Term
| What are some components of exocrine pancreatic secretions? |
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Definition
- Bicarbonate
- Fluid volume
- Electrolytes
- Enzymes
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Term
| What distinguishes mild/moderate vs severe pancreatitis? |
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Definition
| Necrosis (identified through CT). Mild/moderate pancreatitis has no necrosis. |
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Term
| How does nutrition care recommendations differ between mild/moderate and severe pancreatitis? |
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Definition
- Mild/moderate pancreatitis: supportive care
- Severe pancreatitis: EN/PN
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Term
| What is the etiology of pancreatitis? |
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Definition
| Active pancreatic enzymes damage pancreatic tissue |
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Term
| What are the most common causes of pancreatitis? |
|
Definition
- Alcohol abuse
- Biliary tract disease (passage of common bile duct stone)
- Idiopathic
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Term
| What serum enzyme levels are used to diagnose pancreatitis? |
|
Definition
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Term
| How does severe acute pancreatitis compare with sepsis? |
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Definition
| Severe acute pancreatitis is a hypermetabolic, hyperdynamic disease very similar to sepsis |
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Term
| How does severe acute pancreatitis affect risk of hyperglycemia/insulin resistance? |
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Definition
| Patients with severe acute pancreatitis are likely to have hyperglycemia/insulin resistance |
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Term
| What is an important factor to consider when treating hyperlipidemia in the context of pancreatitis? |
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Definition
| Achieving adequate glucose control is essential to decrease serum triglyceride levels |
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Term
| What are the guidelines for enteral feeds in severe acute pancreatitis? |
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Definition
- Continuous infusion should be used
- Estimated energy requirements: 25 kcal/kg/d
- Estimated protein requirements: 1.5 g/kg/d
- Use indirect calorimetry when possible
- Provide mixed fuel regimen (protein/fat/carbs)
- Monitor tolerance closely
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Term
| What are the criteria for formula selection in severe acute pancreatitis? |
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Definition
- Standard polymeric formula may be used if feeding tube is below ligament of Treitz (this differs from new guidelines, which state that gastric feeds are acceptable)
- Switch to elemental low-fat formula or semi-elemental formula if evidence of intolerance (pain, fever, increase in WBC/amylase/lipase)
- Switch to semi-elemental formula if evidence of malassimilation (diarrhea and/or steatorrhea)
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Term
| What are common complications of pancreatitis? |
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Definition
| Pseudocyst, abscess, ascites |
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Term
| Is the presence of pancreatitis complications (pseudocyst, abscess, or ascites) a contraindication to EN? |
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Definition
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|
Term
| When is PN indicated in pancreatitis? |
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Definition
| EN is contra-indicated if it is clearly not tolerated even when placed well below the LOT and with other supportive measures taken |
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Term
| What are the guidelines for PN lipids in patients with pancreatitis? |
|
Definition
- PN lipids are generally appropriate in pancreatitis that is NOT caused by hypertriglyceridemia
- Hypertriglyceridemia-induced pancreatitis generally only occurs in susceptible individuals with TGs >1000 mg/dL; IVFE can be restarted when TGs decrease below 400 mg/dL
- Occurrence of hypertriglyceridemia in PN is limited when lipids are limited to <1 g fat/kg and glucose control is maintained
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Term
| When should diet be advanced after acute pancreatitis, and which diet should be selected? |
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Definition
| Patients should be given free choice regarding when to begin oral intake, and can self-select appropriate foods |
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|
Term
| How does hypertriglyceridemia affect risk of pancreatitis? |
|
Definition
| Hypertriglyceridemia (specifically TG >1000 mg/dL) is associated with pancreatitis |
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Term
| What is the common clinical presentation of chronic pancreatitis? |
|
Definition
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Term
| How does chronic pancreatitis affect nutritional status? |
|
Definition
- Abdominal pain tends to cause anorexia
- Gastric dysmotility is a common complication of CP
- Exocrine insufficiency (and resulting steatorrhea) is a common complication
- Hypermetabolism is a common complication
- DM is a common complication
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Term
| What level of alcohol is safe for chronic pancreatitis patients? |
|
Definition
| They should abstain completely |
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Term
| Are MCTs useful for chronic pancreatitis patients? |
|
Definition
| Yes, although they are not necessary of pancreatic enzymes are used |
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Term
| What is the ideal timing for pancreatic enzymes? |
|
Definition
| Enzymes should be taken with meals/snacks and no more than 30 minutes prior to eating |
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Term
| How does the acidic gastric environment affect pancreatic enzyme administration, and what can be done to maximize effectiveness? |
|
Definition
- Decreased bicarb secretion and increased gastric acidity may reduce enzyme activity
- The enteric coating that protects the digestive enzymes does not dissolve until pH approaches 6. If this does not occur early in the duodenum, it may be helpful to add PPI/H2 blocker/bicarbonate tablet
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Term
| What are the guidelines for dosing pancreatic enzymes? |
|
Definition
- 500-2500 units lipase/kg/meal
- <10,000 units lipase/kg/d
- 1000-4000 units lipase/g dietary fat per day
- Swallow beads without crushing or chewing to maintain enteric coating
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Term
| Should dietary fat be restricted in chronic pancreatitis patients? |
|
Definition
| Restricting fat in the diet is required only if symptoms (weight maintenance, diarrhea, and steatorrhea) are poorly-controlled on enzyme therapy or if pain persists on both enzyme supplementation and narcotic analgesia |
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