Eurytrema coelomaticum infection: correlation between parasite burden and impairment of pancreatic exocrine enzyme secretion / Eurytrema coelomaticum: correlação entre carga parasitária e insuficiência pancreática exócrina

Eurytrema coelomaticum is a trematode reported in the pancreatic ducts of ruminants. It is conjectured that may cause disorders in the pancreas, as well as digestive and metabolic processes dependent on them. This study, determined if there is an impairment of exocrine pancreatic function, and correlated it with parasite burden. Pancreas, blood, and fecal samples were collected from 119 bovines at a abattoir. Stool samples were subjected to the gelatin and x-ray film digestion tests (to detect the presence of trypsin in feces). Using blood samples, the following biochemical tests were performed: amylase, lipase, glucose, fructosamine, cholesterol, triglycerides, total protein, albumin, and globulins. Analyses were correlated with pancreatic parasite burden. Cattle with a high parasitic load presented higher incidence of negative tests in both gelatin digestion and x-ray film digestion tests (P < 0.001) when compared to non-parasitized animals and those with a low parasitic load. Changes in those tests only occurred if the parasitemia was moderate or severe. The activity of the amylase and lipase enzymes was significantly higher in animals with low parasitemia (P < 0.05), compared to non-parasitized animals and with a high parasitic burden. In this study, in cases of high parasitemia, negative results were observed in both gelatin and x-ray film in the feces digestion tests. However, the low infection of E. coelomaticum, higher levels of serum amylase and lipase that also indicated loss of pancreatic exocrine functions were reported.

Eurytrema coelomaticum, um trematódeo de ductos pancreáticos de ruminantes. Conjectura-se que possa ocasionar transtornos nas funções pancreáticas, mais especificamente nos processos digestivos e metabólicos dependentes destas. Neste estudo, o objetivo foi determinar se há comprometimento da função pancreática exócrina, correlacionado-a a carga parasitária. Foram utilizados pâncreas e respectivas amostras de sangue e fezes de 119 bovinos. As amostras de fezes foram submetidas aos testes de digestão da gelatina em tubo e digestão de filme radiográfico, ambos para detecção de tripsina nas fezes. Foram realizados os seguintes exames bioquímicos em amostras de sangue: amilase, lipase, glicemia, frutosamina, colesterol, triglicerídeos, proteínas totais, albumina e globulinas. Após isto, as análises bioquímicas foram correlacionadas com a quantidade numérica de parasitas encontrados no pâncreas (post-mortem). Houve maior quantidade de testes negativos (digestão do filme radiográfico e prova de digestão da gelatina) nos animais com alta carga parasitária (P < 0.001), quando comparados aos animais não parasitados e com baixa carga parasitária. Portanto, os exames supracitados se alteram somente se a quantidade de parasitas for moderada ou severa. As atividades das enzimas amilase e lipase foram significativamente maiores nos animais que apresentavam baixa parasitemia (P < 0.05), em comparação com os animais com alta carga parasitária e não parasitados. Conclui-se que em quadros de alta parasitemia há alteração significativa nos testes de digestão nas fezes, e que em quadros de baixa parasitemia há alterações significativas nos valores de amilase e lipase séricas, ambos comprovando alterações pancreáticas importantes, de acordo com o quadro de parasitemia.

Insuficiência pancreática exócrina em cão - Relato de caso / Exocrine pancreatic insufficiency in a dog ­ Case report / Insuficiencia pancreática exócrina en perro- Relato de caso

A insuficiência pancreática exócrina é uma incapacidade na secreção de enzimas digestivas decorrentes da diminuição do tecido acinar do pâncreas acarretando uma má digestão e absorção. O presente trabalho relata o caso de uma cadela SRD de um ano e meio com histórico de emagrecimento, esteatorréia, burburinhos e polifagia que foi diagnostica com insuficiência pancreática exócrina após teste de imunorreatividade da tripsina. O tratamento instituído com suplementação de enzimas pancreáticas foi eficiente no controle e evolução da doença.(AU)

