Exocrine pancreatic insufficiency Flashcards
What is exocrine pancreatic insufficiency?
Reduced secretion of pancreatic enzymes, resulting in the inability to digest food properly, or maldigestion
what are the main clinical consequences of exocrine pancreatic insufficiency?
Maldigestion and malnutrition associated with low circulating levels of micronutrients, fat-soluble vitamins and lipoproteins
What symptoms can people who suffer with exocrine pancreatic insufficiency present with? (3)
1) Diarrhoea
2) Abdominal cramps
3) Steatorrhoea (fat in stools)
EPI is associated with certain diseases and conditions, list some of these (5)
1) Chronic pancreatitis, pancreatic tumours
2) Cystic fibrosis,
3) Coeliac disease
4) Zollinger-Ellison syndrome
5) GI or pancreatic surgical resection
What is the main treatment for EPI?
Pancreatic enzyme replacement therapy with pancreatin
What does pancreatin contain?
Digestive enzymes: lipase, amylase and protease. These enzymes respectively digest fats, carbohydrates and proteins
How should pancreatin be administered?
1) with meals and snacks. The dose adjusted, to the lowest effective dose according to the symptoms of maldigestion and malabsorption
2) G/R granules should be mixed with slightly acidic soft food or liquid and then swallowed immediately without chewing. not be kept for more than one hour
3) excessive heat should be avoided if mixed with liquids or food
what is fibrosing colonopathy and what are the risk factors?
1) Disease that arises in patients with cystic fibrosis treated with high doses of pancreatic enzyme supplements ( 10 000 units/kg/day of lipase)
2) Possible risk factors are gender more severe cystic fibrosis, and concomitant use of laxatives
The total dose of pancreatin used in patients with cystic fibrosis should not usually exceed what amount in the Pancrease HL® and Nutrizym 22® to avoid fibrosing colonopathy ?
Not usually exceed 10 000 units/kg/day of lipase
To prevent colonic damage what do the manufacturers of pancreatin suggest?
if a patient develops new abdominal symptoms (or any change in existing abdominal symptoms) the patient should be reviewed to exclude the possibility of colonic damage.
what can be prescribed to improve the effectiveness of pancreatin?
Acid-suppressing drugs: PPIs or H2-receptor antagonists (limited evidence)
↳ (Pancreatin is inactivated by gastric acid so always take with or after food)
what should be monitored in patients with EPI?
Levels of fat-soluble vitamins and micronutrients (such as zinc and selenium) should be routinely assessed necessary
Outline the non-pharmacological advice that should be provided to those with EPI (4)
1) Food intake should be distributed between three main meals per day, and 2-3 snacks.
2) Difficult to digest foods should be avoided, e.g. legumes and high-fibre foods
3) Alcohol should be avoided completely
4) Reduced fat diets are not recommended
what patient and carer advice should be provided to those receiving higher strength pancreatin preparations?
It is important to ensure adequate hydration at all times
