Pancreatic insufficiency is a condition that plays a major role in internal medicine. Behind an insufficiency is always a restriction in the functioning of an organ or organ system.
What is pancreatic insufficiency?
The pancreas, the pancreas is, as its name implies, a large gland, which has a very important role in connection with the metabolism of humans. In this context, the islets of Langerhans, which are responsible for the production of the vital insulin, are well known. In the case of pancreatic insufficiency, there is a complete loss of functional capacity as the disease progresses. In this context, pancreatic insufficiency involves a reduction or complete cessation of the production and secretion of enzymes that are important for healthy human digestion. The provision of hormones is also classic in pancreatic insufficiency.
Causes
Pancreatic insufficiency can have several causes. Collectively, these result in damage to the glandular tissue. In most cases, pancreatic insufficiency is the result of a previous condition such as persistent and constantly recurring inflammation, tumor disease, growth of a cyst, or cystic fibrosis. In addition, pancreatic insufficiency can be caused by gastrointestinal diseases, stomach ulcers, diseases of the gall bladder and bile ducts, and so-called autoimmune diseases. The pancreas is a sensitive and very complex organ, which can be difficult to treat if it is not treated properly or not treated at all. Moreover, if pancreatic insufficiency occurs, it can have serious implications for other organs.
Symptoms, complaints, and signs
Exocrine pancreatic insufficiency only becomes noticeable when the organ output has already dropped to about ten percent. The first symptoms are often nausea and vomiting after eating fatty foods, since fat can no longer be digested adequately. In the further course, greasy, shiny, foul-smelling diarrhea occurs, and the stool is usually very brightly colored. Due to the insufficient absorption of nutrients, those affected lose a lot of weight, even though they eat enough food. Vitamin deficiencies can also occur: A deficiency of vitamin K, for example, can result in an increased tendency to bleed, and too little vitamin A impairs vision. If too much undigested food enters the large intestine, the result is a strong gas formation that triggers painful flatulence. Pancreatitis associated with pancreatic insufficiency is manifested by upper abdominal pain radiating to the back. Endogenous pancreatic insufficiency primarily affects sugar metabolism: characteristic signs are excessive thirst, increased urination and a drop in physical and mental performance. The excessive rise in blood sugar can lead to a metabolic derailment (ketoacidosis), which is noticeable through increasing apathy, abdominal pain, nausea and vomiting. Typical is the fruit- or acetone-like bad breath. Hypoglycemia is also possible: signs include cold sweats, tremors, and clouding of consciousness.
Diagnosis and course
Diagnosis of pancreatic insufficiency focuses on laboratory tests related to various enzymes in urine and serum, as well as stool examinations. Clear conclusions about pancreatic insufficiency can be drawn by determining the enzyme elastase. The laboratory tests are supplemented by imaging procedures such as ultrasound examinations, computer tomography or magnetic resonance imaging. It is also important to examine the patient with regard to how he or she is feeling. In addition to painful symptoms, extreme nausea and persistent vomiting occur in pancreatic insufficiency. A light-colored “fatty stool” or diarrhea is typical of so-called exocrine pancreatic insufficiency. In pancreatic insufficiency, this consistency of the stool is based on a disturbance in the metabolism of the fats and proteins contained in the food. The pain that occurs can occur at different times of the day depending on the type of pancreatic insufficiency and can vary in severity. There is pressure pain in the upper abdomen.Patients also lose their appetite and feel generally unwell when pancreatic insufficiency occurs.
Complications
Because excessive alcohol consumption can trigger pancreatic insufficiency via inflammatory processes, it leads to further impairment of the pancreas if not stopped immediately. Therapeutic improvement cannot be achieved with continued alcohol abuse either, so that concomitant alcohol therapy is urgently recommended. If alcohol continues to be consumed, very severe upper abdominal pain, flatulence and diarrhea regularly occur; weight loss and malnutrition due to inadequate fat digestion and diabetic symptoms such as unbearable thirst, frequent urination and dizziness up to coma. Constrictions due to stones, pancreatic cysts and malignant tumors of the pancreas occur more frequently. A yellowish coloration of the skin, jaundice, indicates the occurrence of complications such as insufficient drainage of bile. This is also true for one-fifth of patients who develop pancreatic insufficiency due to a genetic defect or from unidentifiable causes. Lifelong abstinence from alcohol is essential for all pancreatic patients. Pancreatic insufficiency cannot be cured; it usually leads to lifelong digestive disorders and insulin-dependent diabetes. Complications can occur even if therapeutic instructions are followed, but in this case they are much less frequent.
When should you go to the doctor?
