Pancreatitis is the inflammation of the pancreas, an organ that makes the hormones insulin and glucagon. The pancreas also secretes enzymes that help to digest foods. Inflammation occurs when the digestive enzymes leak into the pancreas and irritate it. Chronic pancreatitis occurs over time, but acute episodes of inflammation can occur with chronic pancreatitis causing a pancreatic attack. If the inflammation is severe enough, you may not be able to eat enough to maintain nutrition and require special nutritional support called total parenteral nutrition.
Symptoms
Pancreatitis can be acute, meaning a sudden onset, or occur over a period of time which is called chronic pancreatitis. The most common cause of chronic pancreatitis is alcohol abuse. Symptoms of chronic pancreatitis include dull abdominal pain that is intermittent and aggravated by food. If you have chronic pancreatitis, you can also have episodes of an acute pancreatitis attack. Symptoms of acute pancreatitis include excruciating pain in the left upper quadrant radiating to the back, nausea and vomiting.
Treatment Goals
A primary treatment goal for pancreatitis is nutritional support. For chronic pancreatitis, recommendations are to abstain from alcohol use, adequate protein, fat and carbohydrate intake, and maintaining glucose level less than 200 mg/dL to reduce the risk of infection. Pancreatic enzyme supplements may be necessary to improve protein absorption. During an acute episode of pancreatitis, management may include nothing by mouth to avoid stimulating the pancreas, intravenous fluids and specialized nutritional support, either by total parenteral nutrition or total enteral nutrition. Parenteral nutrition is given intravenously; enteral nutrition is given by a tube into the gastrointestinal tract.
TPN
Total parenteral nutrition is a nutritional formula that is delivered directly into the blood through a catheter in a vein. TPN has been used as part of the treatment for pancreatitis when the individual cannot tolerate oral feedings. According to an August 2008 article in "Critical Care Nurse," patients with acute pancreatitis were either treated with strict bowel rest or given parenteral nutrition to allow the pancreas to "rest" until serum enzyme levels returned to normal.
Considerations
Some disadvantages are associated with the use of total parenteral nutrition; one of the most serious is catheter-related infection. The use of enteral nutrition is preferred for patients with severe pancreatitis because it is more cost-effective and results in fewer complications. TPN is recommended only if the individual is not a candidate for TEN.
References
- University of Michigan Health System: Pancreatitis
- "Nutrition and Diet Therapy"; Carroll Lutz, Karen Przytulski; 2011
- "Critical Care Nurse"; Enteral Versus Parenteral Nutrition for Acute Pancreatitis; Elaine Siow; August 2008
- "Nursing 2006"; Supporting Nutrition With TEN or TPN; Taiga Sudakin; December 2006
