MNT for Pancreatic Disorders Flashcards
What are the endocrine functions of the pancreas?
-Regulation of glucose homeostasis (production of insulin and glucagon)
-Production of somatostatin
What is the exocrine function of the pancreas?
-Synthesize and secrete enzymes for digestion (lipase, amylase, proteases, pancreatic juices-> bicarbonate)
____ is secreted in response to acidic chyme in the duodenum
Secretin
Secretin stimulates the duct cells to secrete ____ in order to neutralize chyme
Bicarbinate
_____ is released in response to fat and protein in the duodenum
Cholecystokinin
Cholecystokinin stimulates _____ cells to release digestive enzymes
Acinar
Acute pancreatitis is caused by the premature activation of the digestive enzymes within the pancreas, causing _____
Autodigestion
The pathogenesis of acute pancreatitis is possibly due to to injury to pancreatic ____ cells
Acinar
Acute pancreatitis results in…
-Pancreatitis inflammation
-Edema
-Hemorrhage
-Fibrosis
-Necrosis
Acute pancreatitis can range in severity from ____ to ____
Mild; severe
What are possible causes of acute pancreatitis?
-Cholelithiasis
-Acute or chronic alcohol abuse
-Idiopathic
-Medications: corticosteroids
-Abdominal trauma
-Hypertriglyceridemia (TG >500 mg/dl)
-Hypercalcemia
Clinical manifestations of acute pancreatitis?
-Severe epigastric pain (may worsen with ingestion of food)
-N/V
-Anorexia
-Abdominal distension
-Ileus
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 is acute pancreatitis diagnosed?
-Clinical manifestations
-Elevated serum lipase and amylase
-Confirmed by a CT scan
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
What are lab findings that are common in someone with acute pancreatitis?
-Altered electrolytes
-Hypoalbuminemia
-Hyperglycemia
-Elevated WBC
-Hypocalcemia
What is the formula for the correction of total serum calcium for hypoalbuminemia?
Total Ca2+ (mg/dl) + ([4 - albumin (g/dl)] x 0.8)
Those with acute pancreatitis are in a _____, _____ state
Hypermetabolic, catabolic
Energy requirements for someone with acute pancreatitis:
25-35 kcal/kg
Protein requirements for someone with acute pancreatitis:
1.2-1.5 g/kg
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
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
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)
Enteral nutrition should be initiated within ____ hours of admission if hemodynamically stable for those with severe, acute pancreatitis
48
____ 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
5
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
