Exocrine Pancreatic Insufficiency

Condition Overview

The acinar cells in the pancreas manufacture digestive enzymes that empty into the duodenum in response to the stimulation of a meal. Without them, food cannot be adequately digested and nutrients therefore cannot be adequately absorbed.

Symptoms

Dogs with pancreatic insufficiency lose weight despite a voracious appetite and increased food consumption. The unabsorbed food produces a diarrhea with large, gray, semi-formed, cow-pie stools with a rancid odor. The hair around the anus is often oily from undigested fat. Intense hunger may cause the dog to eat his own stool.

All symptoms +

Causes

For reasons that are currently unknown, the acinar cells may atrophy and stop producing enzymes. This condition is called pancreatic acinar cell atrophy (PAA), and is one of the major causes of pancreatic insufficiency.

PAA begins in dogs under 2 years of age. All breeds are affected, but there is a predisposition in large breeds, particularly German Shepherds, in whom the disease may be inherited as an autosomal recessive trait.

A less common cause of pancreatic insufficiency is pancreatitis. Following a bout of inflammation, the pancreas may become scarred and contracted. This produces the same effect as acinar cell atrophy. This form of pancreatic insufficiency tends to affect middle-aged and older dogs of the small breeds.

Diagnosis

The diagnosis of pancreatic insufficiency can be suspected from the appearance of the stool and other observations. The best and most accurate test is the serum trypsinlike immunoreactive assay (TLI), available to veterinarians through special mail-out laboratories. Folate and vitamin B-12 levels may also be used as diagnostic aids.

Treatment

Most dogs respond well to having the missings enzymes added to their meals. Powered pancreatic extracts (Viokase-V and Pancrezyme) are superior to enteric coated and uncrushed tablets. Divide the daily food intake into 2 - 3 meals. Add 1 - 2 teaspoons (5 - 10ml) of powdered extract to each meal just before feeding, as directed by your veterinarian.

Prevention

As the diarrhea comes under control, reduce the enzyme replacement to the minimum effective maintenance dose. One teaspoon added to each of 2 daily meals is adequate for most dogs.

Dogs who do not respond completely to pancreatic enzymes may do so when the maintenance diet is switched to a highly digestible, fat-restricted diet. An acid blocker such as cimetidine (Tagamet) or ranitidine (Zantac) may be prescribed by your veterinarian to prevent destruction of the pancreatic enzymes by acid in the stomach.

Vitamin absorption is reduced in dogs with pancreatic insufficiency. Vitamin supplements may be advisable, at least for the first 3 months.

Support

Please contact your veterinarian with questions regarding this condition.