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Pancreatitis - Coggle Diagram
Pancreatitis
Symptoms
BGL levels
Nausea and Vom
fatty stools, pungent, yellow, oily, floating
Abdo pain
Alcohol abuse
smoking
lower food intake
risk osteoporosis
Nutrition Support
EN 24-72 hr of adm in case of intolerance to oral feed. Polymeric, nasogastric preferred (digestive intolerances= nasojejunal) Pancreatic enzyme supp (PERT), emzymes given with meals and snacks
When EN is not feasible or contraindications for PN, parental glutamine should be supped
Oral feed should be offered as soon as clinically tolerated
PN adm (central venous access) when EN not tolerated or requirements aren't met, contraindications for EN incl bowel obstruction, abdominal compartment syndrome, prolonged paralytic ileus, mesenteric ischemia.
ONS only offered in undernourished and intake not meeting req
Necrosectomy= minimally invasive- oral feed in first 24hr after procedure. oral not tolerated= EN (nasojejunal). EN not tolerated = PN
Severe AP and IAP (<15mmHg)= EN via nasojejunal (preferred) or nasogastric. Severe IAP (>20mmHg) EN stopped PN initiated.
Diet/ intervention
low fat, soft oral diet when reintro oral feeding in mild AP
Gain diet Hx, food avoidances/ intolerances, nutritional supps
Inability to feed orally= EN should be preferred to PN
Probiotics should not be recommended
CP avoid high fibre diet, no need for fat restriction unless steatorrhea
Biochem
Blood glucose levels
Lipid levels
Monitor vitamins A,D,E,K, B12, folic acid, thiamine, mg, selenium, iron and zinc. Decrease in these levels will need supp in those with malabsorption
Screening for macro and micro deficiencies every 12 months
Diagnosis
CT
Biopsy
Blood test, BGL, lipid analysis
liver and kidney function
Clinical
malnutrition is common in chronic Pancreatitis. Mod-high risk
Post operatively, watch out for DUMPING SYNDROME
Rapid passage of food to the duodenum
Symptoms: Bloating, sweating, fast heart rate and dizziness
PES
Inadequate Protein and energy
Excessive fat consumption
Nutritional Management
• Energy
• 100-125 kJ/kg BW if well nourished
• 125-145 kJ/kg BW if malnourished or post operatively
• Protein
• 1.0-1.2 g/kg BW if well nourished
• 1.2-1.5 g/kg BW if malnourished or post operatively
Nutrition Support
Pancreatic Ca/Whipples
• Alternative nutrition should be considered for
anyone with weight loss of >15%
• Normal diet post operatively without restrictions
• Alternative nutrition if required
• Pancreatitis
• Low fat soft diet
• Nasogastric vs Nasojejunal
Enteral Nutrition:
• Post operatively: Jejunal
• Pancreatitis: Gastric
• Polymeric formula
• May need to consider PERT
Guidelines
ESPEN
Anthro
wt, wt hx