Exocrine pancreatic insufficiency is the inability to secrete digestive enzymes due to the decrease in the acinar tissue of the pancreas leading to poor digestion and absorption. This work is a case report of a 1.5-years' old mongrel bitch with a history of weight loss, steatorrhea, rumbling sounds and polyphagia that was diagnosed with exocrine pancreatic insufficiency after a trypsin immunoreactivity test. The pancreatic enzyme supplementation was efficient in controlling the evolution of the disease.(AU)

La insuficiencia pancreática exocrina es una incapacidad en la secreción de enzimas digestivas derivadas de la disminución del tejido acinar del páncreas, acarreando mala digestión y absorción. El presente trabajo relata el caso de una perra SRD de un año y medio con historial de adelgazamiento, esteatorrea, burbujas y polifagia que fue diagnosticada con insuficiencia pancreática exocrina después de la prueba de inmune reactividad de la tripsina. El tratamiento instituido con suplementación de enzimas pancreáticas fue eficiente en el control y evolución de la enfermedad.(AU)

Insuficiência pancreática exócrina em cão - Relato de caso / Exocrine pancreatic insufficiency in a dog ­ Case report / Insuficiencia pancreática exócrina en perro- Relato de caso

A insuficiência pancreática exócrina é uma incapacidade na secreção de enzimas digestivas decorrentes da diminuição do tecido acinar do pâncreas acarretando uma má digestão e absorção. O presente trabalho relata o caso de uma cadela SRD de um ano e meio com histórico de emagrecimento, esteatorréia, burburinhos e polifagia que foi diagnostica com insuficiência pancreática exócrina após teste de imunorreatividade da tripsina. O tratamento instituído com suplementação de enzimas pancreáticas foi eficiente no controle e evolução da doença.(AU)

Exocrine pancreatic insufficiency is the inability to secrete digestive enzymes due to the decrease in the acinar tissue of the pancreas leading to poor digestion and absorption. This work is a case report of a 1.5-years' old mongrel bitch with a history of weight loss, steatorrhea, rumbling sounds and polyphagia that was diagnosed with exocrine pancreatic insufficiency after a trypsin immunoreactivity test. The pancreatic enzyme supplementation was efficient in controlling the evolution of the disease.(AU)

La insuficiencia pancreática exocrina es una incapacidad en la secreción de enzimas digestivas derivadas de la disminución del tejido acinar del páncreas, acarreando mala digestión y absorción. El presente trabajo relata el caso de una perra SRD de un año y medio con historial de adelgazamiento, esteatorrea, burbujas y polifagia que fue diagnosticada con insuficiencia pancreática exocrina después de la prueba de inmune reactividad de la tripsina. El tratamiento instituido con suplementación de enzimas pancreáticas fue eficiente en el control y evolución de la enfermedad.(AU)

Exocrine pancreatic insufficiency: a case report / Insuficiência pancreática exócrina: relato de caso

Exocrine pancreatic insufficiency (EPI), a common disease indogs, is mainly caused by pancreatic acinar atrophy, followedby chronic pancreatitis and pancreatic duct obstruction, withconsequent inadequate secretion of pancreatic enzymes.The present paper is a case report observed in a male eightyear-old dog that had the diagnosis of EPI suggested by thefecal proteolytic activity test (X-ray film proof). To date, thetreatment given with pancreatic enzyme supplementation andadequate diet has been able to promote the resolution of theclinical condition.

A insuficiência pancreática exócrina (IPE), doença comum principalmenteem cães, é causada, usualmente, pela atrofia acinar dopâncreas, seguida de pancreatite crônica e obstrução do ductopancreático, com consequente secreção inadequada de enzimaspancreáticas. O caso clínico descrito foi observado em um cão,macho, de oito anos de idade, em que o diagnóstico de IPE foilevantado pelo resultado do teste da atividade proteolítica fecal(prova do filme de raio-x). Até o presente momento, o tratamentoinstituído com suplementação de enzimas pancreáticas eadequação da dieta propiciou a resolução do quadro clínico.

