Reduced exocrine secretions (pancreatin insufficiency) Flashcards
What is it?
Reduced secretions of pancreatic enzymes = maldigestion, malnutrition + GI symptoms
What can cause it?
- Cystic fibrosis
- Chronic pancreatitis
- Obstructive pancreatic tumours
- Coeliac disease
- Zollinger-Ellison syndrome
- GI or pancreatic surgical resection
Dietary advice
Distribute food intake between 3 main meals and 2-3 snacks
- Avoid foods that are difficult to digest
- Avoid high fibre foods
- No alcohol
- Avoid reduced fat diets
What foods are difficult to digest?
Legumes - peas, beans, lentils
Pancreatin
Supplement to compensate for reduced/absent pancreatic enzyme secretion.
Assists with digestion of starch, fat and protein.
How to take
With meals/snacks immediately before or after
Do not mix with excessively hot food/drinks
- Inactivated by heat
- If mixed with food or liquids, consume within 1 hour.
EC preparations
Deliver higher pancreating levels
Pancreatin + gastric acid
Pancreatin inactivated by gastric acid.
Give PPI if symptoms present despite high pancreatin dose
Side effects
- GI side effects (common)
- Irritation of perioral skin + buccal mucosa
- Fibrosing colonopathy in CF with high doses
Irritation of perioral skin + buccal mucosa
Skin irritation and hypersensitivity reactions when handling
Excessive doses:
- Perianal irritation
- Hyperuricaemia
- Hyperuricosuria
Fibrosing colonopathy in CF with high doses
If new or changing abdominal symptoms - exclude colonic damage
Risk factors:
- Male children
- More severe CF
- Laxative use
C/I
Nutrizym 22/Pancrease HL
- Contraindicated in children aged 15 years or under with CF
- Associated with colon strictures
Patient counselling
Ensure adequate hydration at all times with high strength preps
