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Chronic Pancreatitis (Aetiology (EtOH abuse, Chronic inflammation of the…
Chronic Pancreatitis
Goals
Decrease pain - reduce exocrine stimulation
Optimise nutritional status
What is it?
Permanent/long term impairment of the pancreas
Aetiology
EtOH abuse
Chronic inflammation of the biliary tract
Heredity
Repeated attacks of acute pancreatitis
Associated w Cystic Fibrosis
Symptoms
Abdo pain - often after meals
Steatorrhoea - when 90% exocrine function lost
Pancreatic Exocrine Insufficiency
Severe wt loss
Strategies
HPHE
MCT may be necessary
Wt loss common
PERT - not prescribed by DTN's
EtOH avoidance
Glycemic control
Insulin
CHO modification
Low GI
CHO distribution
Vit & Min supplementation
Fat soluble vit's
Surgery
Whipples Procedure aka pancreaticoduodenoectomy
Details
What's removed
Common bile duct
Gall bladder
Duodenum
Head of pancreas
Pylorus of stomach (may be pylorus preserving)
How it's restructured = all these joined to jejunum
Stomach
Common hepatic ducts
Body and tail of pancreas
Indication
Carcinoma of the Ampulla of Vater
Carcinoma of pancreas
MNT
NBM post op
Then clear fluids advancing to full diet as tolerated (med team)
Medical MGT
PERT
Insulin
Complications
Gastroparesis
Nut. deficiencies