Acute Pancreatitis Flashcards
lDescribe the 2 main roles of the pancreas
Exocrine
Endocrine
What are the exocrine functions of the pancreas - how does it work?
Produces and releases digestive enzymes via the pancreatic duct into the duodenum in release to eating and drinking
What active enzymes does the pancreas produce and release? (6)
amylase
lipase
trypsin
chymotrypsin
elastase
carboxypeptidase
What are the 2 endocrine functions of the pancreas?
Makes and releases hormones. Mainly glucagon from alpha cells and insulin from beta cells.
What is the role of insulin?
Insulin transports glucose from blood stream into the cells.
What is the role of glucagon?
Glucagon helps release glucose from the liver stores by converting glycogen to glucose.
If there is disruption with either exocrine or endocrine functions of the pancreas - what are the nutritional implications?
- Disruption of blood glucose control. Hypoglycaemia = if not absorbing nutrition
Hyperglycaemia = if not enough insulin is released - Malabsorption
What is the role of the gall bladder ?
To store and release bile into the duodenum via the common bile duct bladder.
Bile and enzymes both work to break down food in the duodenum after chyme has been released into the duodenum via the pyloric sphincter from the stomach.
What digestive enzymes work on carbs, fat and protein from the saliva?
carb = amylase
fat = salivary lipase
protein - none
What digestive enzymes work on carbs, fat and protein from the gastric secretions?
carb = gastric amylase
fat = gastric lipase
protein = pepsin; rennin and gelatinase
What digestive enzymes work on carbs, fat and protein from the pancreas?
carb = pancreatic amylase
fat = lipase; steapsin
protein = trypsin; chymotrypsin; carboxypeptidase; elastase
What digestive enzymes work on carbs, fat and protein from the jejunal/ileal secretion?
carb = sucrase; maltase; isomaltase; lactase
fat = intestinal lipase
protein = brush border; proteases
What are the 3 phases of regulation and pancreatic secretion?
cephalic phase = triggered by sight, smell and taste of food
gastric phase = initiated by gastric distention; triggers release of enzymes and hormones
intestinal phase = in duodenum; when food is chyme - stimulates two hormones: secretin and cholecystokinin into blood circulation; triggers pancreas to release digestive enzymes
Summarise what acute pancreatitis is?
Pancreas becomes acutely inflamed.
A rapid and dynamic process which requires dietetic vigilance.
What are the main causes of acute pancreatitis? (7)
- gallstones
- excess alcohol intake
- idiopathic (unknown)
- Other = autoimmune, hypercalcaemia
- Post ECRP (endoscopic retrogade cholangio pancreatography) - an investigation with camera up through pancreatic ducts
- Drugs - medications
- Hypertriglyceridaemia
What are some of the consequences of moderate/severe acute pancreatitis?
What causes pancreatic tissue to necrose.
20% of all acute pancreatitis.
Infected necrosis = increased mortality rate. Occurs when there is bacterial translocation across the gut. barrier
Sterile necrosis = Not infected
Fluid can accumulate around the pancreas = necrotic tissue
What are the 3 signs and symptoms needed to diagnose acute pancreatitis? (2012 Atlanta Classification)
- abdominal pain consistent with pancreatitis
- serum amylase and/or lipase of at least 3x the normal upper limit
- Findings consistent with acute pancreatitis on CT, MRI and ultrasound.
Define mild acute pancreatitis
no organ failure.
no local or systemic complications
Define moderately severe acute pancreatitis
Organ failure that revolves within 48 hours (transient organ failure)
and/or local systemic complications without persistent organ failure
Define severe acute pancreatitis
persistent organ failure (> 48 hours)
Single or multiple organs. Often very unwell and need to go to ICU
Why is severity so important to dietetic care? (name 3)
1, Increasing severity = increased mortality risk
- accumulation of fluid in or around the pancreas can lead to necrosis and/or organ failure
- necrotic tissue can become infected from translocation of bacteria from the gut
Why is enteral nutrition important? (3 reasons)
- Starvation = associated with gut atrophy. This can cause bacterial translocation - can lead to necrotic pancreatic infection
- Oral/ enteral nutrition (NG or NJ) has been shown to reduce bacterial translocation from the gut and stimulates intestinal motility, reducing bacterial overgrowth and maintains the gut mucosal integrity
- This can reduce systemic infectious complications and benefits clinical outcomes.
Why should acute pancreatitis be considered at moderate to high nutritional risk?
because of the catabolic nature of the disease and the impact of nutritional status for disease development.
How many acute pancreatitis patients be nutrition screened and why? What method used?
All patients with predicted mild to moderate acute pancreatitis should be screened using validated methods (Nutritional Risk Screening, 2002)
All patients with severe AP should always be considered at nutritional risk
Why are all moderate AP patients be considered high nutritional risk?
Because of the catabolic nature of the disease because of the impact of nutritional status in disease development
When should oral nutrition be offered to AP patients?
as soon as clinically tolerated and independent of serum lipase concentrations in patients with predicted mild AP.
Why should AP patients not be made nil by mouth?
Unless a clear reason for nil by mouth (i.e. severe vomiting) enteral feeding should be offered (oral or tube) to anyone with severe or moderately severe AP.
How quickly should enteral nutrition be offered to anyone with severe or moderately severe AP?
Within 72 hours of presentation.