Differential diagnoses included intestinal parasitism, chronic enteropathy (eg, food-responsive enteropathy, antibiotic-responsive enteropathy, immunosuppressant-responsive enteropathy), protein-losing enteropathy, juvenile neoplasia, chronic intussusception, chronic foreign body, hypoadrenocorticism (ie, Addison’s disease), chronic kidney disease, chronic liver disease, and infection with Pythium spp, which is endemic in Florida.1
CBC, serum chemistry profile, and urinalysis results were within normal limits. Fecal flotation results were negative.
Because of Trixie’s dramatic weight loss, abdominal radiography and ultrasonography were completed on the day of presentation. Radiographs were unremarkable but revealed mild loss of serosal detail, presumably secondary to patient emaciation. Ultrasound images revealed no mural thickening, abdominal mass, lymphadenopathy, or other abnormality. Adrenal glands were slightly decreased in size.
After Trixie was fasted for 12 hours, serum cobalamin (ie, vitamin B12), folate, canine trypsin-like immunoreactivity (cTLI), and baseline cortisol levels were obtained (Table). The results demonstrated a decreased cTLI, which was diagnostic for exocrine pancreatic insufficiency. Cobalamin was also decreased, which was consistent with ileal pathology. Baseline cortisol was increased, ruling out hypoadrenocorticism.2