Pancreatitis Flashcards
risk factors for pancreatitis
breed, age, drugs, hepatobiliary disease, endocrine disorders, hypercalcemia, hyperlipidemia
acute pancreatitis pathogenesis with hypercalcemia
Pancreatic lipase
>Hydrolysis of serum TG in pancreatic microvasculature >Release free fatty acids locally
>Microthrombi and/or
>Bind with calcium to cause further capillary damage
>Releases more pancreatic lipase
>ACUTE PANCREATITIS
dietary risk factors for pancreatits
High-fat (>20%DM) foods, treats or human foods
History of dietary indiscretion of high-fat human foods
Experimentally, feeding high-fat, low-protein foods in dogs
Calorically dense, high-fat foods > Obesity
etiopathogenesis of pancreatitis
Autodigestion of pancreatic tissue with associated inflammation is self-perpetuating and can eventually affect functions of the pancreas:
Endocrine functions: insulin secretion from beta cells >Insulin-dependent diabetes mellitus (DM)
Exocrine functions: digestive enzyme secretion
>Exocrine pancreatic insufficiency (EPI)
key nutritional factors for pancreatitis
fat < 15% for non-obese and non-hypertriglyceridemic
<10% if obese
protein 15-30% for dogs
KNF: fat in pacreatitis cases; how do we decide what to give in short term
Select dietary fat level based on patient’s clinical picture and etiology of pancreatic overstimulation
Trauma/drug induced > tend to see normal fasting TAG
> choose highly digestible diet with moderate fat (<15% DM)
(overall 12-15% DM)
Fat-induced > tend to see high fasting TAG > choose lower dietary fat diet (<10% DM)
Level of restriction depends on the individual:
-Hypertriglyceridemia: <10% DM -Overweight/obese: <10% DM
-Recurring pancreatitis: <10% DM
KNF: fat for long-term pancreatitis case
Some patients recover and can be weaned onto an adult maintenance diet, whereas others must remain on a reduced-fat diet long term
Completely removing fat from the diet is NOT an option: Essential fatty acids (e.g. omega 6’s and 3’s)
Fat soluble vitamins (e.g. Vitamins A, D, E, and K)
Energy source
Palatability
Low fat contra-indicted if:
Volume intolerance, weight loss, reduced appetite
controversy of omega-3 fatty acids with pancreatitis
may help with pancreatitis? but adds calories and fat so use caution
Gradual increase (by 25% weekly) to avoid diarrhea and
belching and reach target intake
Make sure fasted triglycerides are actually improving
>otherwise discontinue
Make sure cPLI’s are not worsening
>otherwise discontinue
KNF: protein effects in pancreatitis
Proteins/amino acids stimulate the exocrine pancreas
Excessive dietary protein is not recommended
>DOGS: 18-30% DM
>CATS: 30-40% DM
Protein level should be near upper limit in pets that: >Require gradual weight loss (to maintain LBM)
>Muscle wasted
KNF: fibre in a case of pancreatitis
Highly digestible diet with <5% DM crude fibre
Long term (following recovery)
higher fibre diets (>5% DM) may be used with overweight/obese patients for weight loss
(i.e. veterinary weight loss diets)
meal frequency for pancreatitis
Huge benefit from small, frequent meals!
>Lower the absolute amount of fat and protein being
consumed at each meal
-At home: 3-4 meals/day
-In hospital: 6-8 meals/day
how can dietary change impact pacreatitis? considerations?
Any sudden dietary change can incite a bout of pancreatitis
Recommend not feeding any commercial treats, bones, chews, or human foods to prevent inciting another bout of pancreatitis
Access to garbage, composters, food on counters, food outside, etc. must be avoided in pets that have a history of pancreatitis
how do we avoid pancreatitis problems when transitioning a diet?
Too rapid of a transition to a new diet can lead to vomiting, diarrhea, nausea, or pancreatitis
Use transition schedule:
Day 1-2: 75% of current diet + 25% of the new diet
Day 3-4: 50% of current diet + 50% of the new diet
Day 5-6: 25% of current diet + 75% of the new diet
Day 7: 100% of the new diet
are treats and human food in a pancreatitis case?
Low fat!
<10% of daily calories!
when should we use a weight loss plan if a dog has pancreatitis?
When recovered from pancreatic episode
Veterinary weight loss diet: low fat, higher fibre
Controlled steady weight loss: 0.5-2.0% BW/wk
Energy requirement: RER for ideal body weight
current diet regime for a new case of pancreatitis
CURRENT: EARLY ENTERAL NUTRITION (EEN)
> Feed through vomiting/diarrhea
> Either per os (PO) or assisted via feeding tube
Purported advantages:
Correction of negative energy balance
Preservation of gut integrity & function
Improved immune function
Reduced bacterial translocation
Attenuated release of inflammatory mediators
Reduced rate of infection & infectious complications
Reduced duration of hospitalization
cat with pancreatitis feeding method and frequency
Small meals frequently: 3-4 at home, 6-8 in hospital
Reduced gastric distension
Decreased gastric secretion
Reduced nausea, vomiting, gastroesophageal reflux
More effective assimilation
if cat in hospital for pancreatitis how can we provide nutrition, optionally
cri
KNF summary for cat with pnacreatitis
fat: <25% for non obese
<15% for obese
protein: 30-40%
hyporexia food intake
Hyporectic patients only eat 1/4 to 1/3 of their energy requirements
issues with protein malnutrition, and markers
Weight loss
increased creatinine (muscle breakdown)
decreased albumin/total protein
KNF for anorexia
Recovery diets (30-36% fat, 44-46% protein DM) if:
Feeding multiple small meals (6-8/day)
Patient is consuming ≤ RER
Patient is tolerating the diet
important consideration for encouraging eating long term in a case of anorexia
AVOID FOOD AVERSION!
Do not feed the diet you want the patient to eat long
term if they are nauseous/vomiting/anorexic
anorexia and pancreatitis balancing act
Balancing act between providing nutrient for recovery from illness vs. stimulating the pancreas
in hospital diet plan for anorexia
Very palatable palatable diet (high protein and fat)
Fat (calories) and protein are needed for recovery
Start with small amounts (multiple small meals)
what if a cat doesnt want to eat
No forced feeding > food aversion
Stimulate appetite
Warm up the food to body temperature
Small, frequent meals (6-8 per day)
Take the food away after 15 min and try again later
Tube feeding > same schedule as per os feeding > The quicker the better!!
weight loss diet long term for cat, type
Lower fat diet appropriate for long term feeding
Highly digestible, low fibre diet
Multiple small meals
