Exocrine Pancreatic Insufficiency (EPI) is a lack of production of adequate amounts of digestive enzymes by the pancreas. Both dogs and cats can be affected. EPI can be genetic/heritable, from a single bout of severe acute pancreatitis or recurrent bouts of chronic pancreatitis or idiopathic (cause unknown). Dogs are perhaps most often diagnosed with the idiopathic form; while, in cats EPI is often associated with chronic pancreatitis. Middle-aged animals are most commonly affected.
The primary clinical sign is weight loss, despite a good or even ravenous appetite. Some times owners may note very large bowel movements for the size of the animal. The stool may be lighter in color than usual and/or softer in consistency than normal. A definitive diagnosis comes from a low TLI test after fasting.
Treatment revolves around oral supplementation with pancreatic enzymes. Viokase-V is a powder form that can be added to daily meals and is probably the most commonly used product. Vitamin supplementation is also often employed. Antibiotic therapy may be needed in some cases to control over growth of intestinal bacteria that thrive in the absence of pancreatic enzymes. Addition of medium chain triglycerides to the diet, which are easily absorbed by the intestine despite appropriate enzyme availability, may aid in weight gain. Owners must be aware that treatment will be lifelong in the majority of cases.
The prognosis for EPI is good. Most dogs and cats reportedly respond well enough to therapy to maintain an acceptable quality of life. Owners should not expect them to become completely normal, however. They may remain under weight.
Possibly the most likely emergency situation that could arise with EPI is coagulation (blood clotting) abnormalities, associated with insufficient absorption of Vitamin K. Vitamin K is essential in several steps of the blood coagulation cascade. If a deficiency exists, animals can develop hemorrhage into the abdomen, chest and/or space around the heart. The owner may notice pale gums, lethargy, weakness, increased respiratory rate/effort, collapse, abdominal distension and/or other abnormalities. This situation warrants immediate emergency attention. Fortunately, this is rarely a complication of EPI, but owners should be aware of it.