Exocrine pancreatic insufficiency Flashcards
(11 cards)
What is exocrine pancreatic insufficiency?
Reduced secretion of pancreatic enzymes into the duodenum, causing maldigestion and malnutrition.
What are the main clinical features of exocrine pancreatic insufficiency?
Maldigestion, malnutrition, low levels of micronutrients and fat-soluble vitamins, diarrhoea, abdominal cramps, and steatorrhoea (excess of fat in stools).
Name some causes of exocrine pancreatic insufficiency.
Chronic pancreatitis, cystic fibrosis, obstructive pancreatic tumours, coeliac disease, Zollinger-Ellison syndrome, gastrointestinal or pancreatic surgery.
What is the main drug treatment for exocrine pancreatic insufficiency?
Pancreatic enzyme replacement therapy with pancreatin.
What enzymes does pancreatin contain and what do they digest?
Lipase (fats), amylase (carbohydrates), and protease (proteins).
When should pancreatin be administered?
With meals and snacks.
What serious complication has been reported in cystic fibrosis patients taking high-dose pancreatic enzyme therapy?
Fibrosing colonopathy - Dense submucosal fibrosis in the colon causing abdominal pain and distension.
How might acid suppression affect pancreatin effectiveness?
Acid-suppressing drugs (e.g. PPI) may improve pancreatin effectiveness in patients with ongoing symptoms despite high enzyme doses.
Why should levels of fat-soluble vitamins and micronutrients be monitored in EPI?
Because malabsorption can cause deficiencies; supplementation may be needed.
What is the maximum recommended lipase dose to reduce risk of fibrosing colonopathy?
Generally not to exceed 10,000 units/kg/day of lipase.
How are pancreatin preparations commonly formulated?
As enteric-coated capsules or granules to protect enzymes from gastric acid.
