Conditions Affecting the Pancreas Functions of the pancreas

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Conditions Affecting the Pancreas

Conditions Affecting the Pancreas

Functions of the pancreas 1. The enzymes secreted in the pancreas help break down

Functions of the pancreas 1. The enzymes secreted in the pancreas help break down carbohydrates, fats, proteins, and acids in the duodenum. 2. The pancreas also secretes a bicarbonate to neutralize stomach acid in the duodenum. 3. The hormones secreted by in the pancreas are insulin and glucagon (which regulate the level of glucose in the blood),

Pancreatitis • Inflammatory disease of the pancreas – release active pancreatic enzymes that may

Pancreatitis • Inflammatory disease of the pancreas – release active pancreatic enzymes that may destroy surrounding tissues • May last few days, weeks or months • Chronic pancreatitis can lead to: - irreversible damage to pancreatic tissue - permanent loss of function

Acute Pancreatitis • Dose not cause permanent damage • It is most often( 70%)

Acute Pancreatitis • Dose not cause permanent damage • It is most often( 70%) a consequence of : - gallstones - excessive alcohol use • Less common causes : hypertriglyceridemia (>1000 mg/d. L), exposure to toxins

Signs and Symptoms of Acute Pancreatitis 1. Severe abdominal pain 2. Nausea and vomiting

Signs and Symptoms of Acute Pancreatitis 1. Severe abdominal pain 2. Nausea and vomiting 3. Abdominal distention 4. Elevated serum amylase and lipase levels In most cases the condition resolves within a week without complications

Nutrition Therapy for Acute Pancreatitis • Nothing by mouth (NPO) until pain subsided Fluids

Nutrition Therapy for Acute Pancreatitis • Nothing by mouth (NPO) until pain subsided Fluids and electrolytes given intravenously • Mild cases : – Oral intake of small sips of water, to clear fluids to liquids to solid foods – Given in small, frequent feedings – Low-fat diet because fat stimulate the pancreas more than the other nutrients.

Severe cases of acute pancreatitis : elemental jejunal tube feedings When beginning oral feedings

Severe cases of acute pancreatitis : elemental jejunal tube feedings When beginning oral feedings - Small, frequent feedings – Low-fat diets (decrease stimulation of pancreas) – High protein and high kcalorie needs due to catabolic and hypermetabolic effects of inflammation

Chronic Pancreatitis Results in permanent damage to structure and function of pancreatic tissue Causes:

Chronic Pancreatitis Results in permanent damage to structure and function of pancreatic tissue Causes: • Alcohol consumption ( 70% - 90% of cases)

Signs and Symptoms of Chronic Pancreatitis • Abdominal pain – severe, worsened by eating

Signs and Symptoms of Chronic Pancreatitis • Abdominal pain – severe, worsened by eating • Steatorrhea • Weight loss and malnutrition as a result of food avoidance (due to pain associated with eating) and malabsorption • In advanced cases , reduction of insulin and glucagon occur and diabetes develops in up to 80% of the patients

Nutrition Therapy for Chronic Pancreatitis The objective of nutrition therapy of chronic pancreatitis are:

Nutrition Therapy for Chronic Pancreatitis The objective of nutrition therapy of chronic pancreatitis are: 1. Improve nutrition status 2. Reduce malabsorption 3. Prevent symptom recurrence

 • Protein and energy need are high in patients who have lost weight

• Protein and energy need are high in patients who have lost weight or malnourished • Dietary supplements are often needed to correct nutrient deficiencies.

 • Steatorrhea treated with enteric-coated pancreatic enzymes (enteric-coated refers to medications or enzyme

• Steatorrhea treated with enteric-coated pancreatic enzymes (enteric-coated refers to medications or enzyme preparations that can withstand gastric acidity and dissolve only at a higher p. H). • If non-enteric-coated enzymes used , acid suppressing drugs may be required.

 • Monitor fecal fat to adjust enzyme dose • Low-fat diet is used

• Monitor fecal fat to adjust enzyme dose • Low-fat diet is used if fat malabsorption resistant to treatment in which MCT oil is recommended

Gallbladder Disease

Gallbladder Disease

Function of Gallbladder : concentrates and stores bile until needed for digestion of fat

Function of Gallbladder : concentrates and stores bile until needed for digestion of fat

Bile is solution of : • bile salts, • cholesterol, • proteins, • phospholipids

Bile is solution of : • bile salts, • cholesterol, • proteins, • phospholipids (lecithin) • bile pigment (bilirubin) • Bile becomes more concentrated as water is extracted © 2009 Cengage - Wadsworth

Formation of gallstones (cholelithiasis) Factors that increase bile’s cholesterol concentration or reduce the gallbladder’s

Formation of gallstones (cholelithiasis) Factors that increase bile’s cholesterol concentration or reduce the gallbladder’s motility favor gallstone formation

Gallstones – some are as small as a pea, or as large as a

Gallstones – some are as small as a pea, or as large as a ping-pong ball. © 2009 Cengage - Wadsworth