Exocrine pancreatic insufficiency: a case report / Insuficiência pancreática exócrina: relato de caso

Exocrine pancreatic insufficiency (EPI), a common disease indogs, is mainly caused by pancreatic acinar atrophy, followedby chronic pancreatitis and pancreatic duct obstruction, withconsequent inadequate secretion of pancreatic enzymes.The present paper is a case report observed in a male eightyear-old dog that had the diagnosis of EPI suggested by thefecal proteolytic activity test (X-ray film proof). To date, thetreatment given with pancreatic enzyme supplementation andadequate diet has been able to promote the resolution of theclinical condition.(AU)

A insuficiência pancreática exócrina (IPE), doença comum principalmenteem cães, é causada, usualmente, pela atrofia acinar dopâncreas, seguida de pancreatite crônica e obstrução do ductopancreático, com consequente secreção inadequada de enzimaspancreáticas. O caso clínico descrito foi observado em um cão,macho, de oito anos de idade, em que o diagnóstico de IPE foilevantado pelo resultado do teste da atividade proteolítica fecal(prova do filme de raio-x). Até o presente momento, o tratamentoinstituído com suplementação de enzimas pancreáticas eadequação da dieta propiciou a resolução do quadro clínico.(AU)

Descrição de quatro casos de atrofia do pâncreas exócrino em cães / Description of four exocrine pancreatic atrophy cases in dogs

Background: Exocrine pancreatic atrophy (EPA) is characterized by marked decrease of the exocrine pancreatic tissue in dogs, the disease is more frequently described in German Shepherd Dogs and there are features of herdability in this breed. Clinical signs observed are those typical of chronic pancreatic insufficiency, including voluminous stool, steatorrhoea and weight loss. The purpose of this paper is to describe clinical and pathological findings of four cases of EPA in dogs. Cases: Files of all necropsies performed in dogs in the Veterinary Pathology Laboratory of the Universidade Federal do Rio Grande do Sul (UFRGS) between January, 2001 and December, 2010 were reviewed, searching for EPA cases. Were collected information about age, breed, clinical signs, evolution of the disease, and pathological findings of the cases that were found. Pancreatic portions of the affected dogs were submitted to immunohistochemistry (IHC) using polyclonal antibodies against cytokeratin and chromogranin, labeled with streptavidin-biotin linked to peroxidase method and red chromogen were applied. Hematoxylin was used for counterstaining. During the period analyzed four cases were found, representing a small percentage (0.9%) of dog cases with post-mortem examination during the period. Two dogs were German Shepherd Dogs, one male and one female, both aged three years. The other two dogs were mixed breed females with one and two years of age. Clinical course of the disease varied between five months and one year and the main clinical signs presented were: pale and voluminous feces (4/4), weight loss (4/4), recent loss of appetite (2/4), vomiting (1/4) and polydipsia (1/4). Loss of appetite was noticed one week before death. Feces of all animals were tested for fecal protease (trypsin), and all resulted negative. In one case feces were also evaluated for fecal amylase and lipase, resulting negative for both enzymes. Gross lesions observed were: pancreatic tissue extremely diminished, semi-transparent and narrow (4/4), decreased muscular tissue volume (4/4), diminished subcutaneous adipose tissue (4/4), intestine filled with soft, voluminous and pale feces (4/4). Microscopically, pancreas presented absence of acinar structures, containing rare epithelial cells scattered throughout the parenchyma, essentially composed of Langerhans islet cells, surrounded by pancreatic ducts and evident supportive stroma. Lymphocytic multifocal mild infiltrate and adipose infiltrate were observed in two cases. Multifocal muscle fiber atrophy occurred in all four cases, in one of them it was associated with hyaline and flocular degeneration of muscle fibers. Remaining cells of pancreatic tissue were positive for chromogranin IHC, staining granular material inside the cells, showing the neuroendocrine tissue. Cytokeratin IHC stained rare remaining acinar cells and duct cells. Discussion: EPA diagnosis of the presented cases was performed based on clinical history, pathological findings and IHC staining. EPA cases shall be considered as causes of weight loss, chronic presentation of voluminous pale feces and death in young German Shepherd Dog. The lack of familiar history among mongrel dogs makes difficult to assess the susceptibility of these dogs to EPA, and it should be considered a differential diagnosis in cases presenting the clinical signs highlighted in this paper.

