pancreatitis | exocrine pancreatic insufficiency (epi)
Introduction: The pancreas is an organ that sits alongside the first loop of the duodenum (upper small intestine) and extends around the bend of the duodenum in an L-shape. The pancreas is divided into two portions based on function. Looking at a pancreas, it is not possible to see the two portions separately, since the entire organ is dispersed with specific cells devoted to one function or the other. The two functions are known as exocrine and endocrine. The exocrine pancreas secretes digestive enzymes that make their way through ducts to the small intestine to help with breakdown of food. The endocrine pancreas secretes hormones that aid in a variety of functions in other places in the body. The cells of the endocrine pancreas tend to be found in little islands within the exocrine pancreatic cells. Exocrine pancreatic enzymes are secreted into the digestive tract through a little duct that opens right next to the bile duct from the liver. Endocrine pancreatic hormones are taken by the bloodstream to the other places in the body where they will have their effect. The following are common diseases associated with the pancreas:
Introduction: Since the function of the exocrine pancreas is to secrete enzymes that break down ingested plant or animal tissues, it is always a danger to have these enzymes within the pancreas itself. A number of defensive and protective mechanisms are built into the pancreas to prevent it from digesting itself with these enzymes. Inappropriate activation of these enzymes within the pancreas can result in inflammation known as pancreatitis. Pancreatitis can occur as an acute illness with sudden onset or as a chronic disease. Acute pancreatitis can occur in cats, but is very uncommon compared to the chronic form.
Causes: High fat diets and obesity are two of the most likely predisposing factors in the development of pancreatitis in cats. When it does occur, pancreatitis also seems to be worse in patients that are overweight than in those that are in good body condition. Some medications have been implicated in the development of pancreatitis, including furosemide, sulfa based antibiotics, tetracycline, and some chemotherapy (cancer-fighting) drugs. Corticosteroids (prednisone, dexamethasone, etc.) have been associated with pancreatitis development also, but the connection between the two is not clear. Feline pancreatitis also commonly occurs in conjunction with cholangiohepatitis, hepatic lipidosis (fatty liver disease), and sometimes inflammation of the kidneys (interstitial nephritis).
Clinical Signs: Clinical signs of pancreatitis in cats are often vague, with waxing and waning fevers, listlessness, decreased appetite, abdominal pain, and sometimes vomiting. Shock and death can occur if the pancreas tissue becomes severely inflamed to the point of causing the death of a large portion of the organ, but this is much less common in cats than it is in dogs.
Diagnosis: Diagnosis of pancreatitis is accomplished by physical examination, routine bloodwork, x-rays or ultrasound of the abdomen, and occasionally, exploratory surgery. Specific enzymes (amylase and lipase) measured in the blood can help to confirm a diagnosis of pancreatitis. These enzymes are frequently increased many times their normal levels in patients with pancreatitis. They are released from other places in the body besides the pancreas, however, and an elevation of amylase and/or lipase in the bloodwork alone does not necessarily diagnose pancreatitis. These enzymes are even less reliable in cats than they are in dogs in providing a diagnosis of pancreatitis. Other pancreatic enzymes have been measured in the blood and have shown some reliability in helping to confirm a diagnosis of pancreatitis. Phospholipase A2 assay and serum trypsin-like immunoreactivity (TLI) are two other blood tests measuring enzymes secreted by the pancreas. A broad look at the entire clinical picture in cats is generally necessary to make a presumptive diagnosis of pancreatitis. Feline TLI has recently become one of the more popular tests to measure inflammation in the pancreas for cats, but still must be used in conjunction with the entire clinical picture to diagnose pancreatitis.
Treatment: Treatment of pancreatitis often involves hospitalization for proper fluid therapy. Frequent monitoring of blood electrolyte activity and other factors is important to treat the more severe cases. Fasting from food is very important when treating dogs with pancreatitis, but withholding food from anorexic cats can worsen other problems such as fatty liver disease. Cats are usually fed a low-fat, highly digestible food source such as Hill’s Science Diet Prescription feline i/d. Because kidney failure can develop, careful monitoring of the kidneys is important for animals with severe pancreatitis. Antibiotics are given, usually through the intravenous line, to help fight off common bacteria that infect the already inflamed pancreas. Pain killers are also commonly given if needed for abdominal pain. Management of chronic low-grade pancreatitis is very important in affected cats; dietary therapy is usually the most effective way of preventing further outbreaks. Prescription feline i/d mentioned above and other diets can help keep cats healthy that are prone to pancreatitis.
Prognosis: Prognosis of pancreatitis is unpredictable. In spite of all supportive measures, some cats will still suffer from recurring episodes of pancreatitis. Other patients may recover fully with appropriate therapy and do well as long as they are strictly fed a special management diet.
Exocrine pancreatic insufficiency (EPI):
Introduction/Causes: Exocrine pancreatic insufficiency (EPI) is, in a way, at the opposite end of the spectrum from pancreatitis. EPI is characterized by abnormally low levels of pancreatic enzyme production. EPI is listed in the feline pancreatic section because it is an important disease to recognize, although it is rarely reported in cats. Chronic pancreatitis with gradual cell destruction of the entire pancreas is the most common cause of those few cases of EPI reported in cats.
Clinical Signs: Clinical signs of EPI relate to malabsorption of nutrients from the digestive tract. Insufficient digestive enzyme production from the pancreas leads to an inability to digest food properly and leads to chronic weight loss with large volumes of rather loose, foul-smelling bowel movements. Often the patient will have a ravenous appetite in the face of chronic weight loss. Loss of muscle mass can lead to generalized weakness. The patient’s hair coat will often be in poor condition.
Diagnosis: Diagnosis of exocrine pancreatic insufficiency requires specialized blood testing. Routine physical examination will often reveal many clinical conditions described above. Standard blood panels, radiographs, and ultrasound will usually show no abnormal findings. A special blood test called serum trypsin-like immunoreactivity (TLI) measures an enzyme manufactured specifically in the pancreas. Cats with EPI will often have a low reading on the serum TLI test. Analysis of the patient’s feces can also help with a diagnosis of EPI with such tests as fecal proteolytic activity, but are much less reliable as a diagnostic tool.
Treatment: Treatment of exocrine pancreatic insufficiency is usually successful by supplementing the diet with manufactured enzymes. Such supplements can be obtained in the form of powders, capsules, or tablets and are usually given with each meal. A variety of brand names and products are available and some can even be obtained over the counter. Some of these enzymes are deactivated in the acid environment in the stomach, so many patients with EPI will also be prescribed medication (such as cimetidine) to help reduce acid secretion. Antibiotics may also be needed from time to time when treating a cat with EPI to keep the bacterial population of the intestines from overgrowth.
Exocrine pancreatic insufficiency is a chronic disease, with little to no hope of complete recovery. Treatment, though relatively simple, is generally needed throughout the cat’s life. With proper treatment, prognosis for a good quality of life is generally good.