scholarly journals Fat-soluble vitamin deficiency and subsequent coagulopathy in a cat with exocrine pancreatic insufficiency

2020 ◽  
Vol 8 (1) ◽  
pp. e001019
Author(s):  
Alexander James Barnes ◽  
Kathryn Gates ◽  
Jodi Kuntz
Keyword(s):  
Vitamin K ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Clinical Signs ◽  
Gastrointestinal Haemorrhage ◽  
Fresh Frozen Plasma ◽  
Exocrine Pancreatic Insufficiency ◽  
Vitamin Deficiency ◽  
Clotting Factor ◽  
Enzyme Supplementation

This report describes the clinical signs, diagnostic findings and treatment of a female spayed Domestic Shorthair with exocrine pancreatic insufficiency (EPI) who presented in shock due to severe gastrointestinal haemorrhage secondary to coagulopathy caused by vitamin K-dependent clotting factor deficiency. Diagnostics revealed a prolonged prothrombin time, activated partial thromboplastin time, low trypsin-like immunoreactvity and gross evidence of pancreatic atrophy. Gastrointestinal haemorrhage resolved quickly with transfusion of fresh frozen plasma and vitamin K supplementation. Following treatment with oral pancreatic enzyme supplementation, the cat was found to have resolution of gastrointestinal signs, improved body condition and normalisation of clotting times. Fat-soluble vitamin levels were below the expected range and improved following treatment. This is the second report of coagulopathy in a cat with EPI and the first to describe fat-soluble vitamin deficiency that improved with pancreatic enzyme supplementation.

scholarly journals Bruising as the first sign of exocrine pancreatic insufficiency

2019 ◽  
Author(s):  
Csilla Enikő Szabo ◽  
Oana Iulia Man ◽  
Radu Sorin Șerban ◽  
Eva Kiss ◽  
Călin Florin Lazăr
Keyword(s):  
Cystic Fibrosis ◽  
Vitamin K ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Exocrine Pancreatic Insufficiency ◽  
Nutritional Deficiencies ◽  
Deficiency Anemia ◽  
Serum Lipase ◽  
Pancreatic Elastase ◽  
Enzyme Replacement

Exocrine pancreatic insufficiency is an important cause of chronic malnutrition, secondary to maldigestion-malabsorption, which can be caused in children especially by cystic fibrosis, but also by other much rarer diseases. The case of a 6 months and 3 weeks old male pediatric patient is reported, who was admitted to the clinic for head and forearms bruising. Laboratory findings identified vitamin K deficiency as the cause of the cutaneous hemorrhagic syndrome. Further investigations revealed association of steatorrhea (which is a marker of fat malabsorption), iron-deficiency anemia and hypovitaminosis D, which had been produced by nutritional deficiencies caused by malabsorption syndrome. From the numerous disorders that could be associated with pancreatic insufficiency in children, the following conditions had been excluded: cystic fibrosis (mucoviscidosis), cow`s milk protein intolerance, gluten-sensitive enteropathy (coeliac disease), Shwachman-Diamond syndrome, abetalipoproteinemia, etc. Based upon decreased levels of stool pancreatic elastase in repeated measurements, together with low serum lipase, the final diagnosis of exocrine pancreatic insufficiency was established. Treatment of this case consisted mainly in pancreatic enzyme replacement therapy, but also oral iron supplementation and dietary supplements with fat-soluble vitamins (A, D, E, K). The outcome was favorable, characterized by normalization of intestinal passage, ascending growth curve and normalization of the majority of laboratory tests values that were modified between the time of patient admission to our clinic and initiation of specific therapy (serum level of vitamin K, vitamin D and lipase, coagulation profile, hemoglobin and red blood cell indexes), as well as higher value of fecal pancreatic elastase.    

scholarly journals Efficacy and Safety of a New Formulation of Pancrelipase (Ultrase MT20) in the Treatment of Malabsorption in Exocrine Pancreatic Insufficiency in Cystic Fibrosis

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Michael W. Konstan ◽  
Theodore G. Liou ◽  
Steven D. Strausbaugh ◽  
Richard Ahrens ◽  
Jamshed F. Kanga ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Gastrointestinal Symptoms ◽  
Signs And Symptoms ◽  
Exocrine Pancreatic Insufficiency ◽  
Efficacy And Safety ◽  
Protein Nitrogen ◽  
Enzyme Replacement ◽  
New Formulation

