Exocrine Pancreatic Insufficiency in Cats

Overview:

The pancreas is an pale pink, lobulated organ located near the liver & behind the stomach. The pancreas performs both exocrine (secretes enzymes via a duct) & endocrine (secretes hormones directly into the bloodstream) functions. Small clusters of cells called Islets of Langerhans  are responsible for the production of the hormones insulin & glucagon which regulate blood sugar. The pancreas also produce  pancreatic juice, a digestive enzyme rich in sodium bicarbonate which helps break down proteins, fats & carbohydrates. This juice is secreted from the pancreas & collected in the pancreatic duct, where it joins with the bile duct from the liver prior to entering the duodenum.

Also known as 'maldigestion disorder', exocrine pancreatic insufficiency (EPI) is a disease caused by a failure of the pancreas to secrete adequate levels of pancreatic   enzymes which results in an inability to properly digest food. It is seen more commonly in dogs & is in fact quite rare in cats.

There are several causes of exocrine pancreatic insufficiency, chronic pancreatitis is the most common. Other causes include neoplasia, pancreatic acinar atrophy & pancreatic flukes. Due to beta cells also being destroyed, diabetes mellitus may occur concurrently.

What are the symptoms of exocrine pancreatic insufficiency in cats?

Symptoms of exocrine pancreatic insufficiency include;

• Diarrhea which is often pale & voluminous & malodorous

• Flatulence

• Greasy coat appearance

• Increased appetite

• Weight loss

How is it diagnosed?

Your veterinarian will perform a complete physical examination of your cat & obtain a medical history from you. Symptoms of EPI are similar to those of hyperthyroidism & inflammatory bowel disease, which are much more common diseases. Your veterinarian may wish to perform specific diagnostic tests for those to rule them out.

Some tests he may perform to test for EPI include;

• fTLI (feline Trypsin-Like Immunoreactivity: This test measures the concentrations of trypsin-like proteins in serum. A low level indicates EPI.

• Fecal proteolytic activity: Examination of the feces for fecal fat & fecal trypsin.

• Routine bloodwork such as a complete blood count & biochemical profile to check for concurrent disease & the general health status of your cat.

How is it treated?

Treatment for EPI is lifelong & includes;

• Pancreatic enzyme extract. Powdered pancreatic extracts (these are obtained from cow & pig pancreases) with each meal.

• Diet: High protein, low fibre diet.

• Antibiotics are indicated for possible small intestinal bacterial overgrowth.

• Cobalamin (vitamin B12). This is recommended if cobalamin levels are found to be low.