Nutritional management protocol in patients with acute pancreatitis
DOI:
https://doi.org/10.18004/Keywords:
acute pancreatitis, malnutrition, nutritional support, severe acute pancreatitis, ParaguayAbstract
Acute pancreatitis is a disease of public health impact due to the increase in cases in recent years, especially the high incidence in acute pancreatitis. Acute pancreatitis is a cause of morbidity and mortality common in hospitals, where the most common cause of biliary origin was. A fundamental principle in the nutritional management of this entity is to avoid fasting for more than 7 days especially in severe acute pancreatitis, as this promotes malnutrition and increases the likelihood of developing infections and systemic complications. All patients admitted with a diagnosis of acute pancreatitis should be stratified in severity, and underwent a nutritional assessment at hospital admission, to early diagnose the severity of the disease at an early stage and to initiate nutritional support. There is consensus in favor early enteral nutrition over parenteral nutrition unless there contraindications to the first. Usually these patients are malnourished on admission norm but at risk of malnutrition by the hyper catabolism to which they are subjected, so that appropriate nutritional support is a key part in the treatment and favorable development of this pathology.
References
1. Lowenfels AB, Sullivan T, Fiorianti J, Maisonneuve P. The epidemiology and impact of pancreatic diseases in the United States. Curr Gastroenterol Rep 2005; 7: 90-5.
2. Corfield AP, Cooper MJ, Williamson RC. Acute pancreatitis; a lethal disease of increasing incidence. Gut 1985; 26: 724-9.
3. Sánchez-Lozada R, * Camacho-Hernández MI,** Vega-Chavaje RG,***, Garza-Flores JH,** Campos-Castillo C,**, Gutiérrez-Vega R**. Pancreatitis aguda: experiencia de cinco años en el Hospital General de México. Gac Méd Méx Vol. 141 No. 2, 2005
4. Ramírez Onieva V***, Galeano Aquino CDJ**, Martínez Leiva M*, Ortiz Guerrero L*, Cirugía Paraguaya. Vol. 30; Nº 1. 2007.
5. Franco F, Sierra F. Gastroenterología y hepatología 5a ed. corporación para investigaciones biológicas, CIB; 2004: Cap 3.
6. Nieto, J. A. Fisiopatología de la pancreatitis aguda /Rev. Colomb. cir; 7(2):101-109, ago. 1992.
7. Figarella C, Amouric M, Guy-Crotte O. Enzyme activation and liberation: intracellular/extracellular events. In: Beger HG, Buchler M, eds. Acute pancreatitis: research and clinical management. Berlin, Germany: Springer-Verlag, 1987:53-60.
8. Opie EL. The relation of cholelithiasis to disease of the pancreas and to fat necrosis. Am J Med Sci 1901;121:27-43.
9. Symmers WSC. Acute alcoholic pancreatitis. Dublin J Med Sci 1917;143:244-247
10. Haber CJ, Meltzer SJ, Present DH, Korelitz BI. Nature and course of pancreatitis caused by 6-mercaptopurine in the treatment of inflammatory bowel disease. Gastroenterology 1986;91:982-986.
11. Mofenson HC, Caraccio TR, Nawaz H, Steckler G. Acetaminophen induced pancreatitis. J Toxicol Clin Toxicol 1991;29:223-230.
12. Maxson CJ, Greenfield SM, Turner JL. Acute pancreatitis as a common complication of 2',3'-dideoxyinosine therapy in the acquired immunodeficiency syndrome. Am J Gastroenterol 1992;87:708-713.
13. Schwartz MS, Brandt LJ. The spectrum of pancreatic disorders in patients with the acquired immune deficiency syndrome. Am J Gastroenterol 1989;84:459-462.
14. Klar E, Messmer K, Warshaw AL, Herfarth C. Pancreatic ischaemia in experimental acute pancreatitis: mechanism, significance and therapy. Br J Surg 1990;77:1205-1210.
15. Foulis AK, Murray WR, Galloway D, et al. Endotoxaemia and complement activation in acute pancreatitis in man. Gut 1982;23:656-661.
16. Bittner R, Block S, Buchler M, Beger HG. Pancreatic abscess and infected pancreatic necrosis: different local septic complications in acute pancreatitis. Dig Dis Sci 1987;32:1082-1087.
17. Balldin G. Release of vasoactive substances in ascites and blood in acute pancreatitis. In: Berger HG, Buchler M, eds. Acute pancreatitis: research and clinical management. Berlin, Germany: Springer-Verlag, 1987:63-70.
18. Corfield AP, Cooper MJ, Williamson RC. Acute pancreatitis; a lethaldisease of increasing incidence. Gut 1985; 26: 724-9.
19. Lankisch PG, Schirren CA, Kunze E. Undetected fatal acute pancreatitis: why is the disease so frequently overlooked? Am J Gastroenterol 1991; 86: 322-6.