Types of Gallstones 1 - Cholesterol Stones Developed because the bile concentrate thickens so

Types of Gallstones 1 - Cholesterol Stones Developed because the bile concentrate thickens so it forms a sludge that cannot be easily expelled by gallbladder contraction. © 2009 Cengage - Wadsworth

Can develop after: rapid weight loss gastric-bypass surgery long-term TPN during pregnancy

Can develop after: rapid weight loss gastric-bypass surgery long-term TPN during pregnancy

Types of Gallstones 2 - Pigment stones are primarily made up of the calcium

Types of Gallstones 2 - Pigment stones are primarily made up of the calcium salt of billirubin ( calcium billirubinate). © 2009 Cengage - Wadsworth

They often develop as a result of 1 - A bacterial infection which causing

They often develop as a result of 1 - A bacterial infection which causing bilirubin to precipitate out of bile to form stones such as in : • Biliary tract infections • Pancreatitis 2 - excessive bilirubin accumulation from RBC breakdown such as in : • Sickle cell anemia • RBC disorders

Risk Factors for Gallstones 1 - Age – Incidence increases with age – Bile

Risk Factors for Gallstones 1 - Age – Incidence increases with age – Bile composition tend to be change with aging. – The cholesterol concentration increases while bile acids decrease leading to likehood of cholesterol stones © 2009 Cengage - Wadsworth

2 - Gender – Incidence three times greater in women than men during reproductive

2 - Gender – Incidence three times greater in women than men during reproductive years. – It falls to similar level after menopause. – Estrogen alters cholesterol metabolism, causes increased secretion of cholesterol into bile and cause an increased secretion of cholesterol into bile – The use of estrogen replacement therapy after menopause increase the gallstone risk © 2009 Cengage - Wadsworth

3 - Pregnancy – Risk is increased due to hormonal changes – Higher serum

3 - Pregnancy – Risk is increased due to hormonal changes – Higher serum progesterone impairs gallbladder motility – Higher estrogen levels increase the secretion of cholesterol into bile © 2009 Cengage - Wadsworth

3 - Obesity and weight loss – Obesity is associated with increased synthesis of

3 - Obesity and weight loss – Obesity is associated with increased synthesis of cholesterol in the liver leading to greater release of cholesterol into bile and an increased risk of gallstone formation. – Dieting increases secretion of cholesterol into bile and may also decrease gallbladder motility. © 2009 Cengage - Wadsworth

Other risk factors – Long term parenteral nutrition reduce gallbladder motility. – Some medications

Other risk factors – Long term parenteral nutrition reduce gallbladder motility. – Some medications for heart disease may increases the concentration of bile and promotes cholesterol crystallization. – High triglyceride levels, hyperinsulinemia, insulin resistance and diabetes mellitus associated with increased gallstone risk © 2009 Cengage - Wadsworth

Symptoms of Gallstones 1. Severe pain steady for minutes or hours ( When a

Symptoms of Gallstones 1. Severe pain steady for minutes or hours ( When a gallstone temporarily blocks the cystic duct). 2. Upper abdominal pain or may radiate to the chest or the back 3. Nausea, vomiting, bloating 4. Symptoms may occur after meals( fatty meals) or awaken patient at night © 2009 Cengage - Wadsworth

Complications of gallstone disease: • When a gallstone blocks the cystic duct it causes

Complications of gallstone disease: • When a gallstone blocks the cystic duct it causes cholecystitis( Inflammation of the gallbladder) • Cholecystitis can lead to infection or to more sever complication such as: -perforation of the gallbladder -peritonitis( inflammation of the peritoneal membrane , which lines the abdominal cavity). © 2009 Cengage - Wadsworth

- When a gallstone blocks the common bile duct it can block bile flow

- When a gallstone blocks the common bile duct it can block bile flow from the liver and leads to jaundice – Acute pancreatitis when a gallstone blocks the pancreatic duct

Treatment for Gallstones Surgery: cholecystectomy ( surgical removal of the gallbladder) - Laparoscopic method

Treatment for Gallstones Surgery: cholecystectomy ( surgical removal of the gallbladder) - Laparoscopic method Shock wave lithotripsy: a nonsurgical procedure that use high sound waves to fragment gallstones.

Before surgery a low fat diet is prescribed – Once gallbladder has been removed,

Before surgery a low fat diet is prescribed – Once gallbladder has been removed, the common bile duct collects bile between meals and replaces it into duodenum at meal time.

Nutrition therapy for gallbladder stones Recommended Foods • Eat small, frequent meals and snacks.

Nutrition therapy for gallbladder stones Recommended Foods • Eat small, frequent meals and snacks. • Limit fat to less than 30% of total daily calories. • Choose foods that are low in fat (Fat tolerance is variable) • Read labels and look for foods that have less than 10 grams fat per serving.

Foods Not Recommended • High-fat foods - Fried foods • Foods with lots of

Foods Not Recommended • High-fat foods - Fried foods • Foods with lots of fiber • Foods that cause gas( Legumes-Cabbage family-Onion family)