What is it?
inflammation of the pancreas (organ that sits near the stomach and liver) |
Role
Produces digestive juices and certain hormones, including insulin. |
S/S
Acute: sudden, severe upper abdo pain, N+V, fever, ↑ pulse (if caused by alcohol, S/S = 1-2 after binge) |
Chronic: Pain in mid abdo, pain worse with eating/drinking, D, weight loss, greasy, foul-smelling stools |
Causes
Gallstones – block the pancreatic duct, triggering inflammation |
Excessive alcohol use – especially with long-term intake |
Medications: steroids, diuretics, oestrogens, azathioprine |
Genetics - CF, family hx pancreatitis |
Structural - pancreas tumours, abdominal injury or post-op |
Idiopathic ~30% cases |
High triglycerides (>11.3mmol/L), hypercalcaemia |
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Consequences
pancreatic exocrine insufficiency (PEI), |
↓ digesting food (particularly fats → lack of digestive enzymes/juices. |
Severe = does not produce insulin → DM |
Biochem
↑ lipase |
x3 more than normal = acute pancreatitis |
↑ CRP |
Marker of inflammation |
↑ BGL |
impaired insulin secretion |
Hypocalcaemia |
Fat saponification in severe cases |
Nutrition Concerns
Fat malabsorption |
Malnutrition |
Alcohol-related causes |
Deficiency Fat-sol V |
Diabetes risk |
Nut Reqs
EER: 105-145kJ/day |
EPR: 1-1.5g/kg |
NEMO Pancreatitis |
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Intervention
Low fat foods |
Avoid alcohol |
CREONS - pancreatic enzyme replacement therapy (PERT) used to manage PEI |
MVT – replace lost V/M |
Insulin |
CREONS
capsule with digestive enzymes (lipase, amylase, protease) to replace those the pancreas can no longer produce adequately due to chronic pancreatitis, pancreatectomy, or PEI |
Why? improves fat digestion. Reduces steatorrhea (greasy stools). Prevents malnutrition & weight loss. Improves fat-sol V absorption |
Typical doses: |
Small meal/snack = 25,000 units (1 capsule) |
Main meal = 1-2 capsules |
Max daily dose = 6-9 capsules |
Taken with meals containing fat and protein |
Not needed with fat-free foods |
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