Descrição de quatro casos de atrofia do pâncreas exócrino em cães / Description of four exocrine pancreatic atrophy cases in dogs

Background: Exocrine pancreatic atrophy (EPA) is characterized by marked decrease of the exocrine pancreatic tissue in dogs, the disease is more frequently described in German Shepherd Dogs and there are features of herdability in this breed. Clinical signs observed are those typical of chronic pancreatic insufficiency, including voluminous stool, steatorrhoea and weight loss. The purpose of this paper is to describe clinical and pathological findings of four cases of EPA in dogs. Cases: Files of all necropsies performed in dogs in the Veterinary Pathology Laboratory of the Universidade Federal do Rio Grande do Sul (UFRGS) between January, 2001 and December, 2010 were reviewed, searching for EPA cases. Were collected information about age, breed, clinical signs, evolution of the disease, and pathological findings of the cases that were found. Pancreatic portions of the affected dogs were submitted to immunohistochemistry (IHC) using polyclonal antibodies against cytokeratin and chromogranin, labeled with streptavidin-biotin linked to peroxidase method and red chromogen were applied. Hematoxylin was used for counterstaining. During the period analyzed four cases were found, representing a small percentage (0.9%) of dog cases with post-mortem examination during the period. Two dogs were German Shepherd Dogs, one male and one female, both aged three years. The other two dogs were mixed breed females with one and two years of age. Clinical course of the disease varied between five months and one year and the main clinical signs presented were: pale and voluminous feces (4/4), weight loss (4/4), recent loss of appetite (2/4), vomiting (1/4) and polydipsia (1/4). Loss of appetite was noticed one week before death. Feces of all animals were tested for fecal protease (trypsin), and all resulted negative. In one case feces were also evaluated for fecal amylase and lipase, resulting negative for both enzymes. Gross lesions observed were: pancreatic tissue extremely diminished, semi-transparent and narrow (4/4), decreased muscular tissue volume (4/4), diminished subcutaneous adipose tissue (4/4), intestine filled with soft, voluminous and pale feces (4/4). Microscopically, pancreas presented absence of acinar structures, containing rare epithelial cells scattered throughout the parenchyma, essentially composed of Langerhans islet cells, surrounded by pancreatic ducts and evident supportive stroma. Lymphocytic multifocal mild infiltrate and adipose infiltrate were observed in two cases. Multifocal muscle fiber atrophy occurred in all four cases, in one of them it was associated with hyaline and flocular degeneration of muscle fibers. Remaining cells of pancreatic tissue were positive for chromogranin IHC, staining granular material inside the cells, showing the neuroendocrine tissue. Cytokeratin IHC stained rare remaining acinar cells and duct cells. Discussion: EPA diagnosis of the presented cases was performed based on clinical history, pathological findings and IHC staining. EPA cases shall be considered as causes of weight loss, chronic presentation of voluminous pale feces and death in young German Shepherd Dog. The lack of familiar history among mongrel dogs makes difficult to assess the susceptibility of these dogs to EPA, and it should be considered a differential diagnosis in cases presenting the clinical signs highlighted in this paper.(AU)

Insuficiência Pancreática Exócrina (IPE) no cão: relato de caso / Exocrine Pancreatic Insufficiency in the dog: a case report / Insuficiencia Pancreática Exocrina en el perro: report de un caso

A IPE é uma doença relativamente comum em cães e rara em gatos, na qual o pâncreas é incapaz de garantir a função secretória enzimática. Um cão sem raça definida de seis anos foi atendido no Hovet -Metodista, apresentando-se caquético, com pelame opaco e histórico de fezes pastosa e em grande volume. Após anamnese, exame físico e descarte de Doença intestinal inflamatória, corpo estranho e endocrinopatia, suspeitou-se de Insuficiência pancreática exócrina, confirmando com o resultado dos exames complementares (hemograma e Imunorreatividade semelhante à tripsina sérica). Após algumas semanas da administração de Extrato de pancreatina, junto com os tratamentos complementares, houve regressão dos sintomas e conclusão do caso.(AU)

