Feline exocrine pancreatic insufficiency: 16 cases (1992–2007)⋆

Abstract

Medical records of 16 cats diagnosed with exocrine pancreatic insufficiency (EPI) were reviewed. The diagnosis was confirmed with either a serum feline trypsin-like immunoreactivity (fTLI) concentration <or=12 microg/l or a fecal proteolytic activity (FPA) <6mm for three consecutive days. The majority of cats were castrated male domestic shorthairs. The median age of cats affected was 7 years. The most common clinical sign was weight loss followed by diarrhea, polyphagia and vomiting. Concurrent disease was present in 10/16 (63%) cats. The most common laboratory abnormalities were normocytic normochromic anemia, lymphopenia, neutrophilia, increased alanine transferase activity, hyperglycemia and increased bilirubin concentrations. All 10 cats that were tested for serum cobalamin levels were found to be deficient. All 10 cats that were tested for serum folate concentrations had normal or increased levels. Ten out of 11 cats had at least a partial response to treatment. All cats were discharged from the hospital alive. Results suggest that EPI should be considered a differential diagnosis in any cat with weight loss or poor growth after more common diseases have been ruled out. Concurrent disease is common in feline EPI. Cobalamin deficiency is common in cats with EPI and cats should receive cobalamin supplementation to improve response to treatment. Cats in this study had a good prognosis.

Exocrine pancreatic insufficiency with concurrent pancreatitis, inflammatory bowel disease and cholangiohepatitis in a cat

“…As in this case, the high fat content of the stools can lead to a greasy appearance of the hair coat, particularly in the perianal and tail region (Steiner 2012). Inadequate digestion and assimilation of nutrients causes a negative energy balance, leading to weight loss and a compensatory polyphagia (Thompson and others 2009). …”

“…Intrinsic factor is exclusively produced by the pancreas in cats. Pancreatic enzyme deficiency can also lead to failure in liberating vitamin B12 from binding R-protein in the duodenum (Thompson and others 2009). …”

“…An abnormally high number of intestinal bacteria may synthesise and release folate (Westermarck and others 2005). Moreover, hypocobalaminaemia may cause decreased folate utilisation because cobalamin is needed for conversion of methylfolate to the active form tetrahydrofolate, which is required for DNA synthesis (Thompson and others 2009). …”

“…An uncommon form of juvenile pancreatic atrophy causing both EPI and insulin-dependent diabetes mellitus has been described in greyhound dogs (Brenner and others 2009). EPI has been rarely reported in cats (Steiner 2012, Wiberg 2013), and chronic pancreatitis is considered the most common cause in this species (Thompson and others 2009, Steiner 2012). It may become more frequently diagnosed now that a validated feline trypsin-like immunoreactivity assay (fTLI) is available.…”

Hyperammonaemia due to cobalamin malabsorption in a cat with exocrine pancreatic insufficiency

“…13 Thus, cats are prone to cobalamin malabsorption secondary to EPI due to insufficient production and secretion of intrinsic factor. 7,9 Hyperammonaemia was not identified after decrease in urinary MMA concentration, suggesting that hyperammonaemia was caused by accumulation of MMA. However, the relationship between the blood concentration of ammonia and the urinary concentration of MMA is currently unknown.…”