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Advanced Medical Nutrition Therapy II > MNT for Pancreatic Disorders > Flashcards

MNT for Pancreatic Disorders Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the endocrine functions of the pancreas?

A

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

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2
Q

What is the exocrine function of the pancreas?

A

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

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3
Q

____ is secreted in response to acidic chyme in the duodenum

A

Secretin

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4
Q

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

A

Bicarbinate

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5
Q

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

A

Cholecystokinin

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6
Q

Cholecystokinin stimulates _____ cells to release digestive enzymes

A

Acinar

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7
Q

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

A

Autodigestion

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8
Q

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

A

Acinar

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9
Q

Acute pancreatitis results in…

A

-Pancreatitis inflammation
-Edema
-Hemorrhage
-Fibrosis
-Necrosis

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10
Q

Acute pancreatitis can range in severity from ____ to ____

A

Mild; severe

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11
Q

What are possible causes of acute pancreatitis?

A

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

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12
Q

Clinical manifestations of acute pancreatitis?

A

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

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13
Q

Complications of severe, acute pancreatitis:

A

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

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14
Q

How is acute pancreatitis diagnosed?

A

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

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15
Q

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

A

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

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16
Q

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

A

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

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17
Q

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

A

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

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18
Q

Those with acute pancreatitis are in a _____, _____ state

A

Hypermetabolic, catabolic

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19
Q

Energy requirements for someone with acute pancreatitis:

A

25-35 kcal/kg

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20
Q

Protein requirements for someone with acute pancreatitis:

A

1.2-1.5 g/kg

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21
Q

MNT for mild-to-moderate acute pancreatitis:

A

-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

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22
Q

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

A

Pancreatic stimulation

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23
Q

MNT for severe acute pancreatitis:

A

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

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24
Q

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

A

48

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25
Q

____ feeding is recommended to minimize pancreatic stimulation

A

Jejunal

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26
Q

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

A

Nasojejunal

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27
Q

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

A

Jejunal

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28
Q

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

A

Polymeric, high protein

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29
Q

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

A

Semi-elemantal

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30
Q

For those on enteral nutrition, we should monitor for _____

A

Tolerance

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31
Q

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

A

Oral

32
Q

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

A

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

33
Q

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

A

5

34
Q

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

A

400

35
Q

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

A

Fibrotic tissues

36
Q

Chronic pancreatitis results in _____ structural and functional impairment

A

Permanent

37
Q

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

A

Exocrine; endocrine

38
Q

Chronic pancreatitis evolves over many _____

A

Years

39
Q

What are possible causes of chronic pancreatitis?

A

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

40
Q

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

A

Epigastric pain

41
Q

What GI symptoms can chronic pancreatitis cause?

A

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

42
Q

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

A

-Fat
-Fat-soluble vitamins
-Protein
-Carbohydrates

43
Q

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

A

Insulin

44
Q

Chronic pancreatitis causes malnutrition due to…

A

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

45
Q

Chronic pancreatitis can cause vitamin _____ deficiency

A

B12

46
Q

Chronic pancreatitis can cause metabolic _____ disease

A

Bone

47
Q

How is chronic pancreatitis diagnosed?

A

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

48
Q

What are examples of pancreatic function tests?

A

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

49
Q

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

A

-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

50
Q

Energy requirements for someone with chronic pancreatitis:

A

35 kcal/kg

51
Q

Protein requirements for someone with chronic pancreatitis:

A

1-2 g/kg

52
Q

MNT for chronic pancreatitis:

A

-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

53
Q

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

A

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

54
Q

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

A

Fat

55
Q

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

A

Water-soluble

56
Q

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

A

Orally

57
Q

What are examples of pancreatic enzyme replacement therapy?

A

-Creon
-Pancreaze
-Viokase

58
Q

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

A

Basic

59
Q

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

A

Exocrine

60
Q

What are examples of pancreatic enzyme replacement therapy doses?

A

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

61
Q

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

A

Tube

62
Q

Tube feeding formula should be high ____ and high ____

A

Protein, calorie

63
Q

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

A

Gastric feeding

64
Q

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

A

Tube

65
Q

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

A

-Partially hydrolyzed, semi-elemental

66
Q

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

A

Orally

67
Q

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

A

Insulin therapy

68
Q

MNT for glucose intolerance is a consistent _____ diet

A

Carbohydrate

69
Q

Consistent carbohydrate diet guidelines:

A

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

70
Q

The Whipple Procedure is also known as a _______

A

Pancreaticoduodenectomy

71
Q

The Whipple Procedure is used to treat ____ ___

A

Pancreatic cancer

72
Q

The Whipple Procedure is a surgical removal of…

A

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

73
Q

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

A

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

74
Q

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)

A

5-6

75
Q

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

A

Jejunal

76
Q

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

A

Pancreatic insufficiency; hyperglycemia

Advanced Medical Nutrition Therapy II (19 decks)

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