Pancreatitis, Chronic

What is Pancreatitis?

Pancreatitis is a Chronic inflammatory condition of the pancreas, that results in functional and structural damage of pancreas. In most patients this is a chronic progressive disease leading to exocrine and endocrine insufficiency.

How to Manage Pancreatitis, General Measures

Abstinence from alcohol reduces abdominal pain in the early stages of the disease. Small frequent meals, and restricted fat intake – reduces pancreatic secretion and pain. Elemental diets (i.e. parenteral or enteral nutrition) in chronically debilitated patients. When weight loss is not responding to exogenous enzymes and diet, consider supplementation with medium chain triglycerides. There is a risk of developing cancer of the pancreas. This should be considered in patients who develop worsening pain, new onset diabetes or deterioration in exocrine function. Dietary advice by dietician.

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Medicine for Treating Pancreatitis

Treatment is aimed at: » pain, » malabsorption, and » endocrine function.

Pancreatic enzymes may reduce pain by negative feedback on pancreatic secretion. Malabsorption Start treatment when >7 g (or 21 mmol) fat in faeces/24 hours while on a 100 g fat/day diet. Reduce dietary fat to < 25 g/meal. Supplementation of fat-soluble vitamins may be indicated. Lipase, oral, equivalent to lipase 30 000 units per day. Aim for symptom control and/or 5% of normal faecal fat output.

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References

Standard Treatment guidelines and Essential Medicine list For South Africa. Hospital Level Adults, 2012 Edition

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