Pancreatic insufficiency

Question 1

Causes of pancreatic insufficiency (7)

Answer 1

Pancreatic causes

1. Chronic pancreatitis
2. Cystic fibrosis
3. Pancreatic duct obstruction

Non-pancreatic causes

4. Abdominal surgery (decreased pancreatic stimulation)
5. Autoimmune (autoimmune pancreatitis, Crohn’s, Coeliac)
6. Congenital (Schwachman-Diamond Syndrome)
7. Zollinger-Ellison syndrome

Question 2

Clinical presentation of pancreatic insufficiency

Answer 2

• Malabsorption (steatorrhoea, flatulence, distention)

- Malnutrition (weight loss, anaemia, coagulopathy, bone pain, neurological, oedema)

Question 3

Investigations in pancreatic insufficiency

Answer 3

• FBE
• UEC
• Nutrient levels
• Coeliac antibodies
• Absorption tests
• Pancreatic function tests (direct - secretin and CCK, indirect - faecal fat and enzyme analysis)
• Abdominal imaging (chronic pancreatitis)

Question 4

Management of pancreatic insufficiency

Answer 4

• Diet and supplements
• Pancreatic enzyme replacement therapy (pancrelipase)
• Treat underlying disease