Exocrine Pancreatic Insufficiency Flashcards
What are the common products of the exocrine pancreas?
Amylase = breaks down carbs/sugars
Lipases = break down fats
Proteases = trypsin/elastase/etc.
- break down proteins
Bicarbonate = neutralizes stomach acid
What are the two stimulation molecules for the exocrine pancreas?
CCK = stimulates protease and lipases from exocrine pancreas
- released by I cells and in the responses to peptides/fatty acids and amino acids
Secretin = stimulates bicarbonate release from exocrine pancreas
- released by S cells and in the presence of acid
Classic presentation of exocrine pancreatic insufficiency
Mild = asymptomatic or mild abdominal discomfort and bloating
Moderate-severe
- bloating, steatorrhea, unintended weight loss
- deficiencies of DEAK and vitamin B12
What are the common risk factors for exocrine pancreatic insufficiency
Chronic pancreatitis
- most common cause in adults
Cystic fibrosis
- most common cause in children
Gastric/small bowel resection
Pancreatic duct obstruction
Acute pancreatitis
1) severe/sharp epigastric abdominal pain w/ tenderness that radiates to the right mid-back/ supraclavicular area
- gets worse with eating
- significant nausea/vomiting can occur with the pain
almost always caused by obstructing gallstones or excessive alcohol use
Confirmation = lipase/amylase is 3x normal and CT imaging shows pancreatic inflammation
Treated by withholding oral intake (liquid diets)
Chronic pancreatitis
Similar pain to acute except it is intermittent sometimes
- also can cause N/V
- also radiates to the mid-back
Also shows pancreatic insufficiency symptoms
Usually a history of recurrent acute pancreatitis
lipase/amylase is often normal or may be even lower than normal
CT doesnt correlate with severity of disease, but can show calcifications (acute doesnt show calcifications)
Cystic fibrosis
Various symptoms but is caused by mutations in CFTR proteins which causes thickened mucus
- can block pancreas and cause pancreas insufficiency
Testing = sweat chloride and genetic testing can confirm
How does resection cause exocrine pancreatic insufficiency?
Can lead to decrease sites of secretin/CCK (if small bowel)
Can lead to less pancreas secretions as well due to less pancreas being present
How to diagnosis pancreatic insufficiency
Can use symptoms and patient history (if they have risk factors)
To confirm malabsorption primary
- elevated fecal fat level and vitamin deficiency
To confirm exocrine pancreatic insufficiency primary
- indirect = decreased fecal elastase-1
- direct = secretin test with pancreas biopsy
Treatment of exocrine pancreatic insufficiency
1) stop alcoholic drinking.
2) start small low-fat meals and switch from high fat meals if applicable
3) give pancreatic enzymes supplements
4) give vitamin supplements
5) Can add medium chain triglycerides if weight loss persistent with 3/4 done already