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Abdominal pain
**It is still controversial whether the symptoms occurring are due to pancreas divisum, there are
studies that suggest it may be more related to genetic mutations **
Treatment & Management:
Pancreas Divisum
Medical & Nutrition Options:
Low Fat Diet
Analgesics
Pancreatic Enzymes
Anticholinergics
Surgical Options:
Puestow Procedure: surgical procedure where the minor papilla is
cut to enlarge the opening and is then connected to a loop of the
jejunum to allow for the pancreatic enzymes to drain directly into the
intestines
*Treatment depends on the severity of the pancreas disorder and based on the
discretion of the physician*
Puestow Procedure
Diagnoses: Pancreatitis
Inflammation of the pancreas that can be acute or chronic that
results in progressive exocrine and endocrine dysfunction, ultimately
leading to abnormal digestion, absorption, and utilization of
nutrients.
Chronic- diagnosed based on intermittent or constant upper
abdominal pain and other clinical symptoms as well as imaging
studies such as a CT scan, MRI, ERCP, endoscopic ultrasound,
etc.
Symptoms: pain in abdomen/back, bloating, fat in stool,
indigestion, nausea, vomiting, weight loss, loss of appetite, sweating
Causes: alcoholism, gallstones, abdominal surgery, medications,
pancreatic disorders, infection, cigarette smoking, etc.
Nutrition Implications: 20-50% increase in resting energy expenditure
indicates for kcal to be up to 35 kcal/kg, protein: 1-1.5 g/kg, 30% of
kcal from fat
Her pain was controlled with a PCA pump and eventually weaned
off to oxycodone as needed and she was treated with IVF fluids.
She was intermittently tolerating oral intake and was administered
Tigan for nausea control
Anthropometrics
Height: 58
Admission Weight: 125 kg (275 lbs)
BMI: 41.8 Class III Obesity
Ideal body weight: 63.6 kg (140 lbs)
Ideal body weight %: 196%
Usual body weight: 130 kg (287 lbs)
Weight History
131
130
129
128
127
126
125 Weight (kg)
124
123
122
6 kg weight loss in 3 weeks, 4% weight loss
121
Nutrition Assessment:
Food/Nutrition-Related History
Typical Daily Intake: Diet Prescription in Hospital:
Soft consistency foods 6 Small Meals,
including pudding, Mechanical Soft
Gatorade, Diet Ginger Clear Liquid
Ale, mashed potatoes, Full Liquid
ice cream, soup,
popsicles Altered GI function,
Biting/Chewing Difficulty
Previous Diet Therapy:
Was a participant in Estimated Nutritional Needs
weight watchers in 2012 Calories: 1600-1900
Instructed on low-fat diet kcal/kg (25-30 kcal/kg of
ideal body weight)
Protein: 76-89 grams per
day (1.2-1.4 grams/kg of
ideal body weight)
Nutrition Assessment:
Biochemical Data
Lab 4/20/17 5/4/2017 5/10/2017 5/22/2017 Reason
BUN 5L 5L 2L 10 Malnutrition or
Ref Range: malabsorption, over-
10-25 mg/dL hydration
Future Needs
Patient is enrolled in Home Health Care and is being
followed by an RD, PT/OT, and Skilled Nursing
Research Articles
Grade: 2B
Efficacy of pancreatic enzyme replacement therapy
in chronic pancreatitis: systematic review and meta-
analysis
Purpose: to determine the pain. Follow-up studies showed
benefits of pancreatic enzyme that it also was able to increase
replacement therapy in chronic serum nutritional parameters,
pancreatitis improve gastrointestinal
symptoms, and overall quality of
Method: Major databases were life. The higher doses and enteric
searched from 1966 to 2015 coated enzymes showed to be
inclusive. 17 studies were included more effective than low-dose or
and assessed qualitatively. non-coated enzymes.
Quantitative data were
synthesized from 14 studies. Conclusion: Pancreatic enzyme
511 patients with chronic replacement therapy is indicated
pancreatitis were assessed. to treat pancreatic exocrine
insufficiency and malnutrition in
Results: PERT improved coefficient chronic pancreatitis and has
of fat absorption compared with been shown to be improved by
baseline and placebo. It also higher doses and enteric coating
showed to improve nitrogen with administration during food
absorption, reduce fecal fat and and acid suppression
fecal nitrogen, and abdominal
Grade: 2B
Efficacy of dietary fat and food consistency on
gastroparesis symptoms in patients with gastroparesis
Results: The high-fat solid meal
Purpose: to determine the effect of increased overall symptoms among
fat intake and solid vs. liquid meal patients with gastroparesis, whereas
consistency on symptoms in low-fat liquid meals had the least
gastroparesis effect.
Method: Subjects had to have an Conclusion: The rate of gastric
established diagnosis of emptying is affected by multiple
gastroparesis with delayed gastric factors including meal volume,
emptying. Participants were studied calorie content, and meal
on four occasions and received one composition, as well as fiber and fat
of four meals on four different days content. Small frequent meals are
(high fat solid and liquid, and low fat another common recommendation.
solid and liquid meals). A food Symptom severity was the main
frequency questionnaire was given outcome variable. Measuring
to determine the patients usual gastric emptying while recording
nutrient intake. Two other symptoms might help determine if
questionnaires were also given the increased symptoms during fatty
regarding pain and exercise habits. meals and less symptoms during the
Body composition was measured as liquid meals were related to gastric
well. emptying.
Grade: 2B
Additional Diet Recommendations
There is limited research, but adding medium-chain
triglycerides to the diet can be beneficial because
they are absorbed in the jejunum and ileum without
the need for lipase or bile salts (which are both
deficient in patients with chronic pancreatitis)
Reducing fiber has also been shown to be
beneficial in patients with gastroparesis to slow
motility as well as in pancreatitis because fiber can
inhibit lipase activity
Enteral nutrition is not heavily studied in chronic
pancreatitis, however long-term jejunal feedings
may result in weight gain and a reduction in
abdominal pain with minimal complications
Conclusion
There are a variety of pancreas disorders and the
treatment depends on the type and severity of the
disorder