Exocrine pancreatic insufficiency (EPI)

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• Much rarer than dogs but a few reports of exocrine pancreatic insufficiency (EPI) exist in cats.
• Cause: absence of pancreatic exocrine secretion maldigestion.
• Signs: weight loss, diarrhea and steatorrhea and polyphagia.
• Diagnosis: low trypsin-like immunoreactivity (TLI), not well documented.
• Treatment: enzyme replacement, low fat, low fiber diet, +/- H2 antagonists, +/- antibiotics and vitamin supplementation.
• Prognosis: reasonable with lifelong treatment but guarded if seen in association with diabetes mellitus.

• Moderate to profound weight loss.
• Bulky feces/diarrhea.
• Polyphagia.
• Steatorrhea.
• Greasy haircoat and tail.

• Very rarely vomiting.

• Middle-aged to old (often as a sequelae to chronic pancreatitis ).

• Chronic pancreatitis .
• Adenocarcinoma of exocrine pancreas with pancreatic duct obstruction.

• Chronic pancreatitis loss of 90% of exocrine pancreatic tissue lack of pancreatic digestive enzymes maldigestion, particularly of fat (pancreatic lipase).
• Malabsorption of fat soluble vitamins, eg vitamin K weight loss, polyphagia, diarrhea and coagulopathies in some cases.
• Also malabsorption of vitamin B12 metabolic consequences of vitamin B12 deficiency.

• Gradual weight loss over months.

• Weight loss and nutrient malabsorption .
• Polyphagia .
• Bulky feces or diarrhea.

• Weight loss.
• Polyphagia.

• Bulky feces.
• Steatorrhea.

• Greasy haircoat and tail

• Pica .

• Poor body condition.
• Often greasy, poor coat.

• Low trypsin like immunoreactivity .

• Low cobalamin . Low folate in many cats too.

• Non-specific alterations suggestive of malnutrition.

Fecal analysis

• For proteolytic activity.
• Repeat samples necessary and needs to be shipped frozen.
   EXTREMELY misleading with false positive and false negative results.

• History.
• Serum assay - TLI and cobalamin/folate may all be reduced.

• Serum assay TLI.
• Histopathology of pancreas

• Very small or grossly unrecognizable pancreas or adenocarcinoma of pancreatic tissue.

• Histopathology typical of chronic pancreatitis or adenocarcinoma.

• Inflammatory bowel disease .
• Eosinophilic enteritis (form of inflammatory bowel disease).
• Lymphangiectasia.
• Intestinal neoplasia (lymphoma ).
• Renal failure .
• Hepatic failure .
• Neoplasia of other systems.
• Metabolic/endocrine disease, eg hyperthyroidism
• Dysphagia/swallowing disorders.
• Chronic vomiting or regurgitation .
• Toxemia/sepsis.
• Poor diet.
• Anorexia.
  Polyphagia
  
• Hyperthyroidism
• Diabetes mellitus
• Hyperadrenocorticism

• See differential list .

• Pancreatic enzyme replacement 1 tsp daily initially.
   Do not use enteric-coated products.
   Powder better than tablets.
• Highly digestible, low fat, low fiber diet.
• Supplement vitamin B12 by injection (1mg/cat SC/3 weeks).
   Management of chronic pancreatitis and diabetes mellitus can be difficult.
• Erratic food absorption may complicate insulin dosage regime.

• Normal feces passed.
• Weight gain.
• Polyphagia reduces.

• If basic treatment regime failing, review for inflammatory bowel disease or GI neoplasia e.g. lymphoma.
• No evidence of bacterial overgrowth in cats but could consider a bio trial.
• If poor response try H-2 antagonists prior to feeding to protect enzyme replacer against gastric acid .

• Regular weight checks.

• Reasonable - lifelong treatment necessary.
• If etiology is chronic pancreatitis may see diabetes mellitus concurrently - and treatment is considerably more complicated.

• Resolution of diarrhea within 2 weeks.
• Some weight gain within 4 weeks and then progressive.
   Long-term will probably be below average weight for breed.
• Resolution of polyphagia unpredictable.

• Client non-compliance with treatment.
• Concurrent diabetes mellitus (may be difficult to manage concurrently).
• Cachexia and cobalamin (B12) deficiency.
• Concurrent IBD/lymphoma.

• Recent references from PubMed.
• Steiner J M & Williams D A (1999) Feline exocrine pancreatic disorders. Vet Clin North Am Small Anim Pract 29 (2), 551-575.
• Browning T (1998) Exocrine pancreatic insufficiency in the cat. Aust Vet J 76, 104-106.
• Steiner J M & Williams D A (1997) Feline exocrine pancreatic disorders - insufficiency, neoplasia and uncommon conditions. Comp Cont Ed 19, 836.

• Simpson J W & Else R W (1991) Diseases of the exocrine pancreas. In Digestive Disease in the Dog and Cat. pp 198-303. Oxford. Blackwell Scientific Publications.

• Penny Watson MA VetMB CertVR DSAM MRCVS, University of Cambridge, Department of Clinical Veterinary Medicine, Madingley Road, Cambridge CB3 0ES, UK.
• Dr Kenneth Simpson BVM&S PhD, Dept of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.

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