FND 431 Lecture Notes - Lecture 1: Acute Pancreatitis, Chronic Pancreatitis, Human Body Weight

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4 Feb 2020
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Course
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Case Study Pancreatitis
1. Alcohol accounts for what percent of all cases of pancreatitis? (circle one)
1. 5-10%
2. 20-30%
3. 40-50%
4. 70-80%
2. What is the medical diagnosis? What is one nutritional diagnosis? Include
N:code.
a. Medical diagnosis: acute pancreatitis and enlarged fatty liver
b. Nutritional diagnosis: excessive alcohol intake (NI-4.3) related to history of
alcoholism as evidenced by 20+ years of heavy alcohol use.
3. Explain the reasoning behind the diet order Mr. S received: “low fat, high protein
with absolutely no alcohol.”
The physician recommended Mr. S adhere to a low fat diet because of fat
malabsorption and steatorrhea associated with acute pancreatitis. A low-fat diet
will prevent the malabsorption of fat, and therefore decrease the likelihood of
steatorrhea. A patient presenting with pancreatitis has increased nutrient needs
due to malabsorption of nutrients, possible nausea/vomiting, diarrhea, and loss of
appetite. With the body’s increased energy expenditure needs due to the illness,
along with decreased nutrient absorption, a higher level of protein consumption is
necessary. According to Krause, between 1.2-1.5 grams of protein per kilogram
of ideal body weight is recommended for patients with chronic pancreatitis.
Alcohol is the number one etiology of chronic pancreatitis and, therefore, can
exacerbate the inflammation of acute pancreatitis. With the alcohol consumption
unchecked, the acute pancreatitis can progress to chronic pancreatitis, leading to
severe maldigestion and diabetes. A complete elimination of alcohol will help the
pancreas recover from the acute pancreatitis. The elimination of alcohol will also
help Mr. S with the enlarged fatty liver condition since the alcohol converts to fat
that gets deposited into the liver.
4. Did the physician give Mr. S enough information about his diet or the condition of
his liver? Outline the topics you would discuss Mr. S concerning his diet and liver
disease.
The physician could have provided Mr. S with more diet plan information such as
the importance of incorporating easily digestible foods (such as smoothies, soups,
and green juices), as well as eating small frequent meals (6 small meals instead of
3 large meals) to help with digestion. In addition, examples of low-fat meals
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and/or meal plans could have been provided to Mr. S. The physician could also
have provided more information regarding the benefits of quitting drinking as
well as the dangers of continuing down his current path. For instance, cirrhosis of
the liver can lead to coma and even death.
Using the Nutrition Care Manual, download-save-attach one educational handout that would
be appropriate for this patient along with this submission. ( This information under the
heading of client/education meal plans at the top of the NCM home page
)
Pancreatitis Label Reading Tips
See Attachment
5. What abnormal lab values are indicative of pancreatitis?
At admission or diagnosis:
Age > 55 yr
White blood cell count > 16,000 m^3
Blood glucose level > 200 mg/ 100 mL
Lactic dehydrogenase > 350 units/ L
Aspartate transaminase > 250 units/ L
During the initial 48 hours:
Hematocrit decrease of > 10%
Blood urea nitrogen increase of > 5 mg/ dL
Arterial Po2 < 60 mm Hg
Base deficit > 4 mEq/ L
Fluid sequestration > 6000 mL
Serum calcium level < 8 mg/ mL
6. What was the purpose of the MD giving Mr. S the potassium chloride? Explain
your answer.
The potassium chloride is used as a potassium supplementation to prevent severe
hypokalemia. Potassium is an important electrolyte for nerve and muscle cell
functioning, especially for muscle cells in the heart. Vomiting and diarrhea that
can result from pancreatitis and liver disease can deplete the body of potassium.
If ascites are present, the administration of diuretics can also cause hypokalemia.
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7. Using a flow diagram, give the pathophysiology of a fatty liver 2° to alcoholism.
8. After the symptoms of acute pancreatitis and hepatitis are gone, should Mr. S be
on a diet for pancreatitis or for a fatty liver? Explain.
Mr. S should be on a diet for fatty liver to help prevent the onset of cirrhosis. The
dietary recommendations are quite similar for both pancreatitis and fatty liver (i.e.
small, frequent meals, low-fat diet, adequate protein, antioxidants,
multi-vitamin/multi-mineral supplementation). Therefore, following a diet for
fatty liver would benefit his pancreas as well as his liver.
************************************************************************
Mr. S followed his diet and took his medication and began to feel better. He stayed off the
alcohol for three or four days but as he began to have detox symptoms, he started drinking
again. During the next six months, he began to have stomach pains different from the epigastric
pain he had experienced earlier. He returned to the urgent care clinic, Mr. S was diagnosed with
an ulcer and a liberal bland diet was recommended. Although he followed the diet
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