Diagnosis and treatment of pancreatic exocrine deficiency

The pancreas is divided into two parts: the exocrine gland and the endocrine gland. The exocrine gland is composed of acinar and glandular tubes and has the function of digesting protein, fat and sugar. The endocrine glands are composed of islets. The islets are mainly composed of four kinds of cells: A cells, B cells, D cells, and PP cells, which mainly secrete various endocrine hormones to participate in humoral regulation.

Pancreatic exocrine deficiency (EPI) is a digestive and absorption disorder syndrome caused by the loss of pancreatic exocrine function and the lack of digestive enzymes secreted by the pancreas. In dogs, the most common cause of EPI is pancreatic acinar atrophy, but the pathogenesis of pancreatic acinar atrophy is not clear, and may be caused by infection, obstruction of the pancreatic duct, or hereditary factors. Chronic pancreatitis, recurrent episodes of acute or subacute pancreatitis, and pancreatic tumors may also cause EPI. The most common cause of cats is chronic pancreatitis. There is also a clinical phenomenon of EPI caused by the attachment of P. sinensis to the pancreatic duct.

The concentration of pancreatic enzymes, bicarbonate, antibacterial substances, intestinal mucosal "nutrition" factors, pancreatic and gastrointestinal modulating peptides in dogs and cats with EPI decreased, eventually leading to various nutrients (fat, carbohydrates) , protein, vitamins, trace elements, etc.) assimilation disorders, intestinal bacterial overgrowth, small intestinal morphology and function changes. Dogs and cats with EPI usually have the following medical history and clinical symptoms: small intestinal diarrhea (large fecal volume, semi-formed, yellowish or gray, with obvious fat sputum), polyphagia, eating, severe weight loss, bowel and Skin problems (such as rough coat, seborrheic dermatitis, etc.), while some cats have symptoms of loss of appetite.

Although the symptoms of EPI are typical, they are not specific and clinically need to be distinguished from intestinal diseases such as intestinal malaria. Dogs and cats with EPI, blood routine examination is generally normal, when the intestinal mucosal permeability changes, resulting in increased absorption of liver toxic substances, or liver fat deposition, alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase Mildly elevated. In some dogs, VB12 decreased, folic acid increased, vitamin E and vitamin A decreased. For cats, VB12 and folic acid decreased, and some cats had lower VK. Some special factors affecting absorption are lost, and the pH value in the intestine changes, which can enhance or decrease the absorption of trace elements. The method of diagnosis of EPI is to determine serum trypsin-like immunoreactivity by radioimmunoassay, which has dual specificity of species and pancreas, and can distinguish EPI from small bowel disease.

The basic principles of EPI treatment mainly follow the improvement of diet and supplementation of trypsin, low-fat, low-fiber, digestible diet to help improve clinical symptoms. The best way to supplement the trypsin is to use a dry powdered trypsin extract.