EXOCRINE PANCREATIC INSUFFICIENCY (Mo'C) Lower GI
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What are the causes of Pancreatic Exocrine Insufficiency?
• Lack of pancreatic digestive enzymes being secreted into duodenum • Specifically lack of Amylase, Lipase, Protease
What is Pancreatic Exocrine Insufficiency? (PEI)
PEI is a condition in which your small intestine can’t digest food completely because of problems with digestive enzymes from your pancreas. PEI often develops slowly, over many years
What digestive enzymes breakdown macronutrients: Carbohydrates, Proteins and fats?
-Carbs= Amylase, Sucrase-Isomaltase, Maltase, Lactase = SUGARS • Proteins (Proteases) = Pepsin, Trypsin, Peptidase = AMINO ACIDS -Fats = Lipase = FATTY ACIDS
What are some of the underlying causes of lack of digestive enzymes in PEI?
• Pancreatic resection • Pancreatitis • Pancreatic tumours • Diabetes (lack of insulin atrophies the pancreas, diabetes is also inflammatory-can lead to pancreatic inflammation) • Coeliac disease (pancreatic fibrosis, fewer secretory granules) • Cystic fibrosis (pancreatic duct becomes blocked with mucus)
What are the Symptoms of Pancreatic Exocrine Insufficiency?
• This is where the overlap with other conditions can be seen. • Macronutrients (fats, carbs, protein) are maldigested. • Malnutrition, lack of energy, low blood levels of fat soluble vitamins (A, D, E, K)
What are the Physical Symptoms of Pancreatic Exocrine Insufficiency?
• Physical symptoms arise from the inability to digest macronutrients properly • Diarrhoea *Cramping, bloating, flatulence • Steatorrhea (fatty, foul smelling stools, usually light in colour)
What does Pancreatic exocrine insufficiency lead to in Children and Adults?
Children = lack of growth rates Adults = weight loss
How do general signs of Malnutrition present in PEI?
General signs of malnutrition can present: -Lethargy, depression - Poor concentration, muscle loss - Dry skin, brittle nail
What can low blood levels of Zinc, Selenium be shown in PEI?
Low blood levels of Zinc, Selenium-can show up as reduced immune function, poor wound healing, thyroid functio
What are the AIMS of Drug Treatments IN PEI?
• Pancreatic enzyme replacement (amylase, lipase, protease) • See medicinal forms section of the Pancreatin monograph in BNF. • Pancrex V • Creon • Nutrizym 22 • Pancrease H
What are the AIMS of Drug Treatments IN PEI in terms of general ADVICE?
• Dose will be tailored according to meal • Higher doses for main meals • Smaller doses for snacks • Physical symptoms should ease • Clinical manifestations such as lethargy, muscle loss, low blood levels of fat soluble vitamins and nutrients should also improve.