Pancreatic Insufficiency

Question 1

What is pancreatic insufficiency?

Answer 1

Reduced secretion of pancreatic enzymes into the duodenum

Question 2

What can cause pancreatic insufficiency?

Answer 2

Pancreatitis, CF, pancreatic tumours, coeliac disease, gastro-intestinal resection

Question 3

Clinical manifestations of pancreatic insufficiency

Answer 3

Maldigestion and malnutrition
Associated with low circulating levels of micronutrients
Fat soluble vitamins and lipoproteins
Diarrhoea
Abdominal cramps and steatorrhea

Question 4

Treatment of exocrine pancreatic insufficiency

Answer 4

Pancreatic enzyme replacement (pancreatin)

Question 5

What does pancreatin contain?

Answer 5

Lipase, amylase and protease which digest fats, carbohydrates and proteins so it can be absorbed and utilised by the body

Question 6

Counselling of pancreatin

Answer 6

Take with meals and snacks as this will prevent early breakdown

Question 7

Dosing of pancreatin in patients with cystic fibrosis

Answer 7

Risk of fibrosing colonopathy = require high dose pancreatin

CF patients should not exceed 10,000 units/kg/day of lipase

Question 8

Risk factors of fibrosing colonopathy.
Advice to give patients regarding this

Answer 8

Children (2-8 years old), boys, severe cystic fibrosis, concomitant use of laxatives

Report any new abdominal symptoms – signs of colonic damage

Question 9

What medication may improve the effectiveness of pancreatin?

Answer 9

Acid suppression - PPI

Add to therapy in patients who continue to experience symptoms despite high doses of pancreatin

Question 10

What should be monitored in patients with pancreatic insufficiency?

Answer 10

Levels of fat-soluble vitamins and micronutrients