Background. Pancreatic enzyme replacement therapy is the standard of care for treatment of malabsorption in patients with cystic fibrosis (CF) and exocrine pancreatic insufficiency (PI).Aim. To evaluate efficacy and safety of a new formulation of pancrelipase (Ultrase MT20) in patients with CF and PI. Coefficients of fat absorption (CFA%) and nitrogen absorption (CNA%) were the main efficacy parameters. Safety was evaluated by monitoring laboratory analyses, adverse events (AEs), and overall signs and symptoms.Methods. Patients (n=31) were randomized in a crossover design comparing this pancrelipase with placebo during 2 inpatient evaluation periods (6-7 days each). Fat and protein/nitrogen ingestion and excretion were measured from food diaries and 72-hour stool collections. CFA% and CNA% were calculated for each period and compared.Results. Twenty-four patients provided analyzable data. This pancrelipase increased mean CFA% and CNA% (+34.7% and +25.7%, resp.,P<.0001for both), reduced stool frequency, and improved stool consistency compared with placebo. Placebo-treated patients reported more AEs, with gastrointestinal symptoms being the most frequently reported AE.Conclusions. This pancrelipase is a safe and effective treatment for malabsorption associated with exocrine PI in patients with CF.

scholarly journals A111 SEVERE FAT MALABSORPTION IN A PATIENT POST ILEAL POUCH ANAL ANASTAMOSIS: A RARE PRESENTATION OF MICROSCOPIC ENTERITIS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 129-130
Author(s):  
M Ricci ◽  
M Ropeleski
Keyword(s):  
Weight Loss ◽  
Weight Gain ◽  
Small Bowel ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Vitamin Deficiency ◽  
Vitamin Deficiencies ◽  
Enzyme Replacement ◽  
Fat Malabsorption ◽  
Subepithelial Layer

Abstract Background Microscopic enteritis (ME) is a rare enteropathy characterized by malabsorptive diarrhea and lymphocytic infiltration +/- collagen deposition in the subepithelial layer of the small bowel. Its etiology is unclear. Aims To elucidate a rare cause of fat malabsorption and vitamin deficiency in a patient with ulcerative colitis and an ileoanal pouch. Methods A 74 yo male with a prior IPAA was referred to Internal Medicine in August 2018 for a 36 kg weight loss over 18 months and &gt;16 bowel movements (BM) per day (baseline 6, no history of pouchitis). Celiac serology and infectious workup were negative. Medical management and nutritional supplements did not result in weight gain or improvement of diarrhea. He was admitted in June 2019 with ongoing weight loss, AKI, and signs of fat-soluble vitamin deficiency. A 72-hour fecal fat analysis showed an average fecal weight of 2100 g/d (ref &lt;250 g/d), and excretion of 70% of daily fat intake (ref &lt;7%). His fecal elastase (FE) was 147 µg/g, consistent with moderate pancreatic insufficiency (PI) with mild atrophy on CT. EGD and pouch endoscopy were macroscopically normal, with histological findings of intraepithelial lymphocytosis and mild villous blunting in the duodenum and afferent limb. CT enterography excluded small bowel abnormalities. He was started on pancreatic enzyme replacement and discharged. He returned with worsening diarrhea and AKI. He was treated with supportive care and sent home. In the ensuing 3 weeks, he had up to 24 BM per day and 4 kg of weight loss. He returned in August 2019 with AKI, lack of PO intake and worsened nutritional status. Re-examination of duodenal biopsies from June 2019 revealed an added finding of focal subepithelial collagen thickening. Budesonide was started. Results On budesonide, his symptoms improved within days. BMs decreased to baseline, and his ability to sustain PO intake improved. At his 4-week follow-up visit, BMs were stable with a 6 kg weight gain and no ensuing laboratory abnormalities. Conclusions ME is a rare enteropathy that presents with malabsorption. Fat-soluble vitamin deficiencies can develop with widespread physiological disruption of the mucosal surface. This patient was a diagnostic challenge. His steatorrhea and reduced FE levels led clinicians down a diagnostic pathway of PI. FE is the most common test used in the diagnosis of PI. Levels &lt;200 µg/g are abnormal. Specificity is highest in chronic pancreatitis; however, this decreases in the presence of mucosal atrophy (i.e. IBD and diffuse small bowel disease). Thus, FE could not delineate the cause of steatorrhea in our patient. We can surmise that he likely has diffuse disease that was underestimated on duodenal biopsy. This is supported by his response to budesonide. This case highlights the heterogeneity of clinical presentations of ME. Awareness can reduce patient morbidity. Funding Agencies None

