There are several important issues related to nutrition and acute pancreatitis. These include the approach to the patients with mild versus severe disease, the type of nutritional support, and when to begin feeding. Traditionally patients have been kept NPO for fear that that feeding would worsen acute pancreatitis by stimulating the inflamed pancreas. The standard of nutritional support has been total parenteral nutrition (TPN). However, TPN is associated with higher infection rates and has not been demonstrated to reduce mortality. Additionally the gut barrier function is compromised during acute pancreatitis; this may be a factor in bacterial translocation and bacterial seeding of pancreatic necrosis. It is tempting to consider that early enteral feeding may preserve gut barrier function. In 1997 Kalfarentzos and colleagues (1997) demonstrated that enteral feeding (via a nasojejunal tube) in severe acute pancreatitis is possible, safe, less expensive, and may reduce pancreatic infections compared to TPN.

Since then there have been several studies that have reproduced these results, although a convincing benefit in mortality has not been demonstrated (Imrie et al, 2002). Most recently there have been reports that NG feeding is well tolerated in these patients. Our practice is to begin enteral feeding in patients by an endoscopically or radiologically placed nasojejunal feeding tube after day 2 or 3 in patients with severe pancreatitis. Feeding is started at low rate of 20 cc/hr. Although this does not provide complete caloric requirements, small amounts of feeding are usually tolerated and may preserve the intestinal barrier. If nausea and vomiting are present, a NG tube can be placed and kept to drainage. A small group of patients (between 10 to 20%) will not tolerate this method of feeding and require TPN. Triglyceride levels should be checked after the onset of feeding, especially in patients with known hypertriglyceridemia.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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