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EXOCRINE PANCREATIC INSUFFICIENCY

What is the pancreas?

The pancreas is a large gland situated in the anterior abdomen in a loop of the duodenum. It is composed of both exocrine and endocrine tissue. The exocrine or ducted part of the gland produces digestive enzymes involved in the digestion of carbohydrates, proteins and fat.

Sodium bicarbonate is also produced. This, combines with the enzymes to form pancreatic juice. This flows from the cells into ducts in the gland. These ducts ultimately join to form the pancreatic duct which opens in to the duodenum near to the bile duct from the liver.

The endocrine portion of the gland, consisting of the Islets of Langerhans, also produce hormones, the most important of which is Insulin. These hormones are conveyed by the blood stream to the tissues and are concerned with the regulation of energy levels in the body, in particular with respect to glucose.

What is exocrine pancreatic insufficiency? (EPI)

Exocrine pancreatic insufficiency, due to the reduction in pancreatic enzymes results in failure to digest the food eaten and in consequence the dog is seriously malnourished.

What are the signs of EPI?

The dog usually has a ravenous appetite but gives a malnourished appearance, often appearing thin or emaciated. Frequent, copious soft feces are passed. These are often fatty in nature due to lack of digestion.

Are any particular breeds affected?

The condition is relatively common in the German Shepherd dog but can be seen in all breeds.

Is any particular age group more prone?

It occurs in dogs of all ages. In relatively young dogs it is often due to atrophy or shrinking of the enzyme producing cells. In older dogs chronic infection of the pancreas (chronic pancreatitis) can often be a cause.

Worms and other intestinal parasites can contribute and it is certainly worthwhile consulting your veterinary surgeon about de-worming your dog on a regular basis.

What are the usual signs?

Dogs with EPI frequently have a ravenous appetite but are thin and never gain weight. Extra feeding produces even greater amounts of watery malodorous feces These are frequently very fatty. Flatulence and bowel rumblings often accompany the condition and some dogs will resort to eating their own feces One theory propounded for this is that since the enzymes pass out unchanged with the stool, the dog instinctively eats its own feces in order to try to recycle the enzymes!

How is EPI diagnosed?

Often a feces sample will indicate the cause and this can be positively confirmed with blood tests. Since the condition can be due to loss of glandular tissue as well as damage due to infection (pancreatitis) biopsies may be necessary in order to definitely establish the cause.

Once it is established that pancreatic insufficiency is present your veterinary surgeon may well check for diabetes mellitus (sugar diabetes) during the investigation since, as mentioned above, the pancreas is also involved in the production of insulin, the lack of which leads to this condition.

Treatment

Dogs having uncomplicated pancreatic insufficiency, i.e. no diabetes, can often be treated very successfully with dietary modification together with pancreatic enzyme supplementation which can be supplied in the form of tablets, capsules, or powder to mix on the food. Alteration to the diet will involve a low fat, low fiber diet. Sometimes your veterinary surgeon may advise antibiotics particularly if there is bacterial overgrowth in the bowel which can accompany the condition. In mild cases a special diet may be all that is necessary to control the condition.

Do I have to alter my dog's routine?

Exercise levels may have to be restricted if the dog is very thin but usually activity levels can remain normal. Sometimes it may be necessary to feed smaller meals more frequently.

Is treatment curative?

Like diabetes mellitus, treatment for exocrine pancreatic insufficiency is palliative rather than curative. A few cases spontaneously resolve but often treatment has to be maintained for life.

Cost

It is worthwhile discussing the costs with your veterinary surgeon at the outset particularly if pancreatic enzyme replacement therapy is involved because this, and the special diets involved, obviously are an ongoing expense. Initially your dog may have to be seen fairly frequently but diarrhea usually resolves within a week or two and the dog starts to gain weight. It may then be possible to reduce the amount of supplementation necessary. The special diets prescribed usually have to be maintained for life. Regular routine check ups, sometimes involving laboratory testing, will be necessary throughout the dog's life.

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