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Pancreatitis Case Study

Pancreatitis Case Study. Leah Wendland Tuesday November 13. 32 y/o female. Currently NPO PMH: HTN Liver Disease Alcoholism Chronic pancreatitis GERD. KJ admitted 10/30 in the evening with vomiting, flank and abdominal pain. KJ’s Social History. Single mom with 3 kids

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Pancreatitis Case Study

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  1. Pancreatitis Case Study Leah Wendland Tuesday November 13

  2. 32 y/o female Currently NPO PMH: HTN Liver Disease Alcoholism Chronic pancreatitis GERD KJ admitted 10/30 in the evening with vomiting, flank and abdominal pain

  3. KJ’s Social History • Single mom with 3 kids • Unemployed and trying to get on disability • Smokes cigarettes and marijuana • History of alcohol abuse

  4. Nutrition Assessment • Anthropometric Data: • Ht: 5’6” • Wt:117# • BMI 18 • 6% weight loss in 1 month • 90% of IBW (130#) • 94% UBW (125#) • Subjective Data: • KJ reported poor appetite related to abdominal pain • N/V • Reported limited access to food/resources • Reported drinks ½ pint of vodka a few times a week

  5. Medical Diagnosis CAT scan showed an atrophic inflamed pancreas indicating chronic pancreatitis History of cholecystectomy Acute Pancreatitis

  6. Pancreatitis: Inflammation of the pancreas where the pancreatic enzymes become activated in the pancreas instead of the duodenum.

  7. Common Causes of Pancreatitis • Chronic alcohol abuse • Gallstones • End Stage Renal Disease • Biliary tract disease • Abdominal trauma • High triglycerides • AIDS • Pancreatic Cancer

  8. Common Treatments • NPO (bowel rest for up to a few days) • Replenish Fluids • Control Pain

  9. Nutrition Related Medication • Medication • Pantoprazole • Metoclopramide • Ranitidine • Ondansetron • Banana Bag

  10. Labs

  11. Hospital Treatment • Improve hydration status with IV fluids • Normal Saline • Replete electrolytes • Banana Bag (MVI, Folic Acid, Thiamine) • Magnesium Sulfate • Control Pain • Morphine Sulfate

  12. PES • Severe Malnutrition • Related to poor appetite and inadequate intake secondary to abdominal pain • As evidence by >5% weight loss in 1 month. <75% estimated energy intake for one month and loss of body fat.

  13. Diet Prescription History of chronic pancreatitis Cholecystectomy Inflammation of pancreas **diet order rec was taken by physician KJ was advanced on 11/1 Low Fat

  14. Energy Requirements • Caloric Needs • 30-35kcal/kg and estimated at 1560-1855kcal • Protein Needs • 1-1.2g/kg and estimated at 53-80g

  15. Intervention: • NUTRITION EDUCATION • Provided pancreatitis nutrition education and sobriety nutrition education. • GOAL: follow up 3-5days, which is the hospital’s protocol for high-risk patients • MEALS • Recommend advancing to a low fat diet as tolerated • GOAL: increase intake to 50-75% of meals • Will assess intake at follow up to consider supplements

  16. Evaluation of compliance • Education: • Handouts from Nutrition Care Manual • Encouraged a low fat diet when was able to eat again • KJ was not engaged in the education • Meals: • Pt advanced from NPO • Physician took recommendation • Pt intake was ~50% 11/1-2

  17. Monitor and Evaluate • Weight: maintain weight +/- 2 # • PO: Advance to low-fat diet within 1-2days as tolerated consuming 50-75% of meals • Labs: Monitor pancreatic enzymes, LFT, electrolytes

  18. Follow Up • Discharged 11/3 • Total patient stay was 4 days • I had one contact with this patient • Follow up was scheduled for 11/3 • RD saw her continued the intervention however due to her intake of ~50% she recommended ensure complete BID • Patient was discharged so this was not effective

  19. References 1. Escott-Stump, S. (2008). Nutrition and diagnosis-related care. (6th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins. 2. Wang, G. (2009). Acute pancreatitis: Etiology and common pathogenesis. World journal of gastroenterology, 15(12), 1427–1430. doi: 10.3748/wjg.15.1427 3. Nelms, M., Sucher, K. P., Lacey, K., & Long Roth, S. (2011). Nutrition therapy & pathophysiology. (2nd ed. ed.). Belmont, CA: Wadsworth, Cengage Learning. 4. The Merek Manual. Pancreatitis. Merek Manual. 2011. http://www.merckmanuals.com/professional/gastrointestinal_disorders/pancreatitis/acute_pancreatitis.html 5. Pandol, S., Lugea, A., Mareninova, O., Smoot, D., Gorelick, F., Gukovskaya, A., & Gukovsky, I. (2011). Investigating the pathobiology of alcoholic pancreatitis. Alcolism clincal and experimental research, 35(5), 830-837. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083481/

  20. Questions? Thank you 

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