Chapter 24: MNT for Pancreatic and Bile Duct CA Flashcards
(14 cards)
What type of cells can get be cancerous in pancreatic tumors? Which are more common?
Exocrine or Endocrine Cells
Exocrine represents 95% of pancreatic CAs
90% being Ductal Cell Carcinoma (adenocarcinoma)
What is the survival rate for exocrine pancreatic CA?
4%
5-10% of cases, the disease is caught early enough to complete surgical resection is achieved, in this group the 5-yr survival is up to 18-24%
In advanced cases - 1% at 5 years
What is the survival rate for endocrine pancreatic CA?
42% of neuroendocrine tumors
55% of resected localized endocrine tumors
15% of non-resectable tumors
What is the survival rate for bile duct CA? Ampullary?
25% of bile duct
30-50% of ampullary
What are the possible nutritional implications of a Pancreaticoduodenectomy (PD—Whipple)? What are the anatomic changes?
Exocrine Insufficiency, dumping syndrome, delated gastric emptying, lactose intolerance, Diabetes/glucose intolerance
Head of pancreas, duodenum, gallbladder, distal stomach, and part of common bile duct are removed
What are the possible nutritional implications of a Pylorus preserving pancreaticduodenectomy (PPPD)? What are the anatomic changes?
Exocrine Insufficiency, delated gastric emptying, lactose intolerance, Diabetes/glucose intolerance (No dumping)
Head of pancreas, duodenum, gallbladder and part of common bile duct are removed (stomach and pylorus are kept intact)
What are the possible nutritional implications of a Total pancreatectomy (TP)? What are the anatomic changes?
Exocrine Insufficiency, dumping syndrome, delated gastric emptying, lactose intolerance, Diabetes/glucose intolerance
*Definitely occurring
Entire pancreas and sometimes spleen in addition to duodenum, gallbladder, distal stomach and part of common bile duct are removed
What are the possible nutritional implications of a Distal pancreatectomy? What are the anatomic changes?
Only exocrine insufficiency and diabetes/glucose intolerance
Removes only tail (or tail and part of body) of pancreas, possibly spleen
What are the common chemos used for pancreatic CA?
Xeloda Cisplatin Taxotere Adriamycin 5-FU Gemzar Irinotecan Mitomycin C Oxaliplatin Taxol Tarceva
What % of pancreatic CA patients have PEI?
80-90%
What are the S/S of pancreatic exocrine insufficiency (PEI)?
abd bloating cramping after meals excessive gas (burping/flatulence) fatty stools frequent stools foul smelling stools or gas floating stools indigestion loose stools unexplained weight loss
What % of patients with normal exocrine function need long-term treatment for PEI after a Whipple?
50%
If patients are having steatorrhea should restrict their fat intake to what amount daily? What could be substituted?
75 grams per day
MCTs - don’t require enzymatic action of bile salts for digestion or absorption
What are the different brands of Pancreatic Enzymes?
Creon Pancreaze Pertzye Ultresa Viokace Zenpep
