Exocrine pancreatic insuffiency Flashcards
What is exocrine pancreatic insuffiency?
It is a condition in which food cannot be completely digested in the small intestine as there is a problem with the digestive enzymes from the pancreas.
Ultimately what is exocrine pancreatic insuffiency caused by?
The lack of pancreatic enzymes being secreted into the duodenum.
These patients usually lack amylase (breakdown of carbs) , lipase (breakdown of lipid) and protease (breakdown of protein).
What are the reasons for lack of pancreatic digestive enzymes?
Pancreatic resection
Pancreatitis
Diabetes
Coeliac disease
Pancreatic tumours
Cystic fibrosis
How can diabetes result in exocrine pancreatic insuffiency?
The lack of insulin production within the pancreas from the pancreatic beta cells can result in pancreatic atrophy which impacts the exocrine gland also.
Furthermore diabetes is an auto-immune disease and so can cause inflammation and lead to pancreatitis.
How can Coeliac disease cause exocrine pancreatic insuffiency?
This can lead to inflammation specifically pancreatic fibrosis, which results in a reduction in the efficiency of the pancreas to produce pancreatic enzymes due to there being fewer secretory granules (responsible for digestive enzyme production) .
How does Cystic fibrosis cause exocrine pancreatic insuffiency?
It can lead to a blockage of the pancreatic duct, due to presence mucus so these enzymes are unable to pass into the duodenum.
State the symptoms of exocrine pancreatic insuffiency.
Maldigestion of macronutrients
Malnutrition (due to macronutrient malabsorption and vitamin defiency)
Weight loss in adults
Growth deficiency in children
Reduced immune function
Poor wound healing
Poor thyroid function
What are some of the generalised signs of malnutrition?
Lethargy
Depression
Poor concentration
Muscle loss
Dry skin
Brittle nails
What specific vitamins will be depleted in exocrine pancreatic insuffiency?
Vitamins A, D, E and K as they are fat soluble vitamins, requiring the complete digestion of fats/lipids which are malabsorbed in exocrine pancreatic insuffiency.
Which symptoms are suggestive of low zinc and selenium levels?
Poor immune system
Poor wound healing
Thyroid function
What are the aims of drug treatment?
To provide pancreatic enzyme replacement (almost as a nutritional supplement containing amylase, lipase and protease)
What are the medicinal forms of Pancreatin?
In the UK: all of which are varying strengths of the pancreatic enzymes
Pancrex V
Creon
Nutrizym 22
Pancrease HL
What are some of the physical symptoms?
Diarrhoea due to incomplete digestion
Cramping due to peristalsis still taking place in attempt to move food through the GI system
Bloating and flatulence due to partially digested food
Steatorrhea (fatty, foul smelling stools, usually light in colour)
What is the dose of Pancreatin dependent upon?
The size of the meal and hence the amount of pancreatic enzymes needed in order to digest that meal and relieve malabsorption.
Therefore higher doses are needed for main meals and smaller doses for snacks.
How do patients known pancreatin is working?
Patients should experience a physical easing of their symptoms:
Reduced bloating, flatulence
Improvement in stool appearance
Clinical manifestations should also improve such as lethargy, muscle loss, low blood levels and fat soluble vitamins and nutrients, now available for digestion.
