does this cat really have EPI?

Re: does this cat really have EPI?

Kate Richardson — Fri, 06 Mar 2015 20:32:26 GMT

+1 for EPI and agree more common than realised. The only thing to add is they often/pretty much always need B12 supplementation long term- go for weekly injections for 4-6 weeks then probably monthly- I had one case that was lost control with the enzyme supplement every 6-8 weeks so the owner would bring in for a B12 injection and then all settled again. Cats can't produce B12 the same way as dogs

Re: does this cat really have EPI?

Andrew Kent — Fri, 06 Mar 2015 19:49:27 GMT

Even end stage pancreatitis can be patchy but anyway this is splitting hairs - the point is that a biopsy won't tell you anything extra in this cat, we already have a diagnosis.

Re: does this cat really have EPI?

Martin Atkinson — Fri, 06 Mar 2015 18:47:10 GMT

[quote user="Andrew Kent"]The problem is that even with a biopsy you will miss a lot of cases [/quote]If its end stage with EPI it should be diagnostic.

Re: does this cat really have EPI?

Andrew Kent — Fri, 06 Mar 2015 14:55:18 GMT

[quote user="Martin Atkinson"]However, you're not going to make a definitive diagnosis without a biopsy.[/quote]

The problem is that even with a biopsy you will miss a lot of cases so I really wouldn't push for this - pancreatitis is as much a clinical diagnosis as histopathological and I would still be convinced even if it wasn't demonstrated in a biopsy. It can be a very focal disease and easily missed.

Andy

Re: does this cat really have EPI?

Martin Atkinson — Fri, 06 Mar 2015 09:31:34 GMT

[quote user="Kerry Peak"]the owners are quite observant I think and have never seen any vomiting/inappetence/abnormal behaviour. [/quote]You have a greater confidence in the average pet owner than I do!

I read somewhere that at PM examination on cats that had died for another reason something like 50% showed evidence of chronic pancreatitis. I suspect most of these were never observed vomiting or being inappetent by their owners.

Given that a high proportion of animals diagnosed with acute pancreatitis don't actually show classical symptoms and may just be a bit unthrifty for a couple of days and the owners dismiss this as being 'not quite him/herself', I'm pretty sure a lot are getting missed.

Like Andrew I suspect this a lot more these days and look for it. However, you're not going to make a definitive diagnosis without a biopsy.

Re: does this cat really have EPI?

Kerry Peak — Thu, 05 Mar 2015 19:53:59 GMT

Thanks Andy.

I did institute a diet trial on initial presentation and he did seem to respond a little to start with. However he went off the food and subsequently was losing more weight because he wouldn't eat. I will try again in a few days with a different diet, and hopefully by then there might have been some improvement with the current treatment.

Re: does this cat really have EPI?

Andrew Kent — Thu, 05 Mar 2015 19:45:08 GMT

Hi Kerry,

I would be happy that your results fit with EPI and that is likely an end stage of chronic pancreatitis. We see this fairly frequently in cats now that we look for it and, if anything, concurrent pancreatitis should elevate TLI so becomes even more convincing.

in cats this syndrome is often associated with inflammatory intestinal changes as well so I would suggest a novel protein diet trial in addition to your other management.

Andy

Re: does this cat really have EPI?

Kerry Peak — Thu, 05 Mar 2015 18:40:17 GMT

I agree that he could have pancreatitis, though the owners are quite observant I think and have never seen any vomiting/inappetence/abnormal behaviour.

He was booked in for an ex lap and biopsies, but after receiving the TLI result I didn't want to rush into an invasive procedure like that if it was unnecessary? As such we have simply put them on hold for a few days while we asses the response to the pancreatic enzyme supplements.

Re: does this cat really have EPI?

Martin Atkinson — Thu, 05 Mar 2015 18:31:48 GMT

Pancreatitis is a lot more common in cats that is commonly recognised and acute on chronic bouts can be frequent without the owner necessarily recognising them as such. It is not inconceivable that destruction of the pancreas would ensue and EPI could result.

I feel this is a rhetorical question and you know that maybe you should be offering the client the option of further investigation. However if they're not keen and you can't feel any thickening of the GI tract, enlarged mesenteric lymph nodes or suspicious anterior abdominal masses (in a thin cat I think your hands plus X-ray, are as useful as ultrasound), I would probably continue as you are.