1. Conditions Affecting the Pancreas

2. Functions of the pancreas 1.The enzymes secreted in the pancreas help break down carbohydrates, fats, proteins, and acids in the duodenum. 2.The pancreas also secretes a bicarbonate to neutralize stomach acid in the duodenum. 3.The hormones secreted by in the pancreas are insulin and glucagon (which regulate the level of glucose in the blood),

3. Pancreatitis Inflammatory disease of the pancreas – release active pancreatic enzymes that may destroy surrounding tissues May last few days, weeks or months Chronic pancreatitis can lead to: - irreversible damage to pancreatic tissue - permanent loss of function

4. Acute Pancreatitis Dose not cause permanent damage It is most often( 70%) a consequence of : - gallstones - excessive alcohol use Less common causes : hypertriglyceridemia (>1000 mg/dL), exposure to toxins

6. Signs and Symptoms of Acute Pancreatitis 1.Severe abdominal pain 2.Nausea and vomiting 3.Abdominal distention 4.Elevated serum amylase and lipase levels In most cases the condition resolves within a week without complications

7. Nutrition Therapy for Acute Pancreatitis Nothing by mouth (NPO) until pain subsided Fluids and electrolytes given intravenously Mild cases : –Oral intake of small sips of water, to clear fluids to liquids to solid foods –Given in small, frequent feedings –Low-fat diet because fat stimulate the pancreas more than the other nutrients.

8. Severe cases of acute pancreatitis : elemental jejunal tube feedings When beginning oral feedings - Small, frequent feedings –Low-fat diets (decrease stimulation of pancreas) –High protein and high kcalorie needs due to catabolic and hypermetabolic effects of inflammation

9. Chronic Pancreatitis Results in permanent damage to structure and function of pancreatic tissue Causes: Alcohol consumption ( 70% - 90% of cases)

10. Signs and Symptoms of Chronic Pancreatitis Abdominal pain – severe, worsened by eating Steatorrhea Weight loss and malnutrition as a result of food avoidance (due to pain associated with eating) and malabsorption In advanced cases,reduction of insulin and glucagon occur and diabetes develops in up to 80% of the patients

11. Nutrition Therapy for Chronic Pancreatitis The objective of nutrition therapy of chronic pancreatitis are: 1.Improve nutrition status 2.Reduce malabsorption 3.Prevent symptom recurrence

12. Protein and energy need are high in patients who have lost weight or malnourished Dietary supplements are often needed to correct nutrient deficiencies.

13. Steatorrhea treated with enteric-coated pancreatic enzymes (enteric-coated refers to medications or enzyme preparations that can withstand gastric acidity and dissolve only at a higher pH). If non-enteric-coated enzymes used, acid suppressing drugs may be required.

14. Monitor fecal fat to adjust enzyme dose Low-fat diet is used if fat malabsorption resistant to treatment in which MCT oil is recommended

15. Gallbladder Disease

16. Function of Gallbladder : concentrates and stores bile until needed for digestion of fat

17. © 2009 Cengage - Wadsworth Bile is solution of : bile salts, cholesterol, proteins, phospholipids (lecithin) bile pigment (bilirubin) Bile becomes more concentrated as water is extracted

18. Formation of gallstones (cholelithiasis) Factors that increase bile’s cholesterol concentration or reduce the gallbladder’s motility favor gallstone formation

19. © 2009 Cengage - Wadsworth Gallstones – some are as small as a pea, or as large as a ping-pong ball.

20. © 2009 Cengage - Wadsworth Types of Gallstones 1- Cholesterol Stones Developed because the bile concentrate thickens so it forms a sludge that cannot be easily expelled by gallbladder contraction.

21. Can develop after: rapid weight loss gastric-bypass surgery long-term TPN during pregnancy

22. © 2009 Cengage - Wadsworth Types of Gallstones 2- Pigment stones Pigment stones are primarily made up of the calcium salt of billirubin ( calcium billirubinate).

23. They often develop as a result of 1- A bacterial infection which causing bilirubin to precipitate out of bile to form stones such as in : Biliary tract infections Pancreatitis 2- excessive bilirubin accumulation from RBC breakdown such as in : Sickle cell anemia RBC disorders

24. © 2009 Cengage - Wadsworth Risk Factors for Gallstones 1- Age –Incidence increases with age –Bile composition tend to be change with aging. –The cholesterol concentration increases while bile acids decrease leading to likehood of cholesterol stones

25. © 2009 Cengage - Wadsworth 2- Gender – Incidence three times greater in women than men during reproductive years. –It falls to similar level after menopause. –Estrogen alters cholesterol metabolism, causes increased secretion of cholesterol into bile and cause an increased secretion of cholesterol into bile –The use of estrogen replacement therapy after menopause increase the gallstone risk

26. © 2009 Cengage - Wadsworth 3- Pregnancy –Risk is increased due to hormonal changes –Higher serum progesterone impairs gallbladder motility –Higher estrogen levels increase the secretion of cholesterol into bile

27. © 2009 Cengage - Wadsworth 3- Obesity and weight loss – Obesity is associated with increased synthesis of cholesterol in the liver leading to greater release of cholesterol into bile and an increased risk of gallstone formation. –Dieting increases secretion of cholesterol into bile and may also decrease gallbladder motility.

28. © 2009 Cengage - Wadsworth Other risk factors – Long term parenteral nutrition reduce gallbladder motility. –Some medications for heart disease may increases the concentration of bile and promotes cholesterol crystallization. –High triglyceride levels, hyperinsulinemia, insulin resistance and diabetes mellitus - associated with increased gallstone risk

29. © 2009 Cengage - Wadsworth Symptoms of Gallstones 1.Severe pain steady for minutes or hours ( When a gallstone temporarily blocks the cystic duct). 2.Upper abdominal pain or may radiate to the chest or the back 3.Nausea, vomiting, bloating 4.Symptoms may occur after meals( fatty meals) or awaken patient at night

30. © 2009 Cengage - Wadsworth Complications of gallstone disease: When a gallstone blocks the cystic duct it causes cholecystitis( Inflammation of the gallbladder) Cholecystitis can lead to infection or to more sever complication such as: -perforation of the gallbladder -peritonitis( inflammation of the peritoneal membrane,which lines the abdominal cavity).

31. - When a gallstone blocks the common bile duct it can block bile flow from the liver and leads to jaundice –Acute pancreatitis when a gallstone blocks the pancreatic duct

32. Treatment for Gallstones Surgery: cholecystectomy ( surgical removal of the gallbladder) - Laparoscopic method Shock wave lithotripsy: a nonsurgical procedure that use high sound waves to fragment gallstones.

33. Before surgery a low fat diet is prescribed –Once gallbladder has been removed, the common bile duct collects bile between meals and replaces it into duodenum at meal time.

34. Nutrition therapy for gallbladder stones Recommended Foods Eat small, frequent meals and snacks. Limit fat to less than 30% of total daily calories. Choose foods that are low in fat (Fat tolerance is variable) Read labels and look for foods that have less than 10 grams fat per serving.

35. Foods Not Recommended High-fat foods - Fried foods Foods with lots of fiber Foods that cause gas( Legumes-Cabbage family-Onion family)