Pancreatitis

Question 1

What is pancreatitis?

Answer 1

Inflammation of the pancreas

Question 2

What causes pancreatitis?

Answer 2

Many causes including:
* alcoholism
* biliary tract disease
* trauma
* cancer
* surgical procedures

Question 3

What is the mechanism of pancreatitis?

Answer 3

1. Pancreatic duct is completely/partially blocked: gallstones, edema
2. Pancreatic flow continues: rich in enzymes
3. Enzymes (trypsin) become activated and high levels overwhelm trypsin inhibitor
4. Trypsin begins “auto” digestion of pancreas initiating inflammation

Question 4

What is the diagnosis for pancreatitis?

Answer 4

Symptoms
* severe abdominal pain, worsens with eating
* nausea, vomiting, edema, shock

Elevated serum amylase, lipase
* enzymes diffuse into blood (100-200x normal)

Radiological confirmation
* ultrasound, CT scan

Question 5

Complications of pancreatitis

Answer 5

• Circulating enzymes ↓ serum calcium
• Hemorrhagic necrosis
• Glucose intolerance/ hyperglycemia (endocrine dysfunction)
• Exudates into peritoneal cavity (release into other tissue causing damage)
• Necrosis of mesenteric fat
• Increased permeability of lung alveoli leading pulmonary edema

Question 6

Prognosis of pancreatitis

Answer 6

Self-limiting
* improves on own
* may develop chronic pancreatitis

No well established treatment
* can be fatal

Question 7

Goal of nutrition care for pancreatitis

Answer 7

• Decrease pancreatic stimulation – organ rest
• Prevent malnutrition until conditionis resolved and oral intake can be resumed
• maintain nutrition status
• Usually require 1.3-1.5 x BEE

Question 8

Nutrition care for pancreatitis

Answer 8

• NPO: No pancreatic stimulation (for severe)
• Jejunal enteral feeding: Elemental (for moderate)
• TPN: If enteral feeding not tolerated
• Insulin: if elevated blood glucose (May require ↓ CHO in enteral/parenteral feeding)

Question 9

Nutrition care for once pancreatitis begins to resolve

Answer 9

• clear fluids then advanced slowly
• low fat
• small meals
• no alcohol
• May require pancreatic enzyme replacement
• Continue to control blood sugars if required (usually resolves)
• encouraged to continue with low fat diet and no alcohol

Question 10

What occurs with chronic pancreatitis?

Answer 10

Recurrent acute attacks
* Most commonly seen in alcoholism
* Occasionally cystic fibrosis

Overtime permanent pancreatic tissue damage

90% loss pancreatic tissue = pancreatic insufficiency
* steatorrhea
* glucose intolerance
* malnutrition if untreated

Question 11

Treatment for chronic pancreatitis

Answer 11

If alcoholic
* treatment as per alcoholic protocol
* folic acid, thiamine, multivit’s

Serum enzymes may be normal or low
* pancreatic tissue is destroyed enzymes may be required

If gallstones responsible
* may improve with cholecystectomy