Pancreatic insufficiency

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Synonyms and keywords: Exocrine pancreatic insufficiency

Overview

Pancreatic insufficiency is characterized by deficiency of the exocrine pancreatic enzymes, resulting in the inability to digest food properly, or maldigestion.

Causes

Common Causes

• Chronic alcoholism
• Chronic pancreatitis
• Cystic fibrosis
• Gall stones
• Gastrectomy
• Shwachman-Diamond syndrome
• Zollinger-Ellison syndrome

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	Diabetic gastroparesis, Hyperparathyroidism
Environmental	No underlying causes
Gastroenterologic	Bowel resection, Celiac disease, Chronic pancreatitis, Cystic fibrosis, Diabetic gastroparesis, Gallstones, Hemochromatosis , Short bowel syndrome
Genetic	Alpha 1-antitrypsin deficiency, Annular pancreas, Ataxia telangiectasia, Congenital lipomatosis of pancreas, Congenital pancreatic dysfunction, Congenital partial lipodystrophy, Cystic fibrosis, Havlikova syndrome, Hemochromatosis, Hereditary pancreatitis, Homocystinuria, Johanson-Blizzard syndrome, Juvenile tropical pancreatitis syndrome, Pancreatic agenesis, Pearson syndrome, Shwachman-Diamond syndrome, Situs inversus totalis with cystic dysplasia of pancreas, Wolfram's disease
Hematologic	Acute intermittent porphyria
Iatrogenic	Bowel resection, Gastrectomy , Pancreatectomy
Infectious Disease	Mumps
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	Malnutrition
Obstetric/Gynecologic	Gestational diabetes
Oncologic	Pancreatic cancer, Zollinger-Ellison syndrome
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	Autoimmune lymphoproliferative syndrome, Lupus, Polyglandular autoimmune syndrome, Sjogren's syndrome
Sexual	No underlying causes
Trauma	Trauma
Urologic	No underlying causes
Miscellaneous	Chronic alcoholism, Pancreatic cyst, Pancreatic duct obstruction, Pancreatic pseudocyst

Causes in Alphabetical Order

• Acute intermittent porphyria
• Alagille syndrome
• Alpha-1 antitrypsin deficiency
• Annular pancreas
• Ataxia telangiectasia
• Autoimmune lymphoproliferative syndrome
• Bowel resection
• Celiac disease
• Chronic alcoholism
• Chronic pancreatitis
• Congenital lipomatosis of pancreas
• Congenital pancreatic dysfunction
• Congenital partial lipodystrophy
• Cystic fibrosis
• Diabetic gastroparesis
• Gallstones
• Gastrectomy
• Gestational diabetes
• Havlikova syndrome
• Hemochromatosis
• Hereditary pancreatitis
• Homocystinuria
• Hyperparathyroidism
• Hypertriglyceridemia
• Idiopathic pancreatitis
• Johanson-Blizzard syndrome
• Juvenile tropical pancreatitis syndrome
• Lupus
• Malnutrition
• Mumps
• Pancreatectomy
• Pancreas divisum
• Pancreatic agenesis
• Pancreatic cancer
• Pancreatic cyst
• Pancreatic duct obstruction
• Pancreatic pseudocyst
• Pearson syndrome
• Polyglandular autoimmune syndrome
• Short bowel syndrome
• Shwachman-Diamond syndrome
• Situs inversus totalis with cystic dysplasia of pancreas
• Sjogren's syndrome
• Trauma
• Wolfram's disease
• Zollinger-Ellison syndrome

Diagnosis

History and Symptoms

• Fatty stools
• Muscle atrophy
• Weakness
• Weight loss

Differential Diagnosis of Causes of Pancreatic insufficiency

• Chronic alcoholism
• Congenital pancreatic dysfunction
• Cystic fibrosis
• Hemochromatosis
• Hyperparathyroidism
• Idiopathic pancreatitis
• Neoplasm
• Pancreatectomy
• Shwachman syndrome
• Gastrectomy
• Trauma
• Zollinger-Ellison syndrome

Treatment

Often pancreatic insufficiency is treated with Pancreatic Enzyme Products (PEPs), such as pancrelipase, that are used to breakdown fats (lipases), proteins (proteases) and carbohydrates (amylases) into units that can be digested by those with pancreatic insufficiency.