MNT for Pancreatic Disorders Flashcards by perjunke fibers

What are the endocrine functions of the pancreas?

-Regulation of glucose homeostasis (production of insulin and glucagon)
-Production of somatostatin

How well did you know this?

Not at all

Perfectly

What is the exocrine function of the pancreas?

-Synthesize and secrete enzymes for digestion (lipase, amylase, proteases, pancreatic juices-> bicarbonate)

How well did you know this?

Not at all

Perfectly

____ is secreted in response to acidic chyme in the duodenum

Secretin

How well did you know this?

Not at all

Perfectly

Secretin stimulates the duct cells to secrete ____ in order to neutralize chyme

Bicarbinate

How well did you know this?

Not at all

Perfectly

_____ is released in response to fat and protein in the duodenum

Cholecystokinin

How well did you know this?

Not at all

Perfectly

Cholecystokinin stimulates _____ cells to release digestive enzymes

Acinar

How well did you know this?

Not at all

Perfectly

Acute pancreatitis is caused by the premature activation of the digestive enzymes within the pancreas, causing _____

Autodigestion

How well did you know this?

Not at all

Perfectly

The pathogenesis of acute pancreatitis is possibly due to to injury to pancreatic ____ cells

Acinar

How well did you know this?

Not at all

Perfectly

Acute pancreatitis results in…

-Pancreatitis inflammation
-Edema
-Hemorrhage
-Fibrosis
-Necrosis

How well did you know this?

Not at all

Perfectly

Acute pancreatitis can range in severity from ____ to ____

Mild; severe

How well did you know this?

Not at all

Perfectly

What are possible causes of acute pancreatitis?

-Cholelithiasis
-Acute or chronic alcohol abuse
-Idiopathic
-Medications: corticosteroids
-Abdominal trauma
-Hypertriglyceridemia (TG >500 mg/dl)
-Hypercalcemia

How well did you know this?

Not at all

Perfectly

Clinical manifestations of acute pancreatitis?

-Severe epigastric pain (may worsen with ingestion of food)
-N/V
-Anorexia
-Abdominal distension
-Ileus

How well did you know this?

Not at all

Perfectly

Complications of severe, acute pancreatitis:

-Pancreatic abscess
-Pancreatic pseudocyst
-Necrotizing pancreatitis
-Hypovolemia, hypotension, shock
-Systemic Inflammatory Response Syndrome (SIRS)
-Multiple Organ Dysfunction Syndrome->pulmonary, renal
-Death

How well did you know this?

Not at all

Perfectly

How is acute pancreatitis diagnosed?

-Clinical manifestations
-Elevated serum lipase and amylase
-Confirmed by a CT scan

How well did you know this?

Not at all

Perfectly

What should be included in a nutrition assessment for someone with acute pancreatitis?

-Current medical status: severity, complications, treatment plan, etiology
-Anthropometrics
-NFPE
-Diet history
-Assess for possible malnutrition
-Lab assessment

How well did you know this?

Not at all

Perfectly

What are lab findings that are common in someone with acute pancreatitis?

-Altered electrolytes
-Hypoalbuminemia
-Hyperglycemia
-Elevated WBC
-Hypocalcemia

How well did you know this?

Not at all

Perfectly

What is the formula for the correction of total serum calcium for hypoalbuminemia?

Total Ca2+ (mg/dl) + ([4 - albumin (g/dl)] x 0.8)

How well did you know this?

Not at all

Perfectly

Those with acute pancreatitis are in a _____, _____ state

Hypermetabolic, catabolic

How well did you know this?

Not at all

Perfectly

Energy requirements for someone with acute pancreatitis:

25-35 kcal/kg

How well did you know this?

Not at all

Perfectly

Protein requirements for someone with acute pancreatitis:

1.2-1.5 g/kg

How well did you know this?

Not at all

Perfectly

MNT for mild-to-moderate acute pancreatitis:

-If pain and vomiting, initially pancreatic rest: NPO with IV fluids
-When pain and N/V decrease: 40-gram low fat diet
-Frequent, small meals may be better tolerated
-Advance to regular diet or appropriate MNT based on the cause of pancreatitis

How well did you know this?

Not at all

Perfectly

The 40 g low-fat diet is used for mild-to-moderate acute pancreatitis in order to limit ____ _____; we should monitor for return of pain or GI distress

Pancreatic stimulation

How well did you know this?

Not at all

Perfectly

MNT for severe acute pancreatitis:

-Current guidelines recommend enteral nutrition over parenteral nutrition (enteral nutrition is associated with less infectious complications and shorter hospital length of stay)

How well did you know this?

Not at all

Perfectly

Enteral nutrition should be initiated within ____ hours of admission if hemodynamically stable for those with severe, acute pancreatitis

How well did you know this?

Not at all

Perfectly

____ feeding is recommended to minimize pancreatic stimulation

Jejunal

For those who will have short-term enteral nutrition, they should receive a ____ tube

Nasojejunal

For those who will have long-term enteral nutrition, they should receive a ___ tube

Jejunal

What type of formula should be used for those with acute pancreatitis on enteral nutrition?

Polymeric, high protein

If someone has fat malabsorption, they should receive a ___-___ formula

Semi-elemantal

For those on enteral nutrition, we should monitor for _____

Tolerance

The goal for those on enteral nutrition is to transition to _____ diet

Oral

What are indications for parenteral nutrition in those with acute pancreatitis?

