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Andrea SigristKNH 413April 9, 2013Diet Instruction: Chronic Pancreatitis Patient and Diagnosis Name: Anna DoughSex: FemaleDOB: 3/18Age: 38Height: 5’ 8”Weight: 152 lbs Chief complaint: “I have pain in my lower stomach almost every day. I am so uncomfortable that I find it hard to eat and have lost 6 pounds in the past two weeks because of it.”Patient History:Anna is a 38-year-old dental assistant who parties and drinks heavily on a regular basis. She often consumes four beers at a time, three to four nights a week, for the past ten years. She smokes a pack a day, but has quit three times over the past four years. She consumes a lot of fast food because she thinks cooking for one is silly. Nutrition History:General: Anna has not been eating very much lately due to the pain in the stomach. Eating is often uncomfortable for her and usually results in diarrhea or vomiting. Usual diet: Coffee for breakfast, peanut butter and jelly with a pepsi and potato chips for lunch, a granola bar for a snack, and a McDonald’s cheeseburger and fries for dinner.Diagnosis:Chronic pancreatitis due to high alcohol consumption for an extended time. Treatment Plan:Ibuprofen for pain management, as neededCreon 10 Oral, 1 capsule per meal or snackSmoking cessation Avoid alcohol High carbohydrate, low fat dietSmall frequent mealsMultivitamin SupplementChronic PancreatitisThe pancreas produces chemicals (enzymes) needed to digest food and produces the hormones insulin and glucagon. Chronic pancreatitis is an inflammation of the pancreas that does not heal or improve, gets worse over time, and leads to permanent damage. Inflammation and scarring of the pancreas prevents the pancreas from producing enzymes, insulin and glucagon. Impairment of the pancreas results in an inability to digest foods, especially fats, properly. Etiology CauseYears of alcohol abuse Repeat episodes of acute pancreatitisGeneticsAutoimmune problemsBlockage of the pancreatic duct or the common bile ductCystic Fibrosis complicationsHypertriglyceridemia- high levels of triglycerides in bloodHyperparathyroidism- overproduction of parathyroid hormoneSymptomsAbdominal painOccurs mainly in the upper abdomenMay last hours or days, or be continuousMay be made worse by eating, drinking, and alcoholMay be felt in the backDigestive problemsChronic weight loss with normal eatingDiarrheaNauseaVomitingFatty or oily stools, Pale or clay-colored stools Symptoms may mimic pancreatic cancerSymptoms may become more frequent as condition worsensSitting up and learning forward may relieve symptomsTestsFecal fat testSerum amylaseSerum amylaseSerum lgG4Serum lipaseSerum trysinogenInflammation or calcium deposits of pancreasAbdominal CT scanAbdominal ultrasoundEndoscopic Retrograde Cholangiopancreatography (ERCP)Endoscopic Ultrasound (EUS)Magnetic Resonance Cholangiopancreatography (MRCP)Diagnostic MeasuresBiochemical measurements are most useful to determine pancreatic function. The biochemical levels most useful in diagnosing chronic pancreatitis are isoamylase, lipase, trysin, and elastase. Pancreatitis TestsFecal Fat Test- measures the amount of fat in the stool to determine how much dietary fat that body is not absorbingSerum Amylase- measures the level of the enzyme (which digests carbohydrates) in the bloodSerum lgG4- determines autoimmune pancreatitisSerum Lipase- measures the amount of the protein enzyme (breaks down fatty acids) in the bloodSerum Trypsinogen- measures the amount of trypsinogen (breaks down proteins into amino acids) in the bloodInflammation or Calcium Deposits in Pancreas(Includes changes in the ducts of the pancreas)Abdominal CT scan- x-ray to create cross-sectional pictures of the belly areaAbdominal Ultrasound- used to examine the internal organs of the abdomen, including the liver, gallbladder, spleen, pancreas, kidneys, and some blood vesselsEndoscopic Retrograde Cholangiopancreatography (ERCP)- an endoscope is passed through a catheter into the ducts that lead to the pancreas and gallbladder to identify stones, tumors, or narrowing bile ductsEndoscopic Ultrasound (EUS)- an endoscope is inserted into an organ and combined with an ultrasound to get images of internal organs in the chest and abdomenMagnetic Resonance Cholangiopancreatography (MRCP)- uses magnetic resonance imaging to visualize the biliary and pancreatic ductsExploratory laparotomy (May be done to confirm diagnosis, but is usually done for acute pancreatitis)While under general anesthesia, a surgeon makes a cut in the abdomen and examines that abdominal organsTreatmentMedical, Surgical, Psychological TreatmentLifestyleConsume a diet to maintain a healthy weightLow fatEat small, frequent