Pancreas/Pancreatitis
Pancreas
the pancreas is an organ located in the abdomen. It plays an essential role in converting the food we eat into fuel for the body's cells. It produces enzymes to help break down sugars, fats and straches
Disorders of the pancreas
pancreatic psuedocyst
cystic fibrosis
pancreatic cancer
pancreatic exocrine insufficiency
acute/chronic pancreatitis
diabetes
Whipple procedure
Is the primary surgical treatment for pancreatic cancer that occurs within the head of the gland. During this procedure, surgeons remove the head of the pancreas, most of the duodenum (a part of the small intestine), a portion of the bile duct, the gallbladder and associated lymph nodes.
Reduces number of enzymes available for digestion and therefore can cause malabsorption
Malnutrition in pancreatic disorders
common in chronic pancreatitis
abdo pain
lower food intake
ETOH abuse
smoking
Pancreatic disease and its treatment can cause nutritional impairments with effects on quality of life
Nutrition assessment
clinical
post operatively
early sateity
nausea & vomiting
poor appetite
blood glucose levels
steatorrhoea
steatorrhoea (fatty diarrhoea)
watch for dumping syndrome
signs include floating, oily, particularly offensive and pale or yellow
also releases insulin into the bloodstream
Dumping syndrome
rapid passage of food from stomach to duodenum
characterised by bloating, sweating, fast heart rate and dizziness
Nutrition management,
ESPEN, 2020
energy
124-145kJ/kg/d if malnourished or post operatively
100-125kJ/kg/d if well nourished
protein
1.0-1.2g/kg/d is well nourished
1.2-1.5g/kg/d if malnourished or post operatively
Nutrition support
Pancreatic cancer/whipples
normal diet post operatively without restrictions
alternative nutrition if required
alternative nutrition should be considered for anyone with wt loss >15%
Pancreatitis
low fat soft diet
enteral nutrition
Enteral nutrition
pancreatitis - gastric
polymeric formula
post operatively - jejunal
PERT?
Immunonutrition not recommended in pancreatic cancer
Pancreatitis - inflammation of the pancreas
Guidelines (ESPEN)
Low-fat, soft oral diet shall be used when reinitiating oral
feeding in patients with mild AP (acute pancreatitis)
In patients with AP and inability to feed orally, EN shall be
preferred to parenteral nutrition (PN).
EN should be started early, within 24e72 h of admission, in
case of intolerance to oral feeding.
Patients with AP should be considered at moderate to high nutritional risk, because of the catabolic nature of the disease and because of the impact of the nutritional status for disease development.
Oral feeding shall be offered as soon as clinically tolerated and independent of serum lipase concentrations in patients with predicted mild AP.
In patients with AP a standard polymeric diet shall be used.
If EN is required in patients with AP, it should be administered via a nasogastric tube. Administration via a nasojejunal tube should be preferred in case of digestive
intolerance.
PERT w/ Enteral Feeds
Dependent on type of feed used
Dependent on location of feeding tube
Gastric: suspended microspheres in acidic thickened fluid, ENFIT
Jejunal: crush microspheres, activate with bicarbonate and flush with water
Can also utilise elemental/semi-elemental formula
PERT
Ensure PERT is prescribed/taken with meals
Ensure enzyme is varied according to fat intake
Ensure dose is appropriate & stepped up
Normal pancreatic lipase secretion is ~3000 IU per minute during eating
1000 IU per gram of fat is a rough rule of thumb or no more than 10 000 IU/kg/day
Don’t be afraid to increase dose - Body’s normal lipase production can be up to 800,000IU at one meal
Caution with long-term use of high doses