Severe pancreatitis intestinal nutrition

Written by Wei Shi Liang
Intensive Care Unit
Updated on August 31, 2024
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In different stages of severe pancreatitis, the energy requirements vary. At the early onset of the disease, the principle of nutritional support is to provide the minimum metabolic substrates needed to maintain basic metabolic demands, correct metabolic disorders, and minimize protein loss to a reasonable level. Caloric provision should be between 20 to 25 kcal per kilogram per day. As the condition progresses, the focus of nutritional support gradually shifts towards increasing or balancing nutrient intake. Early intervention using jejunal tube feeding is considered safer. Formulas used should be tolerable by the intestines; initially, glucose water is used to help the intestines adapt to nutrition. Early use of low-fat formulas containing amino acids or short peptides is advisable. Additionally, whole proteins, after being digested by stomach acid and entering the intestines directly, may lead to poor absorption.

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Written by Wei Shi Liang
Intensive Care Unit
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Severe pancreatitis intestinal nutrition

In different stages of severe pancreatitis, the energy requirements vary. At the early onset of the disease, the principle of nutritional support is to provide the minimum metabolic substrates needed to maintain basic metabolic demands, correct metabolic disorders, and minimize protein loss to a reasonable level. Caloric provision should be between 20 to 25 kcal per kilogram per day. As the condition progresses, the focus of nutritional support gradually shifts towards increasing or balancing nutrient intake. Early intervention using jejunal tube feeding is considered safer. Formulas used should be tolerable by the intestines; initially, glucose water is used to help the intestines adapt to nutrition. Early use of low-fat formulas containing amino acids or short peptides is advisable. Additionally, whole proteins, after being digested by stomach acid and entering the intestines directly, may lead to poor absorption.

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Written by Wei Shi Liang
Intensive Care Unit
1min 4sec home-news-image

Severe pancreatitis complications

Complications of severe pancreatitis primarily include: 1. Acute peripancreatic fluid collection and interstitial edematous pancreatitis, where fluid accumulates around the pancreas without necrosis. This can be diagnosed with enhanced CT. 2. Pancreatic pseudocysts, characterized by fluid encapsulated by a clearly defined inflammatory cyst wall around the pancreas, with no or minimal necrosis, commonly occurring around four weeks after an episode of interstitial edematous pancreatitis. 3. Accumulation of acute necrotic material, involving necrotic tissue and liquids from necrotizing pancreatitis, including the parenchyma and peripancreatic tissues, also diagnosable through enhanced CT. 4. Encapsulated necrosis, observable as a clearly defined inflammatory encapsulation of the pancreas and peripancreatic tissues, commonly occurring four weeks post an episode of necrotizing pancreatitis.

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Written by Si Li Li
Gastroenterology
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How to treat mild pancreatitis

Pancreatitis occurs due to the abnormal activation of pancreatic enzymes, leading to the self-digestion of the pancreas. The primary causes include alcohol, where excessive drinking can induce acute pancreatitis. Another cause is hyperlipidemia, as individuals with high blood lipid levels are prone to acute pancreatitis. Additionally, cholelithiasis, including stones in both the bile ducts and the gallbladder, can also trigger acute pancreatitis. Symptoms of acute pancreatitis manifest as severe pain in the upper abdomen, accompanied by nausea, vomiting, abdominal bloating, and fever. Acute pancreatitis is classified into mild, moderate, and severe categories. Mild cases mainly exhibit edema of the pancreas without bleeding, necrosis, or involvement of other organs. Treatment primarily involves fasting and fluid replacement, typically lasting for more than 48 hours or until abdominal pain ceases. Another aspect of treatment is inhibiting pancreatic enzyme secretion. Some patients with acute pancreatitis might also need antibiotics. Typically, mild acute pancreatitis can heal within one to two weeks of treatment.

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Written by Li Qiang
Intensive Care Unit
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How do you get acute severe pancreatitis?

There are many causes of acute severe pancreatitis, and the mechanisms of onset are not completely the same. Biliary pancreatitis is caused by small gallstones falling into the bile duct, becoming lodged at the distal end of the duct. At this time, the opening of the pancreatic duct is blocked, causing a disorder in pancreatic juice secretion, increasing pancreatic duct pressure, and spilling out of the pancreatic duct. This can corrode pancreatic cells and other abdominal organ cells. Alcohol and drug-induced pancreatitis is due to the direct damage of alcohol and drugs to the pancreatic cells, causing the leakage of pancreatic secretions. Overeating-induced pancreatitis is caused by consuming too much food at once, especially a high-fat diet, leading to a massive secretion of pancreatic juice. If there is an obstacle in the expulsion of this juice, it can also lead to pancreatitis. Hyperlipidemic pancreatitis is caused by excessively high blood lipid levels, which form blockages. These lipids obstruct the secretion of the pancreatic duct, causing pancreatitis. In all types of pancreatitis, the leakage of pancreatic secretions corrodes the pancreatic cells and these secretions enter the abdominal cavity, corroding abdominal organs and leading to a series of severe inflammatory responses and potentially leading to abdominal infections.

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Written by Wei Shi Liang
Intensive Care Unit
1min 22sec home-news-image

Rescue of severe pancreatitis

Severe pancreatitis involves severe illness impacting multiple systems and organs across the body. The rescue of severe pancreatitis should be based in the ICU, with multidisciplinary cooperation. The first step is early fluid resuscitation, with crystalloid solution preferred, and it should be rapidly completed within 48 hours of onset. The second step involves support for circulation and respiration. The third step involves the maintenance of organ functions and the use of blood purification treatments. Early use of blood purification in acute pancreatitis can remove inflammatory mediators, regulate immune dysfunctions, and protect organ functions, potentially extending the survival time of patients with severe pancreatitis. The fourth step includes monitoring intra-abdominal pressure and preventing and treating abdominal compartment syndrome. Further treatments mainly include the use of agents to inhibit pancreatic enzymes and platelet activation, as well as early jejunal nutrition. Additionally, prophylactic use of antibiotics is required, and in cases of biliary acute pancreatitis, ERCP or sphincterotomy should be performed. The final approach is surgical treatment, which is reserved for patients who do not respond to or have poor results from conservative treatment.