EPI is a relatively common in dogs and quite rare in cats, in which the pancreas is unable to assure its enzyme secretory function. An mixed breed dog, six years old was treated at the Metodista - Veterinary Hospital, presenting cachectic condition, opaque fur and history of large amounts of pasty feces. After anamnesis, physical examination and discarding intestinal inflammatory disease, foreign body or endocrinopathy, emerged the suspicion of exocrine pancreatic insufficiency which was confirmed with complementary tests (blood test and Tripsin-like immunoreactivity). A few weeks into the treatment, administering pancreatic enzyme extracts alongside complementary care, there was clear regression of the symptoms and conclusion of the case.(AU)

La IPE es una enfermedad relativamente común en perros y en gatos rara, en la que el páncreas no Metodista es capaz de asegurar la función de la enzima secretora. Un perro de raza mixta 6 anos fue visto en Hovet - Metodista, presentando caquéctico, con heces pastosas pieles opacas e históricos y de gran volumen. Después de la anamnesis, la exploración física y la eliminación de la enfermedad inflamatoria del intestino, cuerpo extrario y enfermedades endocrinas, se sospechó la insuficiencia pancreática exocrina, confirmando IPE con el resultado de pruebas de laboratorio (hemograma y Inmunorreactividad similar a la tripsina en suero). Después de unas semanas de la administración de extracto de pancreatina, junto con los tratamientos complementarios, sus síntomas y el cierre del caso.(AU)

Insuficiência Pancreática Exócrina (IPE) no cão: relato de caso / Exocrine Pancreatic Insufficiency in the dog: a case report / Insuficiencia Pancreática Exocrina en el perro: report de un caso

A IPE é uma doença relativamente comum em cães e rara em gatos, na qual o pâncreas é incapaz de garantir a função secretória enzimática. Um cão sem raça definida de seis anos foi atendido no Hovet -Metodista, apresentando-se caquético, com pelame opaco e histórico de fezes pastosa e em grande volume. Após anamnese, exame físico e descarte de Doença intestinal inflamatória, corpo estranho e endocrinopatia, suspeitou-se de Insuficiência pancreática exócrina, confirmando com o resultado dos exames complementares (hemograma e Imunorreatividade semelhante à tripsina sérica). Após algumas semanas da administração de Extrato de pancreatina, junto com os tratamentos complementares, houve regressão dos sintomas e conclusão do caso.

EPI is a relatively common in dogs and quite rare in cats, in which the pancreas is unable to assure its enzyme secretory function. An mixed breed dog, six years old was treated at the Metodista - Veterinary Hospital, presenting cachectic condition, opaque fur and history of large amounts of pasty feces. After anamnesis, physical examination and discarding intestinal inflammatory disease, foreign body or endocrinopathy, emerged the suspicion of exocrine pancreatic insufficiency which was confirmed with complementary tests (blood test and Tripsin-like immunoreactivity). A few weeks into the treatment, administering pancreatic enzyme extracts alongside complementary care, there was clear regression of the symptoms and conclusion of the case.

La IPE es una enfermedad relativamente común en perros y en gatos rara, en la que el páncreas no Metodista es capaz de asegurar la función de la enzima secretora. Un perro de raza mixta 6 anos fue visto en Hovet - Metodista, presentando caquéctico, con heces pastosas pieles opacas e históricos y de gran volumen. Después de la anamnesis, la exploración física y la eliminación de la enfermedad inflamatoria del intestino, cuerpo extrario y enfermedades endocrinas, se sospechó la insuficiencia pancreática exocrina, confirmando IPE con el resultado de pruebas de laboratorio (hemograma y Inmunorreactividad similar a la tripsina en suero). Después de unas semanas de la administración de extracto de pancreatina, junto con los tratamientos complementarios, sus síntomas y el cierre del caso.

