EXOCRINE PANCREATIC INSUFFICIENCY (Mo'C) Lower GI

Question 1

What are the causes of Pancreatic Exocrine Insufficiency?

Answer 1

• Lack of pancreatic digestive enzymes being secreted into duodenum
• Specifically lack of Amylase, Lipase, Protease

Question 2

What is Pancreatic Exocrine Insufficiency? (PEI)

Answer 2

PEI is a condition in which your small intestine can’t digest food completely because of problems with digestive enzymes from your pancreas.

PEI often develops slowly, over many years

Question 3

What digestive enzymes breakdown macronutrients: Carbohydrates, Proteins and fats?

Answer 3

-Carbs= Amylase, Sucrase-Isomaltase, Maltase, Lactase = SUGARS

• Proteins (Proteases) = Pepsin, Trypsin, Peptidase = AMINO ACIDS

-Fats = Lipase = FATTY ACIDS

Question 4

What are some of the underlying causes of lack of digestive enzymes in PEI?

Answer 4

• Pancreatic resection
• Pancreatitis
• Pancreatic tumours
• Diabetes (lack of insulin atrophies the pancreas, diabetes is also inflammatory-can lead to pancreatic inflammation)
• Coeliac disease (pancreatic fibrosis, fewer secretory granules)
• Cystic fibrosis (pancreatic duct becomes blocked with mucus)

Question 5

What are the Symptoms of Pancreatic Exocrine Insufficiency?

Answer 5

• This is where the overlap with other conditions can be seen.
• Macronutrients (fats, carbs, protein) are maldigested.
• Malnutrition, lack of energy, low blood levels of fat soluble vitamins (A, D, E, K)

Question 6

What are the Physical Symptoms of Pancreatic Exocrine Insufficiency?

Answer 6

• Physical symptoms arise from the inability to digest macronutrients properly
• Diarrhoea

*Cramping, bloating, flatulence

• Steatorrhea (fatty, foul smelling stools, usually light in colour)

Question 7

What does Pancreatic exocrine insufficiency lead to in Children and Adults?

Answer 7

Children = lack of growth rates

Adults = weight loss

Question 8

How do general signs of Malnutrition present in PEI?

Answer 8

General signs of malnutrition can present:

-Lethargy, depression
- Poor concentration, muscle loss
- Dry skin, brittle nail

Question 9

What can low blood levels of Zinc, Selenium be shown in PEI?

Answer 9

Low blood levels of Zinc, Selenium-can show up as reduced immune function, poor wound healing, thyroid functio

Question 10

What are the AIMS of Drug Treatments IN PEI?

Answer 10

• Pancreatic enzyme replacement (amylase, lipase, protease)
• See medicinal forms section of the Pancreatin monograph in BNF.
• Pancrex V
• Creon
• Nutrizym 22
• Pancrease H

Question 11

What are the AIMS of Drug Treatments IN PEI in terms of general ADVICE?

Answer 11

• Dose will be tailored according to meal
• Higher doses for main meals
• Smaller doses for snacks
• Physical symptoms should ease
• Clinical manifestations such as lethargy, muscle loss, low blood levels of fat soluble vitamins and nutrients should also improve.