If irregularities or discomfort occur after eating fatty foods, developments should be monitored further. If the symptoms persist or continuously increase in intensity, a visit to the doctor is advised. In case of nausea and vomiting as well as loss of appetite, a doctor is needed. If there is unwanted weight loss, unpleasant and painful flatulence or a feeling of fullness, there is cause for concern. Pain in the upper abdomen or a decrease in exercise tolerance should be presented to a physician. Since numerous complications can occur when taking pain medication, this should only take place after consultation with a medical professional. An increase in bleeding tendency or disturbances in various functional abilities should be examined and clarified by a physician. Excessive thirst, apathy or a withdrawal from social life are further signs of a health disorder. Diffuse deficiency symptoms, diarrhea or foul-smelling excretions should be examined more closely by a physician. In these cases, there is a disease that needs to be treated. If there is a decrease in the ability to concentrate, problems in coping with everyday life, and clouding of consciousness, action is required. A physician must be consulted, as the quality of life in these cases is already severely limited.
Treatment and therapy
Because there are both endocrine and exocrine forms of pancreatic insufficiency, treatment methods are equally varied. These also depend on the triggers of the disease and the extent and existing symptoms of pancreatic insufficiency. Basically, pancreatic insufficiency that occurs cannot be subsequently cured. The basis for the therapy of pancreatic insufficiency, which should alleviate the symptoms and make life with this disease possible, consists on the one hand of a healthy lifestyle and on the other hand of the intake of specially developed active substances. In terms of a gentle diet for pancreatic insufficiency, it is important not to consume alcoholic beverages and to ensure a composition of food that is rich in vitamins and minerals. These measures are usually supplemented by a dietary food choice, in which dietary margarines are predominantly recommended in the context of pancreatic insufficiency. Drug therapy in pancreatic insufficiency is mainly about taking pancreas-relevant enzymes to support function. Treatment of any pre-existing or concomitant diseases should also be considered in pancreatic insufficiency.
Outlook and prognosis
Pancreatic insufficiency is considered irreversible. This means that the condition cannot be cured.However, there is certainly the possibility of achieving a more favorable course of pancreatic insufficiency through appropriate treatment measures, so that there is a tolerable level of discomfort. The prognosis of the disease also depends on various factors. For example, it plays an important role whether only one function of the pancreas, such as the endocrine or exocrine function, is affected, or several. The particular cause of pancreatic insufficiency is also important. Pancreatic insufficiency reduces the life expectancy of those affected, because weakness of the pancreas is often associated with other serious diseases. The prognosis is particularly negative if the condition results from the constant excessive consumption of alcohol. On the other hand, however, an improvement in the outlook is possible by consistently abstaining from alcoholic beverages. Basically, about half of all patients suffering from pancreatic insufficiency die after ten years. At least a longer life expectancy can be achieved through drug therapy, avoidance of tobacco products, and a healthy diet and lifestyle adjustment. Many patients are afraid of the large number of drugs they need for treatment. But the drugs are absolutely necessary to stabilize fat digestion as much as possible, which in turn has a positive effect on prognosis.
Prevention
Prevention of pancreatic insufficiency is possible only indirectly by avoiding harmful stimulants such as alcohol and eating a balanced diet. If symptoms of the gastrointestinal tract, gall bladder or duodenum, or liver occur, a specialist should be consulted in order to eliminate any existing risk of secondary diseases of the pancreas in good time. When taking medications, it is important to consider their side effects in relation to the risk of pancreatic insufficiency. Persistent malnutrition should also be avoided with regard to prevention of pancreatic insufficiency.
Follow-up
The person affected by pancreatic insufficiency only has access to special measures of aftercare in a few cases. Often, they are severely limited, so the affected person in this disease is primarily dependent on rapid diagnosis and treatment to prevent severe complications. Therefore, a physician should be contacted at the first symptoms and signs of the disease to prevent further complications or discomfort from occurring. Most patients are dependent on taking various medications and drugs to permanently relieve the symptoms of this disease. In doing so, the affected person should always observe correct dosage and also regular intake. If there are any uncertainties or questions, a doctor should be consulted first. Furthermore, a healthy lifestyle with a healthy diet generally has a positive effect on the course of pancreatic insufficiency and can alleviate the symptoms. Most patients depend on the help and support of friends and family in their daily lives. Contact with other sufferers can be very useful, as this can often lead to an exchange of information.
What you can do yourself
Sufferers of pancreatic insufficiency can review and optimize their lifestyle. As a matter of principle, the consumption of harmful substances should be refrained from. In particular, the consumption of alcohol should be completely stopped as soon as possible in pancreatic insufficiency. In the case of pancreatic insufficiency, the self-help measures depend on the cause of the disease. In the case of alcohol abuse, the affected person needs help and support to cope with the symptoms. If withdrawal symptoms occur in everyday life without the consumption of alcohol, an addiction counseling center should be visited. The diet should also be optimized and adapted to the needs of the organism. The diet should be rich in vitamins and balanced. Together with the doctor, a dietary regimen is worked out that is helpful in alleviating the symptoms. Greasy meals or hot spices lead to an increase in the existing symptoms. If a tumor disease is present, the immune system can be supported by a healthy food intake. According to the latest research, foods from the cruciferous vegetables are helpful in the fight against cancer.The food intake should be split into several meals per day. Doctors advise a division into five to seven meals per day. Care should be taken to ensure that the amount consumed per meal is not excessive. The procedure reduces discomfort in the gastrointestinal tract and has a relieving effect on human digestion.
