Exocrine Pancreatic Insufficiency

The pancreas is an abdominal organ which is situated near to the duodenum. It has an important endocrine function since it produces the hormone insulin which is vital in the metabolism of glucose. If insufficient insulin is produced diabetes mellitus may occur. The second important function of the pancreas is to produce enzymes which assist in the digestion of fat, protein & carbohydrate in the diet.

Role of the pancreas in digestion

The pancreas produces several different enzymes which are secreted into the gut in order to help with the digestive process. These enzymes facilitate the break down of food so that it may be absorbed and used by the body. The three main types of enzymes secreted by the pancreas are proteases which break down proteins, lipase which breaks down fats and amylase which breaks down carbohydrates/ starch. If these enzymes are not produced in sufficient amounts to adequately break down the proteins, fats and carbohydrates in the diet then signs of pancreatic insufficiency will arise.

Signs & symptoms

The signs of pancreatic insufficiency may vary according to the underlying cause & extent of the problem. Commonly seen signs are:

• Increased appetite
• Coprophagia (eating faeces)
• Pica (eating abnormal things)
• Weight loss
• Flatulence
• Frequent Borborygmus (rumbling, gurgling gut sounds)
• Diarrhoea

The volume & frequency of faeces usually increases with pancreatic insufficiency and stools may be soft or loose. The faeces may also be pale in colour and have a rancid unpleasant smell due to the presence of undigested fats.

Causes

The most common form of pancreatic insufficiency is caused by the atrophy of the acinar glands which produce the digestive enzymes; this is known as pancreatic acinar atrophy. In this condition the glands degenerate or die and are no longer able to produce enzymes in sufficient amounts to digest the food in the gut properly.

Chronic pancreatitis is another cause of pancreatic insufficiency in the dog. This tends to affect older animals. Dogs with chronic pancreatitis may also have signs of diabetes mellitus. The causes of chronic pancreatitis are not fully known and many causes have been suggested. These include nutritional factors, viruses, bacteria, trauma or an inflammatory process in the pancreas which damage or destroy the acinar glands within the pancreas.

Other causes of pancreatic insufficiency are pancreatic neoplasia (cancer) and acute pancreatitis.

Diagnosis

Blood testing, serum trypsin-like immunoreactivity or TLI test. The concentrations of trypsinogen (the precursor of the enzyme trypsin) in the blood can give a reliable indication of pancreatic insufficiency if they are abnormally low.

Treatment

Treatment of pancreatic insufficiency is usually required for the life of the dog. A special diet which is low in both fats & fibre will help in this condition. The diet should be very easily digested. Hills i/d is a very good food for dogs with pancreatic insufficiency as is tinned 'Chappie' (much cheaper and appears more palatable to dogs)!

In many dogs however, a special diet may not be absolutely necessary & they do well if the pancreatic enzymes they are lacking are replaced by supplementation. This is done by feeding them the enzymes which are given at the same time as their food. Tryplase capsules are often used for this purpose. They contain amylase, lipase and protease enzymes to help break down the food within the gut.