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Advanced MNT 2 > Pancreatic Disorders > Flashcards

Pancreatic Disorders Flashcards

1
Q

Endocrine function of pancreas

A

Regulation of glucose homeostasis – Pancreas produces insulin & glucagon

Produces somatostatin

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2
Q

Exocrine functions of the pancreas

A

Synthesize & secrete digestive enzymes

  • lipase, amylase, proteases (inactive)
  • bicarbonate
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3
Q

Stimulation of Exocrine Pancreatic Secretions occurs to secrete _____ and ______

A

secretin
cholecystokinin (CCK)

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4
Q

Secreted is released in response to _______ in the _________

stimulates the duct cells to secrete ________=> which _________

A

acidic chyme
duodenum

bicarbonate
neutralize chyme

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5
Q

Cholecystokinin (CCK) is released in response to __________ in ______

Stimulates ______ cells to release ________

A

fat & protein
duodenum

acinar
digestive enzymes

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6
Q

Acute pancreatitis is believed to be inflamed when you have _______

Possibly due to ________

A

premature activation of the digestive enzymes within the pancreas

injury to pancreatic acinar cells

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7
Q

acute pancreatitis results in pancreatic inflammation, ______, _______, ______, and ______

A

edema
hemorrhage
fibrosis
necrosis

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8
Q

Causes of Acute Pancreatitis

A

Cholelithiasis (most common)

Acute or chronic alcohol abuse (2nd most common)

Others:
Idiopathic
Medications: corticosteroids
Abdominal trauma
Hypertriglyceridemia (TG >500 mg/dl) (genetic)
Hypercalcemia (can be from hyperparathyroidism)

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9
Q

Clinical Manifestations of acute pancreatitis

A

severe epigastric pain radiating to the back
- may get worse with ingestion of food

N/V
anorexia
abdominal distention
ileus

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10
Q

Complications of Severe, Acute Pancreatitis

A

Pancreatic abscess - now infected

Pancreatic pseudocyst - abscess that is walled off

Necrotizing pancreatitis - some tissue died

Hypovolemia, hypotension, shock - dehydration from vomiting or from inflammation causing leakage

Systemic Inflammatory Response Syndrome (SIRS) - massive inflammatory response

Multiple Organ Dysfunction Syndrome=> pulmonary, renal
Death

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11
Q

Diagnosis of Acute Pancreatitis

A

clinical manifestations
elevated serum lipase and amylase

CONFIRMED BY:
imaging studies - CT scan

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12
Q

Lab findings with acute pancreatitis

A

Altered electrolytes
Hypoalbuminemia
Hyperglycemia
Elevated WBC
Hypocalcemia

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13
Q

For hypoalbuminemia, remember to do the correction of total serum calcium.

equation ?

A

([4 – albumin (g/dL)] x 0.8) + Total Ca2+(mg/dL)

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14
Q

Nutritional Requirements for Acute Pancreatitis
Energy?
Protein?

patients are in _________, ________ state

A

25-35 kcal/kg (lower is for ICU sedated)

1.2-1.5 g/kg (may approach 2 g)

hyper metabolic, catabolic

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15
Q

MNT for Mild-to-Moderate Acute Pancreatitis

If pain & vomiting=> ________ to decrease pancreatic stimulation

When pain, N/V decreases=> __________
- To limit pancreatic stimulation
- Monitor for return of pain or GI distress

__________ meals may be better tolerated
Advance to regular diet or appropriate MNT based on _______

A

NPO with IVF

Low Fat Diet (40 g)

Frequent, small
cause of pancreatitis

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16
Q

MNT for Severe Acute Pancreatitis

Current guidelines recommend ___ over ____

Has been associated with less ____________ and shorter ______

A

EN
PN

infectious complications
hospital LOS

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17
Q

Enteral Nutrition should be Initiated within ______ hrs of admission (if ___________) for those with severe, acute pancreatitis

_____ feeding recommended to minimize pancreatic stimulation
- Short-term: _____
- Longer duration: _____

Formula: ______, ______
If fat malabsorption (not typical) => ____________

Monitor tolerance
Goal: transition to oral diet

A

24-48
hemodynamically stable

Jejunal
NJ tube
J-tube

polymeric, high protein
semi-elemental formula

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18
Q

Parenteral Nutrition (PN) should be used __________ and _____

A

only when prolonged SB ileus
Severe, acute pancreatitis and EN is not tolerated

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19
Q

For PN, _______ does not stimulate pancreatic secretions
Can use them unless _________

A

IV lipid

TG >400 mg/dL

20
Q

Chronic Pancreatitis (CP) is Progressive, irreversible, inflammatory disease in which pancreatic tissue is slowly destroyed and replaced by ________

Results in permanent ______ and ______ impairment

Initial loss of function resulting in _____________ and then eventually also loss of ________

Evolves over many years

A

fibrotic tissues

structural & functional

pancreatic exocrine insufficiency (PEI)
endocrine function

21
Q

Causes of Chronic Pancreatitis

A

Chronic alcohol use disorder (number 1 cause)
Smoking
Hypertriglyceridemia
Hypercalcemia
Genetic mutations
Autoimmune pancreatitis
Obstructions: strictures in pancreatic ducts
Idiopathic

22
Q

Chronic Pancreatitis manifestations…

Recurrent attacks of epigastric pain
Worsens ________, particularly with consumption of _____ foods