Bradyarrhythmias in dogs with exocrine pancreatic insufficiency / Bradiarritmias em cães com insuficiência pancreática exócrina

The exocrine pancreatic insufficiency (EPI) is a digestive disease caused by atrophy or inflammation of pancreatic acinar cells, resulting in nutrient malabsorption and clinical signs related to malnutrition. Three German Shepherds were presented at the Veterinary Hospital with background and clinical signs compatible with EPI, what was confirmed by routine laboratory testing. On physical examination, both presented bradyarrhythmias confirmed by computerized electrocardiogram. After therapy for EPI, the bradyarrhythmias were solved. The authors discuss the influence of the gastrointestinal hormone cholecystokinin, which can increase in pancreatic exocrine impairment, possibly reflecting a failure to provide feedback down-modulation of CCK release, causing cardiovascular effects, such as chronotropic and inotropic negative actions and promoting bradycardia.

A insuficiência pancreática exócrina (IPE) é uma enfermidade causada por atrofia ou inflamação das células acinares pancreáticas, resultando em má absorção de nutrientes e sinais clínicos relacionados à desnutrição. Três pastores alemães foram atendidos no Hospital Veterinário com histórico e sinais clínicos compatíveis com IPE, diagnosticada através de testes laboratoriais de rotina. Ao exame físico, os três animais apresentaram bradiarritmias, que foram confirmadas por eletrocardiograma computadorizado. Após o tratamento da IPE, houve normalização dos valores de freqüência cardíaca de todos os pacientes. Os autores discutem a influência do hormônio colecistoquinina, que pode estar elevado em casos de insuficiência pancreática exócrina e que, por sua vez, exerce efeitos cardiovasculares tais como cronotropismo e inotropismo negativos, promovendo desta forma a bradicardia destes pacientes.

Disfunção miocárdica relacionada à insuficiência pancreática exócrinaem cão - relato de caso / Myocardial dysfunction related to exocrine pancreatic insufficiency in dogs - case report

Insuficiência Pancreática Exócrina (IPE) é um tipo de enfermidade gastrointestinal crônica que promovediversas alterações no organismo. O presente relato refere-se ao atendimento de um cão da raça PastorAlemão com diagnóstico de IPE com sinais clínicos de intolerância a exercícios e de insuficiência miocárdicaobservados em exames complementares antes e após a instituição do tratamento para IPE. Osautores discutem a possível participação da colecistoquinina e do déficit de taurina no desenvolvimentoda insuficiência miocárdica.(AU)

The exocrine pancreatic insufficiency (EPI) is a chronic gastrointestinal disease that promotes severalconsequences to the organism. The present case report mentions the attendance of a German Shepherddog with EPI diagnosis, intolerance to exercises and cardiac alterations in complementary examinations,before treatment. The authors argue the participation of cholecystokinin and deficit of taurine on thedevelopment of this cardiac disturbance.(AU)

Disfunção miocárdica relacionada à insuficiência pancreática exócrinaem cão - relato de caso / Myocardial dysfunction related to exocrine pancreatic insufficiency in dogs - case report

Insuficiência Pancreática Exócrina (IPE) é um tipo de enfermidade gastrointestinal crônica que promovediversas alterações no organismo. O presente relato refere-se ao atendimento de um cão da raça PastorAlemão com diagnóstico de IPE com sinais clínicos de intolerância a exercícios e de insuficiência miocárdicaobservados em exames complementares antes e após a instituição do tratamento para IPE. Osautores discutem a possível participação da colecistoquinina e do déficit de taurina no desenvolvimentoda insuficiência miocárdica.

The exocrine pancreatic insufficiency (EPI) is a chronic gastrointestinal disease that promotes severalconsequences to the organism. The present case report mentions the attendance of a German Shepherddog with EPI diagnosis, intolerance to exercises and cardiac alterations in complementary examinations,before treatment. The authors argue the participation of cholecystokinin and deficit of taurine on thedevelopment of this cardiac disturbance.