Clinical Pathway for Pancreatic Enzyme Replacement Therapy (PERT) in Children with or at Risk for Exocrine Pancreatic Insufficiency (EPI)
Clinical Pathway for Pancreatic Enzyme Replacement Therapy (PERT) in Children with or at Risk for Exocrine Pancreatic Insufficiency (EPI)
History and Physical Exam
Assess patient for clinical features consistent with EPI and for previous PERT use. Review all current/previous pancreatic enzyme therapy orders. Prominent signs of EPI include:
- Poor weight gain/linear growth
- Steatorrhea, loose/frequent stools especially after meals or snacks
- Foul smelling stools
- Flatulence
- Abdominal pain associated with eating
- Voracious appetite
- Rectal prolapse
Considerations | Specific Examples | |
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Birth History |
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HPI | Constitutional | Fatigue |
Eyes | Night blindness | |
Feeding history |
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GI symptoms |
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Growth pattern |
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Family History | Family history of disorders related to EPI | Known gene mutations or inherited disorders |
Past Medical History | Abdominal injuries | Blunt trauma disrupting the pancreas |
Previous surgeries |
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Past illnesses |
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Medication history |
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Physical Exam
Anthropometric Measurements |
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General Appearance | Well-nourished vs wasted |
HEENT | Syndromic facies, Bitot spots |
Cardiovascular | Signs of congenital heart disease |
Respiratory | Work of breathing |
Abdominal |
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Musculoskeletal | Rickets |
Skin and Hair |
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Neurological exam |
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