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Pancreatitis, Diverticular Disease - Coggle Diagram
Pancreatitis
Nutritional Mx
alternative nutrition for weight loss >15% = (ERAS, 2019)
Pancreatitis - low fat, soft diet when re-initiating oral feeding(ESPEN)
No effect from probiotics
PERT - prescribed with meals, vary according to fat intake, progressive
Energy well nouished 100-125 or if malnourished/recent surgery 125-145Kj/kg
Protein normal 1.0-1.2 or mal/recent surgery 1.2 - 1.5g/kg
Creon - released in alkaline environment. 1000 IU/g of fat
Nutrition support - polymeric, PERT (in PEI)
Post op - jejunal, pancreatitis - gastric
Nasogastric>nasojejunal
Disorders
Pancreatitis/necrotizing
Cystic Fibrosis
Exocrine insufficiency: PEI
Diabetes
Cancer: whipples
Clinical
Post-operative - dumping syndrome (rapid passage of food from stomach to duodenum characterised by bloating, sweating, fast heart rate and dizziness), steatorrhea, early satiety, N/V (excess losses), jaundice, BGLs
catabolic nature
Whipple procedure: remove head of pancreas, duodenum, gallbladder + bile duct.
Inflammation caused by gallstones and chronic alcohol consumption
Malnutrition causes
PEI, abdominal pain, EtOH abuse, inadequate intake, DM, smoking
HPHE 5-6 small meals/day
80% of patients with pancreatic head cancer present with weight loss at diagnosis with 40% having greater than 10% weight loss.
NFPF
Post-operative – dumping syndrome, steatorrhea (often don’t eat enough but can come on following discharge).
Steatorrhea, poor appetite, early satiety, N/V, bowel sounds
Dumping syndrome – rapid passage of food from stomach to duodenum characterised by bloating, sweating, fast heart rate and dizziness. With whipples – pyloric sphincter is removed, losing control to duodenum.
Function of pancreas
Exocrine: secrete digestive enzymes (lipase, protease, amylase) into GI tract
Endocrine: insulin release from beta cells
Diverticular Disease
Nutritional Mx
Diverticulosis: high fibre, adequate fluid
Diverticulitis: SHORT TERM (2-4 wks) low fibre/residue (<10g/day) + adequate fluid during flare up to give bowel rest and bring down inflammation.
Low fibre foods: white bread, skinned fruit/veg, dairy products
Path
small pockets forming (divertucla) in bowel wall caused by weakness (aging,
asymptomatic until flare up from infection (diverticulitis). Dx by barium enema or colonoscop
Diverticulitis: infection of diverticula within lrg intestine causing inflammation. antibiotics
Complications: absorption of nutrients, abscess, perforation, stenosis, bleeding, fistula
Symptoms: abdominal pain, bloating, discomfort, diarrhoea, constipation