Pancreatitis

Question 0

Mechanism of Disease

Answer 0

1. Pancreatic duct is completely or partially blocked (gallstones, edema)
2. pacreatic flow continues (enzymes)
3. enzymes (trypsin) becomes activated (high levels overwhelm trypsin inhibitor)
4. Trypsin begins to autodigest the pancreas and initiates inflammation

Question 1

causes for inflammation of the pancreas

Answer 1

• alcoholism
• biliary tract disease
• trauma
• cancer
• surgical procedures

Question 2

Diagnosis

Answer 2

symptoms 
- severe abdominal pain, worsens with eating, nausea, vomiting, edema, shock
Elavated serum amylase, lipase
- enzymes diffuse into blood 
radiological confirmation 
- ultrasound, CT scan

Question 3

Complications

Answer 3

• circulating enzymes decrease the serum calcium
• hemorrhagic necrosis
• glucose intolerance/hyperglycemia
• exudates into peritoneal cavity
• necrosis of mesenteric fat (death)
• increased permeability of lung alveoli (pulmonary edema)

Question 4

Prognosis

Answer 4

• self-limitting; improves on its own, may develop chronic pancreatitis
• no treatment is well established; can be fatal

Question 5

Nutrition Care Goal

Answer 5

• decrease pancreatic stimulation
• organ rest NPO
• prevent malnutrition until condition is resolved and oral intake can be resumed
• usually require a stress factor of 1.3-1.5 X BEE
• chronic alcoholism can be the underlying cause
• jejunal enteral feeding (any form of solution, if tolerated whole nutrients are better to stimulate the gut)
• TPN if enteral feeding not tolerated – pseudocyst, fistula, abcesses
• insulin if blood glucose is elevated ~ may need to reduce CHO in feedings

Question 6

Nutrition Care Remission

Answer 6

• clear fluids and advance slowly
• low fat
• small meals
• no alcohol
• may require pancreatic enzyme replacement
• continue to control blood sugars if sig damage to insulin production

Question 7

Chronic Pancreatitis

Answer 7

• recurrent acute attacks
• most commonly seen in alcoholism and occasionally in cystic fibrosis
• permanent tissue damage - enzymes are not being produced vs them leaking out
• 90% loss tissue = pancreatic insufficiency
• steatorrhea
• glucose intolerance
• malnutrition if untreated
• if gallstones are responsible; cholecystectomy