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 Chen Rong
Gastroenterology
1min 25sec home-news-image

How to check for pancreatitis?

The examination of pancreatitis requires laboratory tests and imaging examinations to assess the severity of the condition and to identify the cause. Elevated amylase and lipase levels more than three times the normal values, increased white blood cells, elevated C-reactive protein, increased blood sugar, elevated transaminases and bilirubin, decreased albumin, increased urea nitrogen and creatinine, decreased blood oxygen partial pressure, decreased blood calcium, elevated triglycerides, and abnormalities in blood sodium, potassium, and pH values all reflect the severity of pancreatitis. Abdominal ultrasound is a routine initial screening imaging examination for acute pancreatitis, and abdominal CT is helpful in confirming the presence of pancreatitis, peripancreatic inflammatory changes, and pleural effusion. Enhanced CT is beneficial in determining the extent of pancreatic necrosis and is generally performed about a week after the onset of the condition. However, when searching for the cause of pancreatitis, the sensitivity and accuracy of CT are not as good as MRI, therefore further MRI should be conducted to investigate causes related to the bile duct and to determine the cause of the pancreatitis.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Severe pancreatitis diagnostic criteria

Diagnostic criteria for severe pancreatitis: First, based on the patient's clinical symptoms, symptoms such as restlessness, cold limbs, and mottled skin, indicative of shock, may appear. Second, physical examination signs, such as rigid abdominal muscles indicative of a positive peritoneal irritation sign, and Grey Turner's sign may also be present. Third, according to laboratory tests, the calcium levels generally significantly decrease, usually below 2 mmol/L, and elevated blood sugar levels greater than 11.2 mmol/L, typically without a history of diabetes. There may also be a sudden decrease in urine amylase. Fourth, diagnostic abdominal paracentesis reveals ascitic fluid with high amylase activity. Based on these points, severe pancreatitis can be considered.

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Written by Wei Shi Liang
Intensive Care Unit
59sec home-news-image

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 Huang Ya Juan
Gastroenterology
1min 51sec home-news-image

Symptoms of Pancreatitis

Pancreatitis is divided into acute pancreatitis and chronic pancreatitis. Acute pancreatitis is a condition caused by various reasons that lead to damage in the pancreatic tissue. This results in the premature activation of enzymes meant for digesting food, which instead begin to digest the pancreas itself. This “self-destructive” behavior leads to a series of consequences known as acute pancreatitis. The symptoms of acute pancreatitis primarily include abdominal pain, predominantly upper abdominal pain, which occurs suddenly and is persistent, severe, or knife-like, with intermittent exacerbation; fever, nausea, vomiting frequently, with vomitus consisting of food, bile, and even blood, and the abdominal pain does not ease after vomiting; some patients may also have jaundice, often caused by gallstones or common bile duct stones inducing pancreatitis, possibly accompanied by itching of the skin. Chronic pancreatitis, on the other hand, is not necessarily caused by repeated attacks of acute pancreatitis, but rather by various causes leading to persistent inflammatory changes in the pancreas, characterized mainly by chronic and persistent inflammation, damage, and fibrosis of the pancreatic parenchyma. This can lead to irreversible morphological changes such as dilation of the pancreatic ducts, pancreatic duct stones, or calcification. Symptoms include abdominal pain, primarily upper abdominal pain, which may radiate to the back, often triggered by alcohol consumption, overeating, a high-fat diet, or fatigue; gastrointestinal symptoms include reduced appetite, bloating, and indigestion; exocrine manifestations include diarrhea, specifically steatorrhea, where the stool contains oil droplets and often has a foul odor; there may also be weight loss, emaciation, and endocrine manifestations, such as what we commonly refer to as diabetes.

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Written by Wei Shi Liang
Intensive Care Unit
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Symptoms of severe pancreatitis

The main symptom of severe pancreatitis is abdominal pain. This type of abdominal pain manifests as intense pain in the upper-middle abdomen, which radiates to the back and both sides of the body. The pain is widespread and severe, with about 95% of patients experiencing abdominal pain. Onset often occurs following binge eating or excessive drinking, and the pain worsens after eating. Another symptom is abdominal distension, which is also a common symptom. It is caused by extensive effusion in the abdominal cavity and retroperitoneum, as well as intestinal paralysis. Fever in the early stage of the disease is also a common symptom, resulting from the absorption of a large amount of necrotic tissue. Fever occurring in the later stages is often caused by infections triggered within the abdominal cavity.