Pancreatic insufficiency

Question 1

Symptoms

Answer 1

• Diarrhoea
• Abdominal cramps
• Steatorrhea
• Malnutrition

Question 2

Treatment

Answer 2

• Replacement therapy
• Vitamin supplements
• Counsel: Avoid foods difficult to digest: peas, beans and lentils, and foods high in fibre, alcohol and low fat diets - poor fat absorption.

Question 3

Pancreatin: MOA

Answer 3

Replaces pancreatic enzymes, digests protein, fat + carbs

Question 4

Pancreatin: how to take

Answer 4

Meals + snacks
- Acid suppressor (PPI): symptoms despite high dose
- Enteric coated: higher pancreatin levels

Do not mix w excessively hot food + drink
- Discard mixture after 1 H
- Digestive enzymes denatured by gastric acid + heat

Counsel: adequate hydration at all times (high dose)

Question 5

Pancreatin: side effect

Answer 5

GI effects

Irritation: perioral skin + buccal mucosa
- Excessive doses: irritate perianal area
- Handling: hypersensitivity reaction

Fibrosing colonopathy
- High risk: Cystic fibrosis + high doses
- If new, changing abdominal symptoms - exclude colonic damage