Ch 28: Pancreatitis Flashcards
When PN is indicated in pancreatitis, initiation may need to be delayed until after ____ day of hospitalization
After 5th day of hospitalization
Most clinical practices today use which test to diagnose steatorrhea
Fecal elastase tests which requires single stool for assay detection
Can pancreatic enzymes may be used with standard EN products?
Pancreatic enzymes may be used with standard EN products; however, micro-spheres are difficult to administer via feeding tube and it may therefore be more cost effective to use semi elemental or elemental products instead of standard formula
What are the differences in nutrition concerns between mild/moderate and severe acute pancreatitis?
Patients with mild acute pancreatitis and no infectious complications typically have enough energy stores to recover in a short period of time and weight loss from muscle metabolism is more minimal
Patients with severe acute pancreatitis are hypermetabolic, with disease process like sepsis including oxidative stress, catabolism, and SIRS leading to rapid decline in nutrition status
What are estimated energy needs for patient with pancreatitis?
25 kcal/kg/day
What are the most beneficial management strategies for severe acute pancreatitis?
ICU admit, delaying CT scans, implementing early and adequate EN, avoiding prophylactic ABX, and treating local complications
What are estimated protein needs for patient with pancreatitis?
1.5 g/kg/day
What cuases maldigestion and malabsorption of luminal nutrients in acute pancreatitis?
Reduced enzyme output
How does elevation of enzymes correlate w/ severity of pancreatitis?
Elevation of enzymes does not correlate w/ severity of individual episode of acute pancreatitis. Amylase and lipase elevations may not definitively indicate pancreatitis unless tests to eval pancreatic specific isoenzymes are ordered
True or false:Complications of pancreatitis such as pseudocyst, abscess, or ascites are a contraindication to EN?
False; complications of pancreatitis such as pseudocyst, abscess, or ascites are not a contraindication to EN if patient demonstrates tolerance to the feeding
patients with chronic pancreatitis are at risk for which vitamin deficiencies?
Fat soluble, A, D, E & K
Provision of as little of ____ of energy as EN in patient with severe pancreatitis helps maintain gut integrity by preventing increases in gut permeability and keeping tight junctions between the intestinal epithelial cells closed
20%
How should pancreatic enzymes be taken?
With or just before meals and snack so timed to be present when food passes into small bowel
What EN formula should be selected for a pancreatitis patient?
Standard polymeric formula may be used in most cases. Patients w/ extensive pancreatitis necrosis or demonstrating maldigestion/malabsorption may benefit from semi elemental or elemental feeding. Fat delivered in the jejunum may inhibit intestinal transient therefore, peptide based semi elemental feeds are often preferred though standard may be used if tolerated
What is the dose of enzymes used to treat steatorrhea in most adults?
The dose of enzymes to treat steatorrhea should approximate 10% of what a normal pancreas would produce at a pH of 7-8. Taking 30,000 IU lipase units orally per meal will usually provide required adult dose