20. Kemppainen EA, Hedstrom JI, Puolakkainen PA, Sainio VS, et al. Rapid measurement of urinary trypsinogen-2 as a screening test for acute pancreatitis. N Engl J Med 1997; 337: 1394-5
21. Gumaste VV, Roditis N, Mehta D, Dave PB. Serum lipase levels in nonpancreatic abdominal pain versus acute pancreatitis. Am J Gastroenterol 1993; 88: 2051-5.
22. Sternby B, O’Brien JF, Zinsmeister AR, DiMagno EP. What is the best biochemical test to diagnose acute pancreatitis? A prospective clinical study. Mayo Clin Proc 1996; 71: 1138-44.
23. Wang SS, Lin XZ, Tsai YT, Lee SD, Pan HB, Chou YH, Su CH, Lee CH, Shiesh SC, Lin CY, et al. Clinical significance of ultrasonography, computed tomography, and biochemical tests in the rapid diagnosis of gallstone-related pancreatitis: a prospective study. Pancreas 1988; 3:153-8.
24. Neoptolemos JP, Hall AW, Finlay DF, Berry JM, Carr-Locke DL, Fossard DP. The urgent diagnosis of gallstones in acute pancreatitis: a prospective study of three methods. Br J Surg 1984; 71: 230-3.
25. Balthazar EJ. CT diagnosis and staging of acute pancreatitis. Radiol Clin North Am 1989; 27: 19-37.
26. Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 2002; 223: 603-13.
27. Kalra MK, Maher MM, Sahani DV, Digmurthy S, Saini S. Current status of imaging in pancreatic diseases. Comput Assist Tomogr 2002; 26: 661-75.
28. Foitzik T, Bassi DG, Schmidt J, Lewandrowski KB, Fernandez-del Castillo C, Rattner DW, Warshaw AL. Intravenous contrast medium accentuates the severity of acute necrotizing pancreatitis in the rat. Gastroenterology 1994; 106: 207-14.
29. Balthazar EJ, Freeny PC. Contrast-enhanced computed tomography in acute pancreatitis: is it beneficial or harmful? Gastroenterology 1994; 106: 259-62.
30. Pamuklar E, Semelka RC. MR imaging of the pancreas. Magn Reson Imaging Clin North Am 2005; 13: 313-30.
31. Arvanitakis M, Delhaye M, De Maertelaere V, Bali M, Winant C, Coppens E, Jeanmart J, Zalcman M, Van Gansbeke D, Deviere J, Matos C. Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis. Gastroenterology 2004; 126: 715-23.
32. Bradley EL 3rd. Members of the Atlanta International Symposium. A clinically based classification system for acute pancreatitis: summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg 1993; 128(5):586-90. 33. Flint RS, Windsor JA. The role of the intestine in the pathophysiology and management of severe acute pancreatitis. HBP 2003;5:69-85.
34. Gutiérrez-Salmeán, G; Peláez-Luna, M ELSEVIER, Terapia nutricional en el paciente con pancreatitis aguda: guía práctica para el inicio del apoyo de nutrición enteral, Rev Gastroenterol Mex.2010; 75 :67-76 - vol.75 núm 01. 35. Windsor AC.J, Kanwar S, Li AG.K, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 1998;42:431-5. 36. Barreda CL.1; Targarona MJ.2; Rodríguez AC.3 Protocolo para el manejo de la Pancreatitis Aguda grave con necrosis Rev. gastroenterol. Perú v.25 n.2 Lima abr./jun. 2005. 37. García Almansa A† y García Peris P, Tratamiento nutricional de los enfermos con pancreatitis aguda: cuando el pasado es presente, Nutr. Hosp. v.23 supl.2 Madrid mayo 2008.
38. Consenso Final sobre Evaluación Nutricional en pacientes hospitalizados. Federación Latinoamericana de Nutrición Enteral y Parenteral (FELANPE) 2008. Disponible en: http://www.felanpeweb.org/consensos
39. Casas M, Mora J1, Fort E2, Aracil C, Busquets D, Galter S, et cols. Nutrición enteral total vs. Nutrición parenteral total en pacientes con pancreatitis aguda grave, REV ESP ENFERM DIG (Madrid) Vol. 99. N.° 5, pp. 264-269, 2007.
40. Stephen A. McClave, MD*; et al Nutrition Support in Acute Pancreatitis: A Systematic Review of the Literature Journal of Parenteral and Enteral Nutrition 30:143–156, 2006.
41. Meier R, Beglinger C, Layer P, Gullo L, Keim V, Laugier R y cols., ESPEN Consensus Group. ESPEN guidelines on nutrition in acute pancreatitis. European Society of Parenteral and Enteral Nutrition. Clin Nutr 2002; 21(2):173-83. 42. Stephen A. McClave, MD, Robert G. Martindale, MD, PhD, Vincent W. Vanek, MD, Mary McCarthy, RN, PhD, Pamela Roberts, MD, Beth Taylor, RD, Juan B. Ochoa, MD, Lena Napolitano, MD, Gail Cresci, RD, el Consejo de Administración ASPEN y el American College of Critical Care Medicine, Clinical Guidelines – Acute Pancreatitis 2009

