Pancreatic insufficiency

Fecal impaction, ischemic bowel, pancreatic insufficiency, and intestinal fistulae... 

Fat-soluble vitamin supplementation is usually required in pancreatic insufficiency. Specially-formulated products for CF patients (ADEKs and Vitamax ) are usually sufficient to attain normal serum vitamin levels at a dose of 1 tablet daily for younger children and 2 tablets daily for teenagers and adults. Additional supplementation may be needed in uncontrolled malabsorption or for replacement of severe vitamin deficiency.5,15 Appetite stimulants such as cyproheptadine may be an option for promoting nutrition and weight gain, but efficacy has not been established. 

The incidence of chronic pancreatitis is approximately 1 in 10,000 people. O The most common cause of chronic pancreatitis in adults in Western countries is ethanol abuse. The most common cause in children is cystic fibrosis, due to preexisting pancreatic insufficiency inherent in the disease. Gallstones can occur at the same time as chronic pancreatitis but are not often implicated as the cause. Unlike acute pancreatitis, chronic pancreatitis has an unknown etiology in a significant number of cases (30%).29,3°... 

Gl Tract Esophageal web stricture or stenosis in the upper to middle third of the esophagus01 Exocrine Pancreatic insufficiency Anorexia Nausea Vomiting Diarrhea Weight loss Failure to thrive (infants and children)... 

Diarrhea Drug related Antibiotic-induced bacterial overgrowth Hyperosmolar medications administered via feeding tubes Antacids containing magnesium Malabsorption Hypoalbuminemia/gut mucosal atrophy Pancreatic insufficiency Inadequate GIT surface area Rapid GIT transit Radiation enteritis Tube feeding related Rapid formula administration Formula hyperosmolalty Low residue (fiber) content Lactose intolerance Bacterial contamination... 

Casellas F, Guamer L, Vaquero E, Antolin M, de Gracia X, Malagelada JR I Iydrogen breath test with glucose in exocrine pancreatic insufficiency. Pancreas 1998 16 481 186. 

The answer is d. (Hardman, p 935.) Pancrelipase is an alcoholic extract of hog pancreas that contains lipase, trypsin, and amylase. It is effective in reducing the steatorrhea of pancreatic insufficiency None of the other drugs mentioned have significant action in the digestion of fats... 

The pancreas, in which the mucus blocks its ducts in 85 per cent of cystic fibrosis patients, causing pancreatic insufficiency. This is chiefly characterized by secretion of greatly reduced levels of digestive enzymes into the small intestine. 

Pancreatin is a pancreatic extract usually obtained from the pancrease of slaughterhouse animals. It contains a mixture of enzymes, principally amylase, protease and lipase, and, thus, exhibits a broad digestive capability. It is administered orally mainly for the treatment of pancreatic insufficiency caused by cystic fibrosis or pancreatitis. As it is sensitive to stomach acid, it must be administered in high doses or, more usually, as enteric-coated granules or capsules that may be taken directly or sprinkled upon the food prior to its ingestion. Individual digestive activities, such as papain, pepsin or bromelains (proteases), or a-amylase are sometimes used in place of pancreatin. 

Exocrine pancreatic insufficiency is most commonly caused by cystic fibrosis, chronic pancreatitis, or pancreatic resection. When secretion of pancreatic enzymes falls below 10% of normal, fat and protein digestion is impaired and can lead to steatorrhea, azotorrhea, vitamin malabsorption, and weight loss. Pancreatic enzyme supplements, which contain a mixture of amylase, lipase, and proteases, are the mainstay of treatment for pancreatic enzyme insufficiency. Two major types of preparations in use are pancreatin and pancrelipase. Pancreatin is an alcohol-derived extract of hog pancreas with relatively low concentrations of lipase and proteolytic enzymes, whereas pancrelipase is an enriched preparation. On a per-weight basis, pancrelipase has approximately 12 times the lipolytic activity and more than 4 times the proteolytic activity of pancreatin. Consequently, pancreatin is no longer in common clinical use. Only pancrelipase is discussed here. 

Pancrelipase Replacement enzymes from animal pancreatic extracts Improves digestion of dietary fat, protein, and carbohydrate Pancreatic insufficiency due to cystic fibrosis, pancreatitis, pancreatectomy Taken with every meal may increase incidence of gout... 

Tissue reserves of retinoids in the healthy adult are sufficiently large to require long-term dietary deprivation to induce deficiency. Vitamin A deficiency occurs more commonly in chronic diseases affecting fat absorption, such as biliary tract or pancreatic insufficiency, sprue, Crohn s disease involving the terminal ileum, and portal cirrhosis deficiency may also occur following partial gastrectomy or during extreme, chronic dietary inadequacy. 

However, in exocrine pancreatic insufficiency, a shortage of pancreatic bicarbonate accretion impairs this neutralization of pH. As a result, the postprandial... 

Flour 13 Postprandial duodenal pH in 6 healthy controls (solid line) and 6 patients with chronic pancreatic Insufficiency (broken line). Ban show mean SEM , p< 0.05. (From Ref. 61.)... 

R DiMagno, J. Malagehda. V. Go, and CL Moend. Rate of orally ingested enzymes in pancreatic insufficiency. N. Engl. 7. Med 296 131B (1977). 

C Abrams, M. Hamosh, V. Hubbaid, S. Dutta, and P. Himorfa. Lingual lipase in cystic fibrosis. tJuaiititBtkm of enzyme activity in the upper smaii intestine of patients with exocrine pancreatic insufficiency. 7. Clio. Invest. 73 374 (1984). 

C. Lumen J. lansen. Omeprazole as adjunct to enzyme replacement treatment in severe pancreatic insufficiency. Sr. Med, J. 293 996 (1986). 

D. Graham and J, Sackman. Mechanism of increase in steatorrhea with caldum and magnesium In exocrine pancreatic insufficiency an animal model Gastroenterology 83 63 (1982),... 

Patients with exocrine pancreatic dysfunction may malabsorb vitamin B12 because a considerable part of the dietary vitamin may bind to R-proteins in the stomach. The R-proteins are normally broken down by pancreatic enzymes. The vitamin is released and binding to intrinsic factor then takes place. If the R-proteins are not degraded, then the vitamin B12 will remain bound to these proteins and will not be absorbed (M10). Harms and his colleagues (H27) measured vitamin B12 absorption in 19 children with exocrine pancreatic insufficiency and found the average absorption to be 8.0% compared to 59.2% in a control group. Adding pancreatin to the test dose of radiolabeled vitamin B12 increased absorption of the vitamin to an average of 61%. 

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