Epi Vs Pancreatitis

[german_shepherd]

Hello,

I have just posted in regards to diet information for my friends dog diagnosed with epi. I have another question if someone could share their knowledge.

I will provide some background information to paint a better picture.

Their GSD was fed bacon fat here and there over a few months. No one knew this was a no-no. He was given a pigs ear as a treat and within a few hours had a very rumbly tummy and extreme diarreah.

The vet was called the next day who advised that it is a virus and not to bother coming in. Just fast the dog and then feed rice and chicken.

After a week or 2, the GSD suddenly showed signs of pain when sitting or trying to stand. They immediately took him to the vet and the vet said upon looking at him that it was EPI.

A blood test revealed problems digesting fat and starch but my question is this...

If the dog had a prolonged bacteria or virus in his tummy, could this have upset his pancreas?? And is so, how do you know if it is just an inflamed pancreas that will mend vs a pancreas failure that wont mend?

Thank you.

[Athena GSD]

Hi,

EPI and pancreatitis are two very different diseases of the same organ, the pancreas. The pancreas has two main roles, one to produce digestive enzymes (the exocrine function) and two to produce insulin (the endocrine function).

Pancreatitis is caused by a few different things but often a fatty meal is the culprit. The digestive enzymes are normally only in an "active" form when they reach the intestine but in pancreatitis they are activated within the pancrease and thus damage the organ. The symptoms are usually vomiting, diarrhoea and abdominal pain. The signs can either be mild or very severe. It is usually treated with fluids, antibiotics and change in diet.

EPI stands for exocrine pancreatic insufficiency. EPI is a lack of digestive enzyme production that results in insufficient digestion of food. Symptoms are usually weight loss and large, soft, volumous faeces. It can either be caused by the body attacking its own pancreatic cells (an autoimmune disorder heritable in GSDs) or rarely prolonged or repeated pancreatitis that physically damages the pancreatic cells. It can be treated by supplementing the pancreatic enzymes in the diet. Interestingly dogs with EPI can get intestinal bacterial overgrowth that is often cured by enzyme supplementation.

In regards to your friend's dog though, whether it had an intestinal virus or bacterial infection is questionable. Because you cannot diagnose the cause of diarrhoea (of which there are MANY) over the phone. I am still unsure from what you have written which disease the dog has. Abdominal pain is usually pancreatitis but an inability to digest fat and starch sounds more like EPI. I would also be interested in what tests the vets performed.

[german_shepherd]

Thank you Athena for your reply.

I am very interested in any *hope* that it may not be EPI and he will eventually be ok with an appropriate diet.

From what I know, the dog was taken to the vet and had a blood test done. They could only manage a few mls of blood as the dog was quite upset. He is generally very good with strangers but didnt take a liking to the vet

The vet was unable to feel his tummy as he was all tensed up and barking.

They also took a poo sample which has not come back yet.

The blood test results said:

colatin digestion test POSITIVE for faccal trypsin

POSITIVE for undigested fat

NEGATIVE for undigested muscle

POSITIVE for undigested starch

Occult blood POSITIVE (by gualac acid detection)

Cryptosporidia and Giardia antigen test Neg.

He was sent home with a tub of enzyplex and some pink syrup (i can find out the name if necessary, but I believe it stops the diarreah??)

I would welcome any interpretation of the above. We are all at a loss to what a lot of the lingo means.

Thanks in advance

Edited October 17, 2007 by german_shepherd

[Rappie]

Sorry for this being a little brief and abrupt - I just found your message and am about to head to bed.

German Shepherd, the results that you have posted appear to be those of a faecal analysis.

Positive faecal trypsin means that protein breakdown activity is present (I think this should read "gelatin digestion test" by the way).

There is undigested fat and starch present, but muscle (hence proteins) are being digested.

There are traces of microscopic blood, but this can also be a reaction to meat by products.

The faeces are negative for two parasites - giardia and crytosporidium.

Enzyplex is a digestive enzyme supplement, pink syrup I'm not so sure about - could be something like Ensal or Peptosyl.

As Athena posted, both exocrine pancreatic insufficiency and pancreatitis are diseases that affect the pancreas, and they occur through two different mechanisms. It is possible for both to occur in the same patient - a severe bout of pancreatitis can destroy sufficient numbers of the exocrine cells and cause EPI however it is something usually seen in more chronic cases. German Shepherds as a breed have a tendency to EPI, along with associated conditions small intestinal bacterial overgrowth and secondary malabsorption and enteritis.

Do you know which blood tests are being run?

Faecal tests are qualitative, not quantitive - they can supply useful information but alone they are not diagnostic, and can have both false positives and false negatives.

There is a definitive test for EPI - it is measurement of serum TLI (trypsin-like immunoreactivity) which reflect the pancreatic function.

"Normal" blood work will show if there are any other issue which may be related to the symptoms, evidence of inflammation etc.

There is a test called canine SpecCPL which is a reasonably new blood test for diagnosing pancreatitis.

I hope that helps a bit.

Please feel free to PM if you have any more questions.

Edited October 17, 2007 by Rappie

[german_shepherd]

Thanks Rappie for helping.

From what I was told, the test results were from the blood test and I have been helping to phone the vet for over a week now waiting for poo results.

Now that I have the test results in front of me I can see that they are talking about a faeces specimen. This was not explained to any of us by the vet.

The only thing I can see that refers to blood (i assume the blood test??) is Occult Blood POSITIVE (by gualac acid detection) which I have no idea what this means.

I have called the vet myself and have been advised that these results are from the blood test. I am really quite concerned now about how well the GSD is being diagnosed.

The syrup was scourban which he has completed 2 bottles of and finished about a day and a half ago. His poos had become firm on the last two days and have now returned soft.

They have been advised to give him natural yoghurt.

Really at a loss what to do.

[Rappie]

Occult blood is still a faecal test - it looks for minute traces of blood in the faeces, it's not very specific but it included in general faecal anaylses.

Depending on the lab, most routine blood tests should have a turn around time of about 24-48 hours. The more specific tests (if they were run) like the TLI ad CPL can take a couple of days as they are often only run a few times per week.

Both EPI and chronic low grade pancreatitis can take a while to settle and can also flare up with only reasonably mild triggers.

Natural yoghurt may help but I would be a little wary of the fat content given the potential diagnoses and maybe suggest a probiotic like Protexin (as I assume that the yoghurt was recommended for the "good bacteria").