meals Drink plenty of liquidsConsume adequate vitamins and minerals May need to add a supplement Limit caffeineAvoid smokingAvoid alcohol MedicationsPancreatic enzymes to take with each mealHelps digest foods better and gain weightPain medications Pancreatic Enzyme Replacement TherapyA stent is placed in the biliary duct to facilitate the flow of bile.Controls diarrheaStabilizes patients weightManage malabsorptionDecrease pressure in the ductal systemHospitalization For people with severe pain or people losing weight may need hospitalized for:Pain medicationsFluids given through a veinInsert a PEG (percutaneous endoscopic gastrostomy) feeding tube into the stomach to limit the activity of the pancreasInserting a tube through the nose or mouth to remove contents of the stomach (nasogastric suctioning) Medical Nutrition TherapyDietary ConcernsNausea, vomiting, diarrhea which can cause malnutrition because food intake may be limitedLoss of appetite Steatorrha (fat in the stool) leads to vitamin deficiency Poor digestion of proteins, fats, and carbohydratesGlucose intolerance Recommendations High CarbohydrateLow fat Six small meals a dayHigh fiberMaintain a healthy body weightMedium-chain triglyceride oilsVitamin B12 supplementDrink plenty of fluids Foods RecommendedFood GroupFoodsProteinBaked, broiled, grilled, or steamed lean meats and poultry without skin, fish, eggsDairyLow fat/nonfat dairy including milk, cheese, yogurt, ice cream, frozen yogurtFruitAll fresh, frozen, cannedVegetableAll fresh, frozen, cookedGrainsWhole grains including bagels, bread, hot/’cold cereals, pasta, riceBeveragesWater, fruit juice, vegetable juice, hot chocolate, teaOtherSpices/herbs, applesauce, angel food cake, honey, mustard, jam, butterFoods to Avoid Food GroupFoodsProteinFried, fatty, or heavily marbled meats and poultry with skin, organ meats, duck, fried eggs, processed meatsDairyCream, fried cheese, whole fat dairy, milkshakes, half and halfFruitAvocado, fried fruitsVegetableFried GrainsFried grains, biscuits, croissants, fried potatoes, granola, corn chipsBeveragesBeverages with cream, eggnog, sodaOtherLard, seeds, shortening, coconut milk, nuts, nut buttersSample Meal Plan MealMenuBreakfastOmelet with peppers, mushrooms, and kale2 slices of toast with 2 tsp butter1 cup Orange JuiceSnack1 cup low fat greek yogurt with ? cup blueberries1 cup waterLunchWhole wheat pita with grilled chicken breast, peppers, spinach, tomatoes, and 2 T hummus ? sweet potato with 2 tsp butter1 cup low fat milk1 cup waterSnack1 cup low fat cottage cheese with ? cup pineapple1 cup waterDinnerGrilled tuna with lemon butter sauceWhole wheat roll1 cup grilled asparagus spears 1 cup low fat milkSnackBaked apple with honey and cinnamon 1 cup waterPrognosisChronic pancreatitis cannot be curedDamage to the pancreas is continuous and irreversible Can lead to complicationsAscitesBlockage of the small intestine or bile ductsBlood clot in a vein of the spleenInfectionsDiabetes due to inability of pancreas to produce insulin Pseudocysts (fluid-filled sacs in the pancreas)Nutrient malabsorptionVitamin malabsorption Especially fat-soluble vitamins A, D, E, and KBreathing problems due to a decrease in the level of oxygen in the bloodPancreas failurePancreatic cancerMay lead to death or disability Symptoms and pain can be managed ReferencesBalentine, DO, FACEP, J. R. (2011, October 31). Pancreatitis Causes, Symptoms, Treatment - Pancreatitis Prognosis on eMedicineHealth. Retrieved from Multum, Inc. (2010, December 12). Creon 10 (Pancrelipase Delayed-Released Capsules) Drug Information: Indications, Dosage and How Supplied - Prescribing Information at RxList. Retrieved from Pancreatitis - Symptoms, Diagnosis, Treatment of Chronic Pancreatitis - NY Times Health Information. (n.d.). Health News - The New York Times. Retrieved from Reference Intakes: Electrolytes and Water. (2005). IOM Home - Institute of Medicine. Retrieved from , Incorporated (2010, May 4). Chloride (Cl). WebMD - Better information. Better health. Retrieved from , MD, J. L. (2012, March 8). Chronic Pancreatitis. Medscape. Retrieved from , MD, A. N. (n.d.). Chronic Pancreatitis: Introduction . Johns Hopkins Gastroenterology and Hepatology. Retrieved from , MD, G. F. (2010, January 20). Chronic pancreatitis - PubMed Health. National Center for Biotechnology Information. Retrieved from , N.D., C. D. (2003). Chloride: The Forgotten Essential Mineral. Elete Water. Retrieved from 411 (2011, October). Eating With Chronic Pancreatitis. Retrieved from Hospitals and Clinics (2012, December). Nutrition Guidelines for Chronic Pancreatitis Patient Education. Retrieved from ................
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