Pancreatic function
The pancreas has two main functions: first to produce the hormone insulin to control blood sugar and second to produce digestive enzymes. Production of insulin is the pancreas’ endocrine function and production of digestive enzymes is an exocrine function. Deficiency of insulin is called diabetes.
Deficiency of the digestive enzymes has a much more descriptive name – exocrine pancreatic insufficiency.
What a cat with EPI looks like
The classic cat with EPI is skinny, greasy, and has bad diarrhea. The absence of digestive enzymes prevents the gastrointestinal tract from breaking food down into it components, and if they are not broken down, the nutrients cannot be absorbed. If your cat has this disorder, he will eat lots of food and lose weight rapidly. Cats with EPI are greasy because they cannot digest fats without pancreatic enzymes and all the undigested fat in their stool gives them nasty diarrhea.
The causes of feline EPI
This disorder is thought to be inherited in certain dog breeds, most commonly German shepherds. Cats never want to be like dogs. Exocrine pancreatic insufficiency in cats does not appear to have a genetic component and is more likely to be the result of chronic damage to the pancreas from long standing pancreatitis. These cats may also be diabetic if the pancreatic damage is severe enough to prevent production of both digestive enzymes and insulin.
Testing the skinny cat
When I see a cat with weight loss, I commonly collect blood for what The Animal Medical Center (AMC) calls a GI panel. This quartet of tests looks at the digestive function of the pancreas and small intestine. One of the tests measures trypsin-like immunoreactivity and is the diagnostic test of choice for feline EPI. Another important test on this panel measures vitamin B12 or cobalamin. A study of feline EPI cases at The AMC and Purdue University found all cats with EPI were deficient in this important vitamin.
Replacement therapy
Once lost, the pancreas do not typically regain exocrine pancreatic function. Management of EPI requires lifelong supplementation with pancreatic enzymes and vitamin B12. Vitamin B12 supplementation is simple: a small injection given under the skin once a week. Pancreatic enzymes come as a powder and are sprinkled on the food. This is where cats can be challenging since many cats refuse food that has been embellished. Raw pancreas (which contains the digestive enzymes) has been recommended, but I haven’t tried it on any patients, yet. The good news is our study of feline EPI showed most cats will respond to therapy.
Resources on pancreatic disease
Exocrine Pancreatic Insufficiency
Pancreatitis
Under the weather
I saw Decoy’s name on the overnight admission list which is emailed to all the veterinarians at The Animal Medical Center at about 5:30 every morning. Decoy came to The AMC ER for vomiting and limping. The ER doctors found abdominal pain, a fever and an elevated heart rate. On my way into the hospital, I stopped by his cage to say hello, but could tell my normally tail-waggin’ friend was a hurtin’ pup; Decoy was living up to his name by looking more like an inert, stuffed dog than a real one.
In the blood tests
Blood tests for AMC patients are available online. To help with interpretation, abnormal results are displayed in red, normal results in black. Decoy’s reports were shockingly red. His illness was impacting his liver, his blood calcium level, and dramatically increasing his infection-fighting white blood cells.
Inside the abdomen
Because Decoy’s blood tests indicated multiple organs within the abdomen were affected by whatever was making him sick, his internal medicine specialists ordered an ultrasound of his abdomen. Ultrasounds let veterinarians look at intra-abdominal structures in a different fashion than x-rays allow. X-rays show bones and lungs very clearly, but we can only see the outline of abdominal organs like the liver and kidneys. The pancreas cannot be seen using x-rays and we rely on ultrasound to help make a diagnosis of pancreatic disease. Because pancreatic disease could account for Decoy’s clinical findings of vomiting and diarrhea and his multiple blood test abnormalities, an ultrasound was done and confirmed the suspicion of pancreatic inflammation or pancreatitis. The ultrasound showed pancreatic swelling. The swollen pancreas displaced the colon out of its normal position and was even causing a small amount of fluid to accumulate in the abdomen.
On the road to recovery
There is no antidote to stop pancreatic inflammation. Veterinarians provide what we call supportive therapies while the inflammation subsides and then we try to decrease risk factors for recurrence. Decoy received intravenous fluids, antiemetic agents, and antibiotics in case the pancreatitis was turning into an abscess. Every day he improved a little bit and he was discharged from the hospital a few days later.
Follow up
To help prevent another bout of pancreatitis, Decoy’s doctors made several recommendations to his family. First, overweight dogs are at greater risk of developing pancreatitis. I suspect a diet will be on Decoy’s list of New Year’s resolutions. High-fat diets increase the risk of pancreatitis. This means he may need to eat a special low-fat diet and certain dog delicacies like bacon will no longer be a menu option for him. In the future, his doctors will avoid certain medications to prevent provoking another serious case of pancreatitis.
Pancreatitis is a common disorder of dogs and it can become a recurrent problem. In Decoy’s case, the problem was quickly corrected, but when pancreatitis becomes a chronic problem, seeking input from an internal medicine specialist is a good idea.
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