DDSEP® 8 Quick Quiz

July 2015 Quiz 2

Publish date: July 27, 2015

A 65-year-old man is admitted with severe abdominal pain, fever, nausea, and vomiting. On examination, he is febrile, with stable vital signs. The upper abdomen is diffusely tender, with rebound and absent bowel sounds. Left flank ecchymosis is present. Serum amylase and lipase are elevated. After aggressive fluid resuscitation, a contrast CT scan on day 2 of illness demonstrates an edematous pancreas with nonenhancement of about 30% of the gland and multiple peripancreatic fluid collections. In terms of management, which of the following statements about nutrition is correct?


 

References

Critique

Patients with mild pancreatitis can be treated with hydration alone. Initial feeding with a low-fat diet is safe and may reduce the duration of hospitalization, compared with a clear liquid diet in patients with mild pancreatitis. Multiple studies have demonstrated that enteral feeding is safe and tolerated in acute pancreatitis. Additionally, enteral feeding may preserve gut barrier function and prevent translocation of bacteria, which are implicated in pancreatic infections. A meta-analysis of the existing literature has demonstrated improved outcome with enteral feeding, compared with parenteral feeding, with less infectious complications, reduced cost, and better glycemic control.

References

1. McClave, S.A., Change, W.K., Dhaliwal, R., et al. Nutritional support in acute pancreatitis; a systemic review of the literature. J. Parenteral Enteral Nutr. 2006;30:143–56.

2. Vu M.K., van der Veek P.P., Frolich M., et al. Does jejunal feeding activate exocrine pancreatic secretions? Eur. J. Clin. Invest. 1999;29:1053–9.

3. Petrov M.S., van Santvoort H.C., Besselink M.S., et al. Enteral nutrition and the risk of mortality and infectious complications in patients with severe acute pancreatitis: a meta-analysis of randomized trials. Arch. Surg. 2008;143:1111–7.

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July 2015 Quiz 1