Suspected Isolated Pancreatic Enzyme Deficiencies in Dogs

Abstract

A 6-month-old, male intact, German Shepherd Dog (GSD) was examined for a 3 month history of chronically loose feces since the owner acquired him at 12 weeks of age. Over the 3 month period the dog maintained an excellent appetite with little weight gain and had persistently abnormal feces. The consistency of feces ranged from soft to liquid diarrhea. The dog tested positive for Giardia spp. on multiple occasions despite multiple treatments with fenbendazole and metronidazole. Additional therapies including tylosin and probiotics resulted in transient or no improvement. Two weeks before examination, the dog started vomiting once every 5 days.On examination, the dog weighed 22 kg with a body condition score of 3/9. Physical abnormalities included brachygnathism with malocclusion lesions on the lower lip and hard palate, erythema with occasional pustules on its ventrum, consistent with a superficial pyoderma, and pain when extending both hips suggestive of bilateral hip dysplasia. Abdominal palpation was nonpainful and rectal examination revealed only soft feces of normal color. Complete blood count (CBC), serum chemistry, and electrolytes were within the reference interval with the exception of a mild increase in serum phosphorus (7.6 mg/dL; reference interval, 2.1-6.3 mg/dL), which was consistent with the dog's age. Abdominal ultrasound examination did not reveal abnormalities. The spleen was mottled and multiple lymph nodes were visible, but of normal echogenicity and consistent with dog's age. Serum concentrations of bile acids before and after eating were 1.6 lmol/L (reference interval 0-28 lmol/L) and <1.0 lmol/L (reference interval 0-28 lmol/L), and cortisol (2.3 lg/dL, reference interval 1-5 lg/dL), cobalamin (513 ng/L; reference interval 251-908 ng/L), and folate (20.7 lg/L, reference interval 7.7-24.4 lg/L) were all within the reference interval. The dog's serum pancreatic lipase immunoreactivity (cPLI) a was less than the lower limit of detection (<30 lg/L, reference interval 30-200 lg/L) and trypsin-like immunoreactivity (TLI) was below the reference interval (5.2 lg/L, reference interval 5.7-45.2 lg/L), a level not associated with clinical signs of exocrine pancreatic insufficiency (EPI).