Pancreatitis Flashcards

1
Q

risk factors for pancreatitis

A

breed, age, drugs, hepatobiliary disease, endocrine disorders, hypercalcemia, hyperlipidemia

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2
Q

acute pancreatitis pathogenesis with hypercalcemia

A

Pancreatic lipase
>Hydrolysis of serum TG in pancreatic microvasculature >Release free fatty acids locally
>Microthrombi and/or
>Bind with calcium to cause further capillary damage
>Releases more pancreatic lipase
>ACUTE PANCREATITIS

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3
Q

dietary risk factors for pancreatits

A

High-fat (>20%DM) foods, treats or human foods
History of dietary indiscretion of high-fat human foods

Experimentally, feeding high-fat, low-protein foods in dogs

Calorically dense, high-fat foods > Obesity

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4
Q

etiopathogenesis of pancreatitis

A

Autodigestion of pancreatic tissue with associated inflammation is self-perpetuating and can eventually affect functions of the pancreas:

Endocrine functions: insulin secretion from beta cells >Insulin-dependent diabetes mellitus (DM)

Exocrine functions: digestive enzyme secretion
>Exocrine pancreatic insufficiency (EPI)

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5
Q

key nutritional factors for pancreatitis

A

fat < 15% for non-obese and non-hypertriglyceridemic
<10% if obese

protein 15-30% for dogs

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6
Q

KNF: fat in pacreatitis cases; how do we decide what to give in short term

A

 Select dietary fat level based on patient’s clinical picture and etiology of pancreatic overstimulation

 Trauma/drug induced > tend to see normal fasting TAG
> choose highly digestible diet with moderate fat (<15% DM)
(overall 12-15% DM)

 Fat-induced > tend to see high fasting TAG > choose lower dietary fat diet (<10% DM)

 Level of restriction depends on the individual:
-Hypertriglyceridemia: <10% DM -Overweight/obese: <10% DM
-Recurring pancreatitis: <10% DM

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7
Q

KNF: fat for long-term pancreatitis case

A

Some patients recover and can be weaned onto an adult maintenance diet, whereas others must remain on a reduced-fat diet long term

Completely removing fat from the diet is NOT an option: Essential fatty acids (e.g. omega 6’s and 3’s)
Fat soluble vitamins (e.g. Vitamins A, D, E, and K)
Energy source
Palatability

Low fat contra-indicted if:
Volume intolerance, weight loss, reduced appetite

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8
Q

controversy of omega-3 fatty acids with pancreatitis

A

may help with pancreatitis? but adds calories and fat so use caution

Gradual increase (by 25% weekly) to avoid diarrhea and
belching and reach target intake

Make sure fasted triglycerides are actually improving
>otherwise discontinue
Make sure cPLI’s are not worsening
>otherwise discontinue

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9
Q

KNF: protein effects in pancreatitis

A

Proteins/amino acids stimulate the exocrine pancreas

Excessive dietary protein is not recommended
>DOGS: 18-30% DM
>CATS: 30-40% DM

Protein level should be near upper limit in pets that: >Require gradual weight loss (to maintain LBM)
>Muscle wasted

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10
Q

KNF: fibre in a case of pancreatitis

A

Highly digestible diet with <5% DM crude fibre

Long term (following recovery)
higher fibre diets (>5% DM) may be used with overweight/obese patients for weight loss
(i.e. veterinary weight loss diets)

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11
Q

meal frequency for pancreatitis

A

Huge benefit from small, frequent meals!
>Lower the absolute amount of fat and protein being
consumed at each meal

-At home: 3-4 meals/day
-In hospital: 6-8 meals/day

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12
Q

how can dietary change impact pacreatitis? considerations?

A

Any sudden dietary change can incite a bout of pancreatitis
Recommend not feeding any commercial treats, bones, chews, or human foods to prevent inciting another bout of pancreatitis
Access to garbage, composters, food on counters, food outside, etc. must be avoided in pets that have a history of pancreatitis

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13
Q

how do we avoid pancreatitis problems when transitioning a diet?

A

Too rapid of a transition to a new diet can lead to vomiting, diarrhea, nausea, or pancreatitis

Use transition schedule:
Day 1-2: 75% of current diet + 25% of the new diet
Day 3-4: 50% of current diet + 50% of the new diet
Day 5-6: 25% of current diet + 75% of the new diet
Day 7: 100% of the new diet

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14
Q

are treats and human food in a pancreatitis case?

A

Low fat!
<10% of daily calories!

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15
Q

when should we use a weight loss plan if a dog has pancreatitis?

A

When recovered from pancreatic episode
Veterinary weight loss diet: low fat, higher fibre
Controlled steady weight loss: 0.5-2.0% BW/wk
Energy requirement: RER for ideal body weight

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16
Q

current diet regime for a new case of pancreatitis

A

 CURRENT: EARLY ENTERAL NUTRITION (EEN)
> Feed through vomiting/diarrhea
> Either per os (PO) or assisted via feeding tube

Purported advantages:
 Correction of negative energy balance
 Preservation of gut integrity & function
 Improved immune function
 Reduced bacterial translocation
 Attenuated release of inflammatory mediators
 Reduced rate of infection & infectious complications
 Reduced duration of hospitalization

17
Q

cat with pancreatitis feeding method and frequency

A

Small meals frequently: 3-4 at home, 6-8 in hospital
Reduced gastric distension
Decreased gastric secretion
Reduced nausea, vomiting, gastroesophageal reflux
More effective assimilation

18
Q

if cat in hospital for pancreatitis how can we provide nutrition, optionally

A

cri

19
Q

KNF summary for cat with pnacreatitis

A

fat: <25% for non obese
<15% for obese

protein: 30-40%

20
Q

hyporexia food intake

A

Hyporectic patients only eat 1/4 to 1/3 of their energy requirements

21
Q

issues with protein malnutrition, and markers

A

Weight loss
increased creatinine (muscle breakdown)
decreased albumin/total protein

22
Q

KNF for anorexia

A

 Recovery diets (30-36% fat, 44-46% protein DM) if:
 Feeding multiple small meals (6-8/day)
 Patient is consuming ≤ RER
 Patient is tolerating the diet

23
Q

important consideration for encouraging eating long term in a case of anorexia

A

 AVOID FOOD AVERSION!
 Do not feed the diet you want the patient to eat long
term if they are nauseous/vomiting/anorexic

24
Q

anorexia and pancreatitis balancing act

A

 Balancing act between providing nutrient for recovery from illness vs. stimulating the pancreas

25
Q

in hospital diet plan for anorexia

A

 Very palatable palatable diet (high protein and fat)
 Fat (calories) and protein are needed for recovery
 Start with small amounts (multiple small meals)

26
Q

what if a cat doesnt want to eat

A

No forced feeding > food aversion

Stimulate appetite
Warm up the food to body temperature
Small, frequent meals (6-8 per day)
Take the food away after 15 min and try again later

Tube feeding > same schedule as per os feeding > The quicker the better!!

27
Q

weight loss diet long term for cat, type

A

Lower fat diet appropriate for long term feeding
Highly digestible, low fibre diet
Multiple small meals