Exocrine Pancreatic Insufficiency Flashcards

1
Q

What are the common products of the exocrine pancreas?

A

Amylase = breaks down carbs/sugars

Lipases = break down fats

Proteases = trypsin/elastase/etc.
- break down proteins

Bicarbonate = neutralizes stomach acid

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2
Q

What are the two stimulation molecules for the exocrine pancreas?

A

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

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3
Q

Classic presentation of exocrine pancreatic insufficiency

A

Mild = asymptomatic or mild abdominal discomfort and bloating

Moderate-severe

  • bloating, steatorrhea, unintended weight loss
  • deficiencies of DEAK and vitamin B12
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4
Q

What are the common risk factors for exocrine pancreatic insufficiency

A

Chronic pancreatitis
- most common cause in adults

Cystic fibrosis
- most common cause in children

Gastric/small bowel resection

Pancreatic duct obstruction

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5
Q

Acute pancreatitis

A

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)

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6
Q

Chronic pancreatitis

A

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)

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7
Q

Cystic fibrosis

A

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

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8
Q

How does resection cause exocrine pancreatic insufficiency?

A

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

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9
Q

How to diagnosis pancreatic insufficiency

A

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
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10
Q

Treatment of exocrine pancreatic insufficiency

A

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

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