Introduction

• Congenital, inherited or acquired disease.
• Inherited predisposition common in German Shepherd Dog, Collies and English Setters.
• Acquired disease secondary to pancreatitis, or pancreatic duct obstruction.
• May predispose to small intestinal bacterial overgrowth.
• Cause: absence of pancreatic exocrine secretion → maldigestion.
• Signs: weight loss, polyphagia, bulky feces/diarrhea.
• Diagnosis: sub-normal serum trypsin-like immunoreactivity (TLI).
• Treatment: enzyme replacement, digestible diet, +/- low fat diet +/- H2 antagonists +/- antibiotics.
  Print off the owner factsheet on Exocrine pancreatic insufficiency (EPI) Exocrine pancreatic insufficiency (EPI) to give to your client.

Pathogenesis

Etiology

• Most common - idiopathic atrophy of pancreatic acinar tissue, (age of onset usually <1-2years of age).
• Less common - as a consequence of chronic pancreatitis Pancreatitis: chronic - older age group (>4 years of age).
• Very rare - congenital pancreatic hypoplasia, usually associated with diabetes mellitus Diabetes mellitus.

Pathophysiology

• Progressive pancreatic acinar atrophy → lack of pancreatic digestive enzymes → maldigestion → polyphagia and profound weight loss.
• Atrophy preceded by accumulation of lymphocytes, and acinar apoptosis (in GSD).
• No evidence of specific anti-pancreatic antibodies in circulation.
• Destruction of pancreatic enzymes in intestine, eg gastric hypersecretion.
• Possible small intestinal bacterial overgrowth.
• Malabsorption of vitamin B12 Vitamin B12, and vitamin E Vitamin E, rarely vitamin K Vitamin K:
  • Metabolic consequences of vitamin B12 deficiency.​

Timecourse

• Gradual weight loss over months.

Diagnosis

Treatment

Outcomes