Pancreatitis

Question 1

Lab tests for pancreatitis

Answer 1

(1) amylase/lipase elevated
(2) secretin stimulation test (esp bicarb production)
(3) glucose tolerance test (insulin - endocrine fxn)
(4) 72 hr stool fat (fat malabsorp/pancreatic lipase)

Question 2

Etiology/risk factors for pancreatitis

Answer 2

(1) gallstones and biliary dyskinesia (only acute)
(2) alcoholism (most freq cause)
(3) medications
(4) trauma
(5) hypertriglyceridemia (chylomicrons blocking pancreatic capillaries; release of lipase; FFAs; release of inflame mediators/free radicals; inflam, edema, necrosis
(6) hypercalcemia (kidney disease or vit D sup
(7) viral infections

Question 3

functions of the pancreas

Answer 3

(1) exocrine (enzymes - ducts)
- amylase
- lipase
- carboxypeptidase
- phospholipase A
- chymotrypsenogen
- aminopeptidase
- trypsinogen
- cholesterase
(2) endocrine (hormones - ductless)
- insulin
- glucogon

Question 4

MNT for mild pancreatitis

Answer 4

• withhold oral/enteral feeding
• IV fluids/pain control
• after 3 days start oral feeding - easily digestible, low fat, small freq meals, adequate protein, increased kcals - and transition to more fat diet

Question 5

MNT for severe pancreatitis

Answer 5

• TF if can’t eat for 5-7 days
• can TF into jejunum, hydrolyzed, MCT
• may have problems with glucose levels
• no lipids if hypertriglyceridemia was cause
• drugs to decrease HCL and pancreatic secretions can be added

Question 6

MNT chronic pancreatitis vs acute

Answer 6

• 90% malnourished due to increased BEE and poor oral intake
• oral diet as in acute
• TF into jejunum if oral is inadequate
• antacids or meds to decrease acid (if pancreas not making bicarb)
• suppl fat soluble vitamins and B12 (lack of enzyme to cleave B12 from IF)
• PERT with meals
• lower fat diet and/or MCT oil
• TPN long term if needed

Question 7

whipple procedure for pancreatic cancer

Answer 7

take out gallbladder, attach stomach to jejunum, take out ⅓ - ½ of pancreas and attach rest to jejunum

Question 8

Nutrition problems with pancreatitis

Answer 8

• steatorrhea
• chronic pancreatitis
• weight loss
• metabolic bone disease (due to malabsorp of vit D)
• clotting disorders (malabsorp of vit K)
• B-12 deficiency (no pancreatic protease to cleave)

Question 9

Goals of MNT for pancreatitis

Answer 9

(1) provide minimal stimulation to minimize pain and rest pancreas
(2) avoid pancreatic irritants (caffeine, alcohol, fat)
(3) provide nutrition support to maintain or improve nutritional status, avoid overfeeding
(4) correct fluid electrolyte imbalances (from NG suction, N/V)