_______, ______, _______, _______

Progressive pancreatic insufficiency leading to ______ => _____

A

after meals
high fat

Anorexia
N/V
diarrhea*
steatorrhea*
wt loss

malabsorption=> fat, fat soluble vitamins, protein, & CHO

23
Q

Chronic Pancreatitis results in

Decreased_______ production=> ____

Malnutrition due to:
Decreased intake due to=> abdominal pain, anorexia, fear of eating
Malabsorption
Continued alcohol use
Hypermetabolism
Fat-restricted diets

________ deficiency
__________

A

insulin
DM

Vitamin B12
Metabolic bone disease

24
Q

why B12 deficiency sometimes

A

B12 needs to be free

pancreas makes protease to separate some factor from B12 to be absorbed

25
Q

Diagnosis & Evaluation of Chronic Pancreatitis

Combination of _____, _____, and ______

A

symptoms, imaging (CT scan or MRI), & functional tests

26
Q

Pancreatic function tests:

A

72-hr fecal fat test: >7 g/d=> malabsorption

Fecal elastase-1 (one stool)

Secretin stimulation test: measures volume of pancreatic bicarbonate produced

27
Q

CP Nutrition Assessment…

Anthropometrics
Nutrition-focused physical examination
Diet history
- Diet PTA
- Analysis of diet recall
- Wt loss despite eating well
- GI c/o
- _____ consumption

A

Alcohol

28
Q

CP Assessment…

Labs: _____, ______, _____

Monitor for potential micronutrient deficiencies: ______, ___, ____, ____, ______, _____, _____

Food-medication interactions
High nutrition risk=> assess for malnutrition

A

electrolytes, glucose, fecal fat test

fat-soluble vitamins, Ca, Mg, Zn, vitamin B12, thiamin & folate

29
Q

Chronic Pancreatitis

energy ?
Protein ?

A

35 kcal/kg

1-2 g/kg

30
Q

MNT for Chronic Pancreatitis

A

No alcohol
High kcal, high protein diet
6-8 small meals per day
Avoid large meals with high fat foods

31
Q

Micronutrient Supplementation for Chronic Pancreatitis

everyone gets _______

Possible ________ supplementation

Role of ________ supplements are being researched

If alcohol use disorder, recommend supplementation of:
________
_______

A

MVI with minerals

IM vitamin B12

antioxidant

Thiamin: 50-100 mg
Folic acid: 1 mg daily

32
Q

MNT for Steatorrhea

If on pancreatic enzyme replacement therapy=> ________

  • Unless fat malabsorption cannot be controlled by enzyme replacements alone

__________ supplementation

A

No fat restriction

Fat-soluble vitamin (in water-soluble form)

33
Q

Pancreatic Enzyme Replacement Therapy Examples ? (3)

A

Creon
Pancreaze
Viokase

34
Q

Pancreatic Enzyme Replacement Therapy…

Given ______ with _______

Contain _____, _____, and _____

Function best in a _____ environment
May require _____________ to decrease acidity

A

orally
all meals & snacks

lipase, protease, amylase

basic
H2 blockers/proton pump inhibitors

35
Q

beads in enzyme replacement have ______ that’s resistant to _____ so that it reaches _____

A

enteric coating
acid
duodenum

36
Q

Pancreatic Enzyme Replacement Therapy - Dosage

Individualized dosage based on severity of exocrine insufficiency and composition of meal or body wt

Example recommendations:
_____ units of lipase per ______
_____ units of lipase/________ and adjust as needed

A

1800
gram of fat

1000
kg per meal

37
Q

Enteral Nutrition Support

Supplemental tube feeding may be required to meet nutritional needs

should be _______, _______ formula
Route: _______

A

High protein, calorically dense
gastric feeding

38
Q

Enteral Nutrition Support – Pancreatic Insufficiency

The optimal way to dose pancreatic enzymes when on TF has not been established

___________________ formula

For cycle TF, provide _______________ at the _______ of the feeding and then _________ the feeding

A

Partially-hydrolyzed/semi-elemental

pancreatic enzymes orally
beginning
halfway through

39
Q

Glucose Intolerance Management:

_______ therapy

MNT=>
________ diet
Balance CHO intake with insulin therapy
__________ if experiencing frequent episodes of hypoglycemia

A

Insulin

Consistent CHO
Small frequent meals

40
Q

Pancreatic Surgeries

A

Whipple Procedure

41
Q

What is the name for a Whipple?

A

Pancreaticoduodenectomy

42
Q

Whipple is used to treat ___________

involves surgical removal of ______, ______, sometimes _______, and _______

A

pancreatic cancer

head of pancreas
duodenum
distal stomach
portion of common bile duct

43
Q

WHIPPLE

stomach, lil duodenum, jejunum
pancreatic ducts attached to ______
reattach bile ducts to _______

A

jejunum
jejunum

44
Q

Post-op complications from WHIPPLE

A

Delayed gastric emptying OR Dumping syndrome

Weight loss

Possible fat malabsorption=> provide pancreatic enzyme supplements

Possible development of DM

45
Q

MNT s/p Whipple Procedure

When appropriate begin oral diet=> ______ meals/day

Adapt MNT if the patient is having delayed gastric emptying or dumping syndrome

If severe, delayed gastric emptying with N/V=> ______

Monitor for possible ______________
Monitor for _________

A

5-6 small

NPO with jejunal TF

pancreatic insufficiency
hyperglycemia

46
Q
A

Advanced MNT 2 (17 decks)

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