Pancreatitis is a common infammatory disease of the exocrine pancreas that causes severe abdominal pain and multiple organ dysfunction that may lead to pancreatic necrosis and persistent organ failure. Pancreatitis is one of the leading causes of hospital admission from gastrointestinal diseases, with approximately 300 000 emergency department visits each year.Acute pancreatitis is a complex disease with a variable course that is often difficult to predict early in its development.
Clinical Presentation and Diagnosis
Abdominal pain is the most common presenting symptom. The pain is usually described as constant and often with radiation to the back that may be exacerbated by eating, drinking, or lying supine. Accompanying symptoms often include nausea, vomiting, and low to moderate-grade fever.
Assessment should focus on a history of episodes of acute pancreatitis and risk factors, including biliary colic/gallstone disease, alcohol use, family history of acute or chronic pancreatitis, recent infections, trauma, insect bites,and new medications. Physical examination often reveals abdominal distention and decreased bowel sounds. Amylase, lipase, and liver panel tests can help confirm the diagnosis of acute pancreatitis as well as identify underlying etiology (ie, hypercalcemia). An elevated direct bilirubin and/or alkaline phosphatase level may indicate the presence of a gallstone in the common bile duct (ie, choledocholithiasis) .Additional testing with transabdominal ultrasound to evaluate for gallstones and serum triglyceride levels should also be obtained. IgG4 levels are helpful when autoimmune pancreatitis is suspected. Computed tomography (CT) or magnetic resonance imaging (MRI) may be indicated to evaluate for structural causes of acute pancreatitis.
Overview of Management
There are 2 cornerstones in acute pancreatitis management, regardless of the etiology:
(1) fluid resuscitation to maintain or restore tissue perfusion and
(2) nutritional support to counter the catabolic state and decrease the rate of infectious complications.
Vomiting, reduced oral intake, and peripancreatic inflammation contribute to fluid deficits. The diminished circulatingvolume leads to decreased tissue perfusion and may result inmultiorgan failure. Intravascular volume status can be estimated by observing vital signs and measuring urine output, BUN, and hematocrit.
The provision of nutrition is an important feature of the care of patients with acute pancreatitis. Early nutrition, particularly enteral nutrition,mitigates these effects by several mechanisms: replenishing caloric losses, increasing splanchnic blood flow to preserve the integrity of the bowel mucosa, and stimulating intestinal motility.
Historically, there was reluctance to feed patients with acute pancreatitis enterally because of concern that the inflamed pancreas would be stimulated to secrete, exacerbating the disease. Parenteral nutrition was widely used. However,this concern about enteral nutrition has not been validated, and evidence overwhelmingly supports enteral nutrition over parenteral nutrition. In general, patients tolerating oral nutrition should be placed on a low-fat soft or solid diet. If patients are unable to tolerate an oral diet within 72 hours, they should be started on nasoenteral nutrition (ie, nasogastric or nasojejunal). Patients who cannot tolerate enteral feeding due to paralytic ileus, obstruction, or other causes should be started on parenteral nutrition within 72 hours.
A diet beneficial for pancreatitis may be rich in fruits, vegetables, beans and lentils, whole grains, lean meats, fish, and healthy fats such as medium-chain triglycerides (MCTs). Some people may need an alternate way of getting nutrition if they are unable to consume the required amounts for their body to work properly. This can involve specialized oral nutritional supplements, liquid nutrients administered though an IVTrusted Source, or a combination of methods.
Here is a list of foods that may be recommended and why:
beans and lentils
other plant-based foods that are not fried
These foods are recommended for people with pancreatitis because theytend to be naturally low in fat, which eases the amount of work thepancreas needs to do to aid digestion.
Fruits, vegetables, beans, lentils, and whole grains are also beneficialbecause of their fiber content. Eating more fibermay lower the chancesTrusted Source of developing gallstones and acutepancreatitis. In addition to fiber, the foods listed above also provide antioxidants.
Pancreatitis is an inflammatory condition, and antioxidants may help
reduce inflammation. Lean meats can help people with pancreatitis meet their protein needs.
Some examples include:
skinless chicken or turkey
lean or extra-lean ground chicken or turkey
95% lean ground beef.
Chronic pancreatitis is a long-term condition that can make it harder for the body to absorb nutrients from food. If dietary changes and medication are not helping a person to absorb enough nutrition, a doctor may prescribe oral nutritional supplements to help a person gain weight and get the nuritients they need.
List of foods to avoid with pancreatitis
Drinking alcohol during an acute pancreatitis attack can worsen the condition or contribute to chronic pancreatitis. Chronic alcohol use can also cause high triglyceride levels, a major risk factor for pancreatitis.
Fried foods and high-fat foods
Fried foods and high-fat foods, such as burgers and french fries, can be problematic for people with pancreatitis. The pancreas helps with fat digestion, so foods with more fat make the pancreas work harder.
Other examples of high-fat foods to avoid include: high-fat dairy products, such as cream, whole milk, and full fat cheeses processed meats, such as hot dogs and sausage mayonnaise potato chips Eating these types of processed, high-fat foods can also lead to heart
Acute pancreatitis is a complex disease that varies in severity and course. Acute pancreatitis is a common disease affecting all age Care should taken to determine accurately the cause of pancreatitis, as misidentifcation will lead to recurrent disease and worse outcomes.
Pancreatitis is a long-term condition that can permanently damage the pancreas. It is essential to seek medical attention for pancreatitis, as both acute and chronic forms can have serious complications.
Following dietary recommendations can help people to improve thesymptoms of pancreatitis and allow for a quicker recovery in some cases.