-Prolonged SB ileus -Severe, acute pancreatitis AND enteral nutrition is not tolerated

Initiation of parenteral nutrition should be delayed for at least ____ days after admission, after the peak of inflammation

We can use IV lipids with PN unless triglycerides are above ____ mg/dL

400

Chronic pancreatitis is a progressive, irreversible, inflammatory disease in which pancreatic tissue is slowly destroyed and replaced by ____ ____

Fibrotic tissues

Chronic pancreatitis results in _____ structural and functional impairment

Permanent

Chronic pancreatitis causes an initial loss of _____ function and then eventually also the loss of _____ function

Exocrine; endocrine

Chronic pancreatitis evolves over many _____

Years

What are possible causes of chronic pancreatitis?

-Chronic alcoholism -Smoking -Hypertriglyceridemia -Genetic mutations -Autoimmune pancreatitis -Obstructions: strictures in pancreatic ducts -Idiopathic

Chronic pancreatitis leads to recurrent attacks of _____ _____ that worsens after meals, particularly consumption of high-fat foods

Epigastric pain

What GI symptoms can chronic pancreatitis cause?

-Anorexia -N/V -Diarrhea -Steatorrhea -Weight loss

Chronic pancreatitis leads to progressive pancreatic insufficiency, causing malabsorption of...

-Fat -Fat-soluble vitamins -Protein -Carbohydrates

Chronic pancreatitis can also cause decreased ____ production, leading to diabetes mellitus

Insulin

Chronic pancreatitis causes malnutrition due to...

-Decreased intake due to abdominal pain, anorexia, fear of eating -Malabsorption -Continued alcohol use -Hypermetabolism -Fat-restricted diets

Chronic pancreatitis can cause vitamin _____ deficiency

B12

Chronic pancreatitis can cause metabolic _____ disease

Bone

How is chronic pancreatitis diagnosed?

-Combination of symptoms, imaging (CT scan or MRI), and function tests -Pancreatic function tests

What are examples of pancreatic function tests?

-72-hour fecal fat test: >7 g/day -Fecal elastase-1 -Secretin stimulation test: measures volume of pancreatic bicarbonate produced

What should be included in a nutrition assessment for someone with chronic pancreatitis?

-Anthropometrics -NFPE -Diet history (diet PTA, analysis of diet recall, weight loss despite eating well, GI complaints, alcohol consumption) -Labs: electrolytes, glucose, fecal fat test -Potential micronutrient deficiencies: fat-soluble vitamins, magnesium, calcium, zinc, vitamin B12, thiamin, and folate -Food-medication interactions -High nutrition risk: assess for malnutrition

Energy requirements for someone with chronic pancreatitis:

35 kcal/kg

Protein requirements for someone with chronic pancreatitis:

1-2 g/kg

MNT for chronic pancreatitis:

-No alcohol -High kcal, high protein diet -6-8 small meals per day (avoid large meals with high fat foods) -MVI with minerals -Possible IM vitamin B12 supplementation -Possible role of antioxidant supplements

If someone with chronic pancreatitis has alcohol use disorder, recommend supplementation of...

-Thiamin: 50-100 mg -Folic acid: 1 mg daily

If someone with chronic pancreatitis is having steatorrhea and they are on pancreatic enzyme replacement, they do not need a ____ restriction unless the fat malabsorption cannot be controlled by enzyme replacement alone

Fat

If someone is having steatorrhea, they should get a fat-soluble vitamin supplementation in ____-____ form

Water-soluble

Pancreatic enzyme replacement therapy is given _____ with all meals and snacks

Orally

What are examples of pancreatic enzyme replacement therapy?

-Creon -Pancreaze -Viokase

Pancreatic enzyme replacement function best in a ____ environment, so patients may require H2 blockers/proton pump inhibitors to decrease acidity

Basic

There is an individualized dose of pancreatic enzyme replacement therapy that is based on severity of _____ insufficiency and composition of meal or body weight

Exocrine

What are examples of pancreatic enzyme replacement therapy doses?

-1800 units of lipase per gram of fat -1000 units of lipase/kg per meal and adjust as needed

Supplemental ____ feedings may be required for someone with chronic pancreatitis to meet calorie needs

Tube

Tube feeding formula should be high ____ and high ____

Protein, calorie

What route of tube feeding should be used for those with chronic pancreatitis?

Gastric feeding

The optimal way to dose pancreatic enzymes when on ____ feeding has not been established

Tube

For those on tube feeding with pancreatic insufficiency, provide what type of formula?

-Partially hydrolyzed, semi-elemental

For cycle tube feedings, provide pancreatic enzymes ____ at the beginning of the feeding and then halfway through the feeding

Orally

Management of glucose intolerance for someone with chronic pancreatitis is done with ____ ____

Insulin therapy

MNT for glucose intolerance is a consistent _____ diet

Carbohydrate

Consistent carbohydrate diet guidelines:

-Banalce carbohydrate intake with insulin therapy -Small, frequent meals if experiencing frequent episodes of hypoglycemia

The Whipple Procedure is also known as a _______

Pancreaticoduodenectomy

The Whipple Procedure is used to treat ____ ___

Pancreatic cancer

The Whipple Procedure is a surgical removal of...

-Head of the pancreas -Duodenum -Sometimes the distal stomach -Portion of the common bile duct -Gallbladder

What are some post-op complications of the Whipple Procedure?

-Delayed gastric emptying -Dumping syndrome -Weight loss -Possible fat malabsorption-> provide pancreatic enzyme supplements -Possible development of diabetes mellitus

After the Whipple, we should begin an oral diet as soon as appropriate, and recommend ___-___ small meals/day (we can adapt MNT if the patient is having delayed gastric emptying or dumping syndrome)

5-6

If someone has severe, delayed gastric emptying with nausea and vomiting, we should recommend NPO with _____ tube feed

Jejunal

After the Whipple, we should monitor for possible ____ ____ and ____

Pancreatic insufficiency; hyperglycemia