Podcast
Questions and Answers
Which condition can lead to the blockage of the pancreatic duct?
Which condition can lead to the blockage of the pancreatic duct?
Low blood levels of fat-soluble vitamins can lead to malnutrition.
Low blood levels of fat-soluble vitamins can lead to malnutrition.
True
Name one symptom of exocrine pancreatic insufficiency.
Name one symptom of exocrine pancreatic insufficiency.
Diarrhoea
Pancreatic enzyme replacements such as ______ help patients break down and digest food.
Pancreatic enzyme replacements such as ______ help patients break down and digest food.
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Which of the following is NOT a form of pancreatin?
Which of the following is NOT a form of pancreatin?
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Match the symptoms with their descriptions:
Match the symptoms with their descriptions:
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What is a potential effect of low zinc levels in the body?
What is a potential effect of low zinc levels in the body?
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Cystic fibrosis results in an increase in secretory granules within the pancreas.
Cystic fibrosis results in an increase in secretory granules within the pancreas.
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What is the first line treatment for patients on opioids experiencing constipation?
What is the first line treatment for patients on opioids experiencing constipation?
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Senna can be safely used close to term in pregnant patients to treat constipation.
Senna can be safely used close to term in pregnant patients to treat constipation.
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What dietary fiber intake should patients aim for per day to aid in constipation management?
What dietary fiber intake should patients aim for per day to aid in constipation management?
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If a patient with constipation does not respond to pure laxatives, the next step may involve switching to a __________.
If a patient with constipation does not respond to pure laxatives, the next step may involve switching to a __________.
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Match the following treatments with their corresponding patient conditions:
Match the following treatments with their corresponding patient conditions:
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What non-pharmaceutical intervention can benefit patients suffering from constipation?
What non-pharmaceutical intervention can benefit patients suffering from constipation?
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Suppositories and enemas are recommended for routine use in primary care for children with constipation.
Suppositories and enemas are recommended for routine use in primary care for children with constipation.
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What is a suggested maintenance treatment duration for laxatives in children with constipation?
What is a suggested maintenance treatment duration for laxatives in children with constipation?
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Which of the following is a potential cause of constipation?
Which of the following is a potential cause of constipation?
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Diarrhoea is considered a disease.
Diarrhoea is considered a disease.
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Name one class of medication that can cause constipation.
Name one class of medication that can cause constipation.
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Diarrhoea involves the passage of ______ stools.
Diarrhoea involves the passage of ______ stools.
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Match the medication to its action in the gut:
Match the medication to its action in the gut:
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What is the role of sennosides A and B in the treatment of constipation?
What is the role of sennosides A and B in the treatment of constipation?
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Colonic water retention is increased by stimulant laxatives.
Colonic water retention is increased by stimulant laxatives.
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What is the main characteristic of acute diarrhoea?
What is the main characteristic of acute diarrhoea?
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Study Notes
Exocrine Pancreatic Insufficiency
- Causes:
- Coeliac disease: May lead to pancreatic fibrosis and fewer secretory granules
- Pancreatic tumor: May block the pancreatic duct
- Cystic fibrosis: Pancreatic duct may be blocked with mucus
- Symptoms: Undigested macronutrients leading to malnutrition, lack of energy, low blood levels of fat-soluble vitamins (ADEK), and low blood levels of zinc and selenium.
- In children: May result in lack of growth rate or weight loss in adults.
- Other symptoms include:
- Lethargy, depression, poor concentration, muscle loss, dry skin, and brittle nails
- Diarrhoea: Caused by the inability to release enzymes for digestion.
- Cramping/bloating/flatulence: Incomplete food digestion leads to stimulation of peristalsis.
- Steatorrhea: Fatty, foul-smelling stools, often light in color, often float.
Treatment
- Goal: Replace pancreatic enzymes (amylase, lipase, protease)
- Options:
- Pancrex V
- Creon
- Nutrizym 22
- Pancrease HL
- Dosage is tailored to the meal size.
Opioid-induced Constipation
- First line:
- Osmotic laxatives: Docusate or macrogols
- Stimulant laxatives: Senna
- Alternative:
- Peripherally acting mu-opioid receptor antagonist (PAMORA): Naloxegol
- Lifestyle modifications:
- Increased physical activity
- Fluid intake of at least 2L per day.
Pregnancy and Breastfeeding
- First line: Bulk forming laxative with potential addition or switch to osmotic laxative
- Alternative: Short course of stimulant Senna (not near term, prescribed, NOT OTC)
- Other options: Glycerol suppository
Children
- First line: Macrogol (pediatric version) and non-punitive behavioral intervention
- Second line: Stimulant laxative or switch to stimulant laxative if first line is not tolerated
- Third line: Lactulose if macrogol is not tolerated
- Maintenance dose may be needed for several months
- Informed consent required for children under 2
- Avoid suppositories and enemas for routine use
Bulk Forming Laxatives
- Action::
- Glycoside bond hydrolysis by colonic bacteria releases irritant anthracene glycoside derivatives.
- Direct action on myenteric nerve plexus increases smooth muscle activity, boosting peristalsis
- Increased PGE2 secretion enhances gut motility, reducing colonic water retention.
Stool Softeners or Emollient Laxatives
- Action:
- Surface wetting agents/surfactants like Docusate reduce surface tension, allowing water/fats to penetrate stool.
- Docusate also has stimulant activity.
- Arachis oil and paraffin create a barrier between stool and intestinal wall.
- Paraffin is no longer popular due to potential carcinogenicity.
Other Laxatives
- PAMORA (peripherally acting mu-opioid receptor antagonists):
- Block opioid activation of intestinal mu-opioid receptors.
- Restore normal propulsion and peristalsis.
- Prucalopride:
- 5HT4 receptor agonist
- Present in the GI tract, especially the myenteric plexus.
- Activation increases acetylcholine release, boosting parasympathetic drive and peristalsis.
Diarrhoea
- Definition: Change in bowel habit with increased frequency of bowel movements, soft and watery stools and potentially colicky pain.
- Acute Diarrhoea: Abrupt onset, more than 3 loose stools per day, lasting no longer than 14 days. Often caused by dietary insult.
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Description
This quiz covers the causes, symptoms, and treatment options for Exocrine Pancreatic Insufficiency. Participants will learn about various conditions that may lead to this disorder, how it affects nutrient absorption, and the importance of enzyme replacement therapy. Test your understanding of this important aspect of digestive health.
