Pancreatic exocrine dysfunction

Introduction Pancreatic exocrine insufficiency refers to the symptoms of nutrient digestion and malabsorption caused by insufficient secretion of pancreatic enzymes and unsynchronized pancreatic enzyme secretion caused by various reasons.

Cause

The cause of pancreatic exocrine dysfunction:

Insufficient pancreatic exocrine function (PEI), including chronic pancreatitis (CP), hereditary pancreatitis, autoimmune pancreatitis, pancreatic cancer, acute pancreatitis (AP), cystic fibrosis, celiac disease, diabetes and Iatrogenic PEI (such as gastrectomy).

an examination

Related inspection

Cancer antigen 19-9 (CA19-9) serum chymotrypsin pancreatic exocrine function test serum phospholipase A2 trypsin-trypsin test

Examination and diagnosis of pancreatic exocrine dysfunction:

Currently, methods for diagnosing PEI include: detection of fecal fat, fecal elastase, fecal chymotrypsin, etc., a secretin-cholecystokinin test and a mixed triglyceride breath test. Among them, there is a very good correlation between the modified carbon (13C) triglyceride breath test and the secretin-cholecystokinin test, with sensitivity and specificity of 100% and 92%, respectively.

Differential diagnosis

Pancreatic exocrine dysfunction confusing symptoms:

Pancreatic insufficiency and neutrality in children are mainly due to dysplasia of the pancreas, mainly due to poor development of exocrine tissue, which is characterized by sparse acinar cells, normal islet development, total amount of pancreatic secretion, and normal HC03 content. At the same time, accompanied by dysplasia of the myeloid cell line, occasionally lack of megakaryocytes, may have dysplasia of the skeletal metaphysis, and focal calcification in the ankle. When the disease is complicated by pulmonary infection, it is easily confused with cystic fibrosis of the pancreas. Should also pay attention to the identification of acute pancreatic, chronic pancreatitis.

Differential diagnosis of chronic pancreatitis:

1. Chronic recurrent pancreatitis and acute recurrent pancreatitis: the latter has a significant increase in serum amylase during the attack, more normal pancreatic secretion test, abdominal plain film is generally negative, after the remission period, no histological or pancreatic function remains. The change in the above, the prognosis is good; the former can eventually develop pancreatic insufficiency and the prognosis is poor.

2. Lack of ampulla and its surrounding lesions: Chronic pancreatitis when the obstructive jaundice of the common bile duct is often confused with pancreatic head cancer, ampullary tumor, and common bile duct stones. Retrograde cholangiopancreatography and B-ultrasound are helpful for identification, but sometimes laparotomy is needed to confirm the diagnosis.

3. Peptic ulcer: The identification of repeated pancreatic pain and ulcer disease in chronic pancreatitis depends on medical history, gastrointestinal sputum and gastroscopy.

In addition, pancreatic diarrhea still needs to be differentiated from intestinal malabsorption syndrome, D-xylose test is normal in the former, and the latter shows absorption disorder. It is also helpful to identify by means of the pancreatic exocrine function test.

Currently, methods for diagnosing PEI include: detection of fecal fat, fecal elastase, fecal chymotrypsin, etc., a secretin-cholecystokinin test and a mixed triglyceride breath test. Among them, there is a very good correlation between the modified carbon (13C) triglyceride breath test and the secretin-cholecystokinin test, with sensitivity and specificity of 100% and 92%, respectively.

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