Gastric operation (Billroth I, vagotomy and pyloroplasty)
Clinical features
Fat malabsorption
Diarrhoea
Weight loss
Postprandial abdominal pain
Voluminous foul-smelling stools
Diabetes
Chronic pancreatitis is associated with impaired glucose tolerance but actual diabetes is a late complication.
Laboratory investigations
Serum cholesterol concentration is typically remarkably low.
Serum albumin is decreased.
Hypocalcaemia (real)
Blood glucose concentration is increased in 50% of the patients.
Serum alkaline phosphatase concentration is increased if the patient has biliary obstruction or deficiency of vitamin D.
Pancreatic function tests show abnormal results (serum trypsin and pancreatic amylase concentrations are normal or slightly increased, secretin-stimulated pancreatic bicarbonate secretion is low).
Faecal elastase I determination is useful in the diagnosis of moderate or severe pancreatic dysfunction.
Investigations for pancreatic dysfunction should be performed if the cause of diarrhoea and malabsorption is not evident on the basis of the patient's history (alcoholic pancreatitis, pancreatic carcinoma).
Treatment of pancreatic exocrine dysfunction
Diet
Total abstinence from alcohol
Treatment of undernutrition prevents complications.
Meals are divided into several servings, and sufficient energy content of the meals is ensured.
Only 30-40% of total energy should come from dietary fats.
In patients with cystic fibrosis Cystic Fibrosis (CF), the prevention of malnutrition is a primary goal, and fat consumption should not be restricted (diet with 35 to 40% of calories from fat is recommended) 2.
High intake of carbohydrates
Proteins 1-1.5 g/kg body weight/day
Pancreatic enzyme substitution
Pancreatic enzymes should be given if the patient has