Pancreas

Accessory Organs

Pancreas

I Pancreatitis: Inflammation of the pancreas
A. acute: due to organ auto digestion (pancreas digesting itself)
1. usually as a result of duct obstruction
a. enzymes become activated in duct instead of duodenum
b. The gall bladder and the pancreas share the common duct. If a patient eats a mixed meal of fat, carbs, and protein and the duct is blocked by a gall stone; bile and pancreatic enzyme will remain in the duct at the same time. Usually it is one or the other. The enzyme (to break down protein) is activated when it recognizes the pancreas as a protein. It then starts to digest itself. (auto digestion) Very painful.
2. alcohol abuse
3. gallstones (~45% of all cases)
4. Symptoms of acute pancreatitis
a. sudden, severe abdominal pain
b. nausea, vomiting
c. diarrhea
d. approximately 25% develop chronic pancreatitis
e. sometimes jaundice
f. acute can turn chronic, especially if alcohol involved.
5. Medical nutrition therapy
a. NPO with IV feedings ~ 48 hours (complete bowel rest)
b. jejunostomy feedings if longer (to bypass digestion)
c. clear liquid progress to low fat diet
d. provide pancreatic enzyme replacement
e. small frequent meals
f. no alcohol, caffeine
B. chronic pancreatitis
1. fibrotic, necrotic disease where cells suffer permanent damage.
2. decreased enzyme production
3. nausea, vomiting, abdominal pain
a. symptoms not as severe as acute
4. most common cause is alcohol abuse (~70%)
5. Other causes: pancreatic cancer, cystic fibrosis (lung disease, but starts in the pancreas)
6. Medical Nutrition Therapy
a. If unable to eat, high calorie, semi-elemental (hydrolyzed/pre-digested) tube feeding.
b. If able to eat:
i. low fat, high calorie, moderate protein
ii. low fiber
iii. six small meals per day
iv. no alcohol, caffeine, or gastric stimulants
v. vitamin and mineral supplementation
c. co morbidity in case of alcoholics. Make sure to look at the whole person, not just the disease (pancreatitis).


II Cystic Fibrosis
A. Starts in the pancreas
B. Consequences
1. pancreatic insufficiency (80-90%)
a. may require:
i. enzyme replacement (for protein digestion)
ii. insulin (for carb metabolism)(have a diabetic life state)
2. chronic lung disease
a. lung infections – major cause of death
b. thick secretions may cause bacterial growth
3. growth retardation (85%)
4. decreased bone density
5. abnormally high electrolytes in sweat
6. may live to 30’s or 40’s, but used to be 20’s
C. Medical Nutrition Therapy
1. High kcal, high protein (they lose a lot in digestion)
a. 20-50% above normal needs
2. Pancreatic enzymes
a. to control steatorrhea
3. multivitamin supplementation (water based so not passed in fatty stool)
4. liberal salt use (b/c a lot lost in perspiration)
5. encourage fluids
6. When body weight falls below 85% of standard, alternate feedings are indicated. (usually tube feedings) (Nocturnal feedings all night, then eat normally during the day)
7. Infant feeding
a. enzyme replacement during breast feeding
b. up to ¼ tsp salt daily given to replace losses