Feline exocrine pancreatic insufficiency

28 Feline exocrine pancreatic insufficiency



Case contributed by Nicki Reed




Initial presentation


Weight loss, diarrhoea, steatorrhoea and vomiting


Signalment: 7-year-old, male neutered domestic shorthaired cat, body weight 3.33 kg



Case history


This cat presented for investigation of weight loss, diarrhoea, steatorrhoea and vomiting, which were accompanied by a good appetite.


The cat had been acquired 5 years previously and lived indoors. He had received core vaccinations and regular boosters, but no endo- or ectoparasiticides. His episodes of diarrhoea had occurred since acquisition. The diarrhoea was usually semi-formed and brown and would usually resolve without treatment after 2 to 3 days. The episodes occurred approximately six to eight times per year. The nature of the diarrhoea had changed approximately 3 months prior to presentation. The faeces were described as voluminous, greasy and malodorous and had also previously been white in colour. During defecation the cat did not strain and there was no blood or mucus in the faeces.


Occasional episodes of vomiting (one to three times per year) were also reported. The vomitus generally comprised semi-digested food. In the 3 months prior to presentation the cat’s appetite had increased. He was eating a 450 g tin of commercial canned cat food and approximately 50 g of dried biscuits per day.


The cat had always been overweight (previously 6 kg) but there had been a steady weight loss since his last vaccination 8 months previously.



Physical examination


The cat was in poor body condition (body condition score 2/9), but otherwise bright and well. His coat was greasy, matted and unkempt. On abdominal palpation the intestines felt fluid filled, but the cat did not appear uncomfortable during palpation. Thoracic auscultation was unremarkable. His heart rate was 160 beats per minute with matched good quality pulses, respiratory rate 28 breaths per minute and rectal temperature 37.9° C. There was faecal soiling around the perineum.



Problem list and discussion of problems


The primary problems were weight loss and diarrhoea, but the presence of a good appetite helped to narrow the differential diagnoses list and the vomiting and weight loss were thought to be related to the diarrhoea in this case. The clinical signs were consistent with diarrhoea due to small intestinal disease.



Differential diagnosis


Differential diagnoses for diarrhoea in this cat include:


• Maldigestion
• exocrine pancreatic insufficiency (EPI)

• Malabsorption
• inflammatory bowel disease (lymphocytic-plasmacytic, eosinophilic, granulomatous)

• lymphoma

• Metabolic disorders
• hyperthyroidism

• diabetes mellitus

• Gastrointestinal parasites

• Pancreatitis

• Lymphocytic cholangitis

The presence of steatorrhoeic, malodorous faeces suggested a maldigestion problem was most likely.



Case work-up


Routine haematology, serum biochemistry and urinalysis were performed as a minimum data base. Total thyroxine was also measured to screen for hyperthyroidism. Results were all within the reference range, with the exception of alanine aminotransferase (ALT), which was markedly elevated at 865 IU/l (reference range 20–75 IU/l) and alkaline phosphatase which was elevated at 124 IU/l (reference range 20–80 IU/l). Faecal analysis for parasites was repeated and was again found to be negative.


More specific investigations for the gastrointestinal tract were performed. Feline pancreatic lipase immunoreactivity (fPLI) and feline trypsin-like immunoreactivity (fTLI) were performed to assess pancreatic function. Folate and cobalamin were measured to assess for malabsorption of these vitamins. Folate and fPLI were both within their reference range. Cobalamin was low at 99 ng/l (reference range 290–1499 ng/l) and fTLI was also low at 9.2 µg/l (reference range 12.0–82.0 µg/l).


Abdominal ultrasonography was performed, primarily to evaluate the liver and pancreas. The liver appeared grossly normal and although the pancreas was identified, it appeared small. In light of the raised liver enzymes, a liver biopsy was felt to be useful; however, prior to this being performed an assessment was made of clotting times. Whilst the activated partial thromboplastin time (APTT) was normal, the prothrombin time (PT) was prolonged at 27.7 seconds (reference range 7.0–12.0 seconds). The liver biopsy was thus deferred.



Diagnosis


The history, clinical examination findings and the sub-normal fTLI were supportive of a diagnosis of EPI. Cobalamin deficiency is frequently reported in association with EPI in cats and prolongation of the PT is attributed to Vitamin K deficiency.

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  4. Pancreatitis in a cat

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Sep 22, 2016 | Posted by in SMALL ANIMAL | Comments Off on Feline exocrine pancreatic insufficiency

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