scholarly journals State of the Art in Exocrine Pancreatic Insufficiency

Medicina ◽  
2020 ◽  
Vol 56 (10) ◽  
pp. 523
Author(s):  
Carmelo Diéguez-Castillo ◽  
Cristina Jiménez-Luna ◽  
Jose Prados ◽  
José Luis Martín-Ruiz ◽  
Octavio Caba
Keyword(s):  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Bacterial Overgrowth ◽  
Exocrine Pancreatic Insufficiency ◽  
Enzyme Replacement ◽  
Non Invasive ◽  
Invasive Test ◽  
Pancreatic Enzyme Replacement Therapy ◽  
Risk Patients

Exocrine pancreatic insufficiency (EPI) is defined as the maldigestion of foods due to inadequate pancreatic secretion, which can be caused by alterations in its stimulation, production, transport, or interaction with nutrients at duodenal level. The most frequent causes are chronic pancreatitis in adults and cystic fibrosis in children. The prevalence of EPI is high, varying according to its etiology, but it is considered to be underdiagnosed and undertreated. Its importance lies in the quality of life impairment that results from the malabsorption and malnutrition and in the increased morbidity and mortality, being associated with osteoporosis and cardiovascular events. The diagnosis is based on a set of symptoms, indicators of malnutrition, and an indirect non-invasive test in at-risk patients. The treatment of choice combines non-restrictive dietary measures with pancreatic enzyme replacement therapy to correct the associated symptoms and improve the nutritional status of patients. Non-responders require the adjustment of pancreatic enzyme therapy, the association of proton pump inhibitors, and/or the evaluation of alternative diagnoses such as bacterial overgrowth. This review offers an in-depth overview of EPI in order to support the proper management of this entity based on updated and integrated knowledge of its etiopathogenesis, prevalence, diagnosis, and treatment.

scholarly journals A Case of Chronic Pancreatic Insufficiency Due to Valproic Acid in a Child

2001 ◽  
Vol 15 (2) ◽  
pp. 127-130 ◽  
Author(s):  
Mary Anne Cooper ◽  
Aubrey Groll
Keyword(s):  
Valproic Acid ◽  
Weight Loss ◽  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Exocrine Pancreatic Insufficiency ◽  
Radiological Evaluation ◽  
Enzyme Replacement

A 14-year-old child treated with valproic acid over several years for a seizure disorder developed abdominal pain with radiological evidence of acute pancreatitis. The association with valproic acid was not recognized, and the child continued to take the drug. The patient eventually developed steatorrhea and weight loss that improved with pancreatic enzyme replacement. Radiological evaluation showed an atrophic pancreas. Without evidence of other etiological factors, valproic acid by itself appeared to be the cause of chronic pancreatitis with exocrine pancreatic insufficiency in this patient.

scholarly journals Immunoreactive elastase I: clinical evaluation of a new noninvasive test of pancreatic function

1996 ◽  
Vol 42 (2) ◽  
pp. 222-226 ◽  
Author(s):  
J Stein ◽  
M Jung ◽  
A Sziegoleit ◽  
S Zeuzem ◽  
W F Caspary ◽  
...  
Keyword(s):  
Pancreatic Insufficiency ◽  
Pancreatic Enzyme ◽  
Correlation Coefficients ◽  
Diagnostic Value ◽  
Exocrine Pancreatic Insufficiency ◽  
Pancreatic Function ◽  
Noninvasive Test ◽  
Enzyme Replacement ◽  
Fecal Chymotrypsin ◽  
Immunoreactive Elastase

Abstract We have evaluated the diagnostic value of the fecal elastase test in comparison with the secretin-pancreozymin test in the diagnosis of exocrine pancreatic insufficiency. Pancreatic elastase was measured immunologically. Immunoreactive elastase activity in spot stools from controls ranged from 136 to 4440 microgram/g; 95% of all values were within 175 to 1500 microgram/g. The elastase assay CVs ranged from 3.3% to 6.3% (intraassay) and from 4.1% to 10.2% (interassay). The output of elastase correlated well with those of amylase, lipase, and trypsin, yielding respective correlation coefficients of 0.83, 0.82, and 0.84 in controls and 0.86, 0.91, and 0.91 in patients with impaired pancreatic function. In contrast to fecal chymotrypsin, the test results were unaffected by pancreatic enzyme replacement therapy. These results indicate that fecal immunoreactive elastase may be recommended as a new, noninvasive tubeless test of pancreatic function.

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