated bouts of pancreatitis cause increased scarring, thus reducing the functional remainder of healthy pancreatic tissue. Schnauzers are one breed prone to pancreatitis, as are obese dogs. If enough tissue is destroyed, your dog will not have the capability to digest food properly. This is acquired EPI.

Most dogs with EPI are thought to be born with it, but researchers are working on how dogs inherit this condition. These pups have what is referred to as pancreatic acinar (exocrine/digestive) atrophy called PAA. This is noninflammatory in nature, in contrast to the example above. The acinar cells of the pancreas atrophy, like the muscles of your leg in a cast, rendering the digestive function of the pancreas impotent.

Thus, this is the most common cause of EPI in young dogs. It usually occurs in dogs less than two years old! Large breed dogs are seemingly more at risk, with German Shepherds holding the dubious honor of being the poster-pup for EPI. But no dog breed is exempt from this inherited disease.

Symptoms reflect the lack of digestion and lack of absorption of nutrients. If EPI follows the text book, your pup would be a skinny, skinny dog with a ravenous appetite that continues to lose weight, while having a gassy, gurgly abdomen and yellowish, oily diarrhea. Nasty, huh? Frankly, the dog is starving to death.

Veterinarians have a very useful tool to confirm the diagnosis of EPI. It is a test called trypsin-like immunoreactivity assay, or TLI. There are other tests that can be performed to help with the diagnosis like specialized stains for dog poop. These test for the stuff that has passed undigested from the stomach to the colon. Stuff like excessive fat or starch in the stool. In simplistic terms, the TLI is the easiest and most effective test.

Now for the good—if not great—news. Most dogs suffering with EPI can be treated, and return to a normal healthy weight and body condition easily. Some will take longer than others to get back to normal and may even require adjunct therapy, but these dogs do have a good prognosis. EPI needs to be diagnosed early and correctly, and treatment started quickly and thoroughly.

Treatment consists of replacing what the pancreas lost. You stop the starvation by allowing the dog to digest again. You do this by substituting the digestive functions of the pancreas with certain supplements. This is accomplished with powdered pancreatic extracts, given with your dog’s meal. Diets that are low in fat and fiber are also helpful. You may need to give vitamin supplements to aid in the management of EPI. Pretty easy, really.

So if your pooch has pancreatitis or PAA causing EPI, get a TLI and supplement them back to health with PPE’s. That’s porcine pancreatic enzymes. Whew!

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