China
Africa
Explore chapters and articles related to this topic
Pancreatic Exocrine Insufficiency (PEI)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Pancreatic exocrine insufficiency is an important cause of maldigestion. Exocrine pancreatic insufficiency is caused by a generalized reduction in pancreatic exocrine (digestive) enzyme production and delivery, leading to severe impairment in fat and fat-soluble vitamin absorption.1 Acute and chronic pancreatitis can cause such an insufficiency as can celiac and Crohn's disease, cystic fibrosis, Shwachman-Diamond syndrome, and previous pancreatic surgery. Patients with EPI manifest lethargy, weakness, abdominal pain, bloating, diarrhea, and steatorrhea. PEI is one of the major complications in chronic pancreatitis and should be considered in all chronic pancreatitis patients.
Do I Have IBS?
Published in Melissa G. Hunt, Aaron T. Beck, Reclaim Your Life From IBS, 2022
Melissa G. Hunt, Aaron T. Beck
Exocrine pancreatic insufficiency (EPI) is a condition in which the pancreas doesn’t produce enough of the enzymes that help with certain aspects of digestion. Most people know that the pancreas makes insulin, which is crucial to managing glucose or blood sugar. But few people know that the pancreas also makes a number of digestive enzymes, including amylase (which breaks down carbohydrates), lipase (which breaks down fats), and protease and elastase (which break down proteins). If you can’t break down food, it passes through the intestines partially undigested, which can result in abdominal pain, gas, bloating, diarrhea (typically), or constipation, and, if it’s severe, weird poop that looks pale and oily, and can smell bad and sometimes floats (because there’s too much fat in it). One of the main causes of EPI is chronic pancreatitis, so if you’ve ever experienced even one incident of pancreatitis, it’s worth being tested for EPI. The easiest test for EPI is a stool test called the fecal elastase test (FE-1). Elastase is one of the digestive enzymes. If there is little or no elastase in your stool, that can indicate EPI.
Cancer
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Pancreatic cancers are considered to be unresectable when they are diagnosed, due to metastases. Based on tumor location, surgery is performed. External beam radiation therapy is often used. Chemotherapy and radiation combinations may be also used. If there are liver or distant metastases, chemotherapy may be used. For moderate to severe pain, oral opioids are administered. Pain control is more important than any concern about addiction. Long-acting preparations are good for chronic pain, and include transdermal oxymorphone, oxycodone, or fentanyl. Exocrine pancreatic insufficiency is treated with oral pancrelipase. Dosage is based on symptoms, the amount of steatorrhea, and dietary fat content. Proton pump inhibitors or H2-blockers may also be required. If diabetes mellitus is present, it must be monitored and controlled with care.
Trypsinogen and chymotrypsinogen: potent anti-tumor agents
Published in Expert Opinion on Biological Therapy, 2021
Aitor González-Titos, Pablo Hernández-Camarero, Shivan Barungi, Juan Antonio Marchal, Julian Kenyon, Macarena Perán
The pancreas plays a very important role in the digestive function through the secretion of several enzymes necessary for the degradation of nutrients. These enzymes are secreted by acinar cells as zymogens (inactive forms also known as (pro)enzymes) [3]. Once secreted, they are transferred to the small intestine where they are activated. The most studied zymogens are Trypsinogen and Chymotrypsinogen. In the case of Trypsinogen, it is activated to Trypsin in the small intestine by enterokinase. Once activated, it is capable of activating the rest of the pancreatic zymogens, including Chymotrypsinogen into Chymotrypsin [4]. A failure in the production of these proteins can cause poor absorption of nutrients, the most common diseases that lead to exocrine pancreatic insufficiency are chronic pancreatitis and cystic fibrosis [5].
Clinical case report: endoluminal thermal ablation of main pancreatic duct for patients at high risk of postoperative pancreatic fistula after pancreaticoduodenectomy
Published in International Journal of Hyperthermia, 2021
Benedetto Ielpo, Eva M. Pueyo-Périz, Aleksandar Radosevic, Anna Andaluz, Enrique Berjano, Luis Grande, Patricia Sánchez-Velázquez, Fernando Burdío
A 56-year-old man with a BMI of 30.2 was admitted to our center (Hospital del Mar-IMIM, Barcelona, Spain) with painless jaundice in February 2020. Computerized tomography (CT) showed a 2.7 cm mass in the pancreatic head, considered as resectable. Abdominal magnetic resonance (MR) revealed a main pancreatic duct <2 mm in diameter. A biliary stent was endoscopically placed to reduce jaundice and PD was indicated. During surgery, an important peripancreatic and liver hilum edema component was observed mainly due to the cancer itself and the biliary stent associated with very soft pancreas texture. As the association of a long intervention (almost 5 h), soft pancreas and confirmation of the main pancreatic diameter <2 mm suggested a very high likelihood of developing POPF, we decided to perform ETHA of the main pancreatic duct prior to Blumgart-type pancreatico-jejunal anastomosis with abdominal drainage. The postoperative period was uneventful, with slightly elevated amylase levels (40 IU/L) in the drainage fluid on the 3rd postoperative day, with a mean drainage output of 20 cc per day and a normal CT scan (Figure 2(a)). Drainage was removed on the 10th postoperative day and the patient was discharged 2 days later. Histopathological examination revealed a pT3N1 moderately differentiated adenocarcinoma with all margins being negative. One month after surgery, fecal elastase was 64 m μg/gr, demonstrating exocrine pancreatic insufficiency due to ETHA. To date, the patient has had no further symptoms related to exocrine pancreatic insufficiency such as steatorrhea or the need for substitute pancreatic enzymes.
Exocrine pancreatic insufficiency is common in people living with HIV on effective antiretroviral therapy
Published in Infectious Diseases, 2018
Pancreas is the only gland in the human body with both exocrine and endocrine functions. Dysfunction of the endocrine part results in diabetes and exocrine dysfunction results in pancreatic insufficiency [1]. Exocrine pancreatic insufficiency (EPI) results from a progressive loss of acinar pancreatic cells, which leads to secretion of an insufficient quantity of digestive enzymes into the duodenum. Maldigestion results when exocrine pancreatic function is reduced by more than 90% [2]. Symptoms of EPI include steatorrhoea, diarrhoea, flatulence, bloating and abdominal discomfort [3]. The most common cause of EPI is chronic pancreatitis, but EPI can also be caused by several other conditions, such as diabetes, celiac disease, inflammatory bowel diseases, cystic fibrosis, partial or total surgical resection of pancreas, loss of function of pancreatic tissue or obstruction of the main pancreatic duct and gastrectomy [4]. EPI has also been associated with HIV and it has been proposed as an underdiagnosed and important cause of diarrhoea and fat malabsorption in adults and children living with HIV [5–7].