The pancreas serves both digestive and endocrine functions, making pancreatic disorders particularly complex conditions requiring specialised management.
• Pancreatic Exocrine Insufficiency
Pathophysiology
Pancreatic exocrine insufficiency occurs when the pancreas produces insufficient digestive enzymes, leading to maldigestion of fats, proteins, and carbohydrates. This condition results from various causes including chronic pancreatitis, cystic fibrosis, and pancreatic cancer.
Symptoms
Classic symptoms include steatorrhoea (fatty, floating stools), abdominal pain, bloating, and weight loss despite adequate caloric intake. Patients may develop deficiencies of fat-soluble vitamins (A, D, E, K) and experience flatulence and abdominal distension.
Diagnosis
Diagnosis combines clinical presentation with evidence of maldigestion. Faecal elastase measurement provides a non-invasive screening test, while direct pancreatic function tests offer definitive diagnosis. Imaging studies assess pancreatic morphology and identify underlying causes.
Treatment
Pancreatic enzyme replacement therapy (PERT) forms the cornerstone of treatment, with enzymes taken with all meals and snacks. Acid suppression may be necessary to optimise enzyme activity. Nutritional support addresses vitamin deficiencies and ensures adequate caloric intake.
