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Chronic\tcholecystitis\tis\tlongstanding\tinflammation\tof\tthe\tgallbladder.\tIt\tis\tcaused\tby\trepeated,\tmild\tattacks\tof\nacute\tcholecystitis.\tThis\tleads\tto\tthickening\tof\tthe\twalls\tof\tthe\tgallbladder.\tThe\tgallbladder\tbegins\n\tto\tshrink\tand\neventually\tloses\tthe\tability\tto\tperform\tits\tfunction:\tconcentrating\tand\tstoring\tbile.\tEating\tfoods\tthat\tare\thigh\tin\tfat
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may\taggravate\tthe\tsymptoms\tof\tcholecystitis\tbecause\tbile\tis\tneeded\tto\tdigest\tsuch\tfoods.\tChronic\tcholecystitis\noccurs\tmore\toften\tin\twomen\tthan\tin\tmen,\tand\tthe\tincidence\tincreases\tafter\tthe\tage\tof\t40.\tRisk\tfactors\tinclude\tthe\npresence\tof\tgallstones\tand\ta\thistory\tof\n\tacute\tcholecystitis.\nSurgical\tmanagement
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] |
acute\tcholecystitis.\nSurgical\tmanagement\nAcute\tcholecystitis\trequires\tsurgical\tintervention\tunless\tmedically\tcontraindicated.\tWithout\tsurgery,\tthe\tcondition\nmay\teither\tsubside\tor\tprogress\tto\tgangrene.\nMedical\tnutrition\ttherapy\nAcute\tcholecystitis.
|
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] |
Medical\tnutrition\ttherapy\nAcute\tcholecystitis.\nIn\tan\tacute\tattack,\toral\tfeedings\tare\ttemporarily\tdiscontinued.\tPN\tmay\tbe\tindicated\tif\tthe\tpatient\tis\tmalnourished\nand\tit\tis\tanticipated\tthat\n\tthey\twill\tnot\tbe\ttaking\tanything\torally\tfor\ta\tprolonged\tperiod.\tWhen\tfeedings\tare\tresumed,
|
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] |
a\tlow-fat\tdiet\tis\trecommended\tto\tdecrease\tgallbladder\tstimulation.\tA\thydrolyzed\tlow-fat\tformula\tor\tan\toral\tlow-fat\ndiet\tconsisting\tof\t30\tto\t45\tg\tof\tfat\tper\tday\tcan\tbe\tgiven.\t\nTable\t28.8\n\tshows\ta\tfat-restricted\tdiet.\nTABLE\t28.8\nFat-Restricted\tDiet\nFood\tAllowed\nFood\tto\tLimit\tor\tExclude\nBeverages
|
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] |
Fat-Restricted\tDiet\nFood\tAllowed\nFood\tto\tLimit\tor\tExclude\nBeverages\nSkim\tmilk\tor\tbuttermilk\tmade\twith\tskim\tmilk;\tcoffee,\ttea,\nPostum,\tfruit\tjuice,\tsoft\tdrinks,\tcocoa\tmade\twith\tcocoa\npowder\tand\tskim\tmilk\nWhole\tmilk,\tbuttermilk\tmade\twith\twhole\tmilk,\tchocolate\nmilk,\tcream\tin\texcess\tof\tamounts\tallowed\tunder\tfats\nBread\tand\tCereal\tProducts
|
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] |
Bread\tand\tCereal\tProducts\nPlain,\tnonfat\tcereals;\tspaghetti,\tnoodles,\trice,\tmacaroni;\tplain\nwhole\tgrain\tor\tenriched\tbreads,\tair-popped\tpopcorn,\tbagels,\nEnglish\tmuffins\nBiscuits,\tbreads,\tegg\tor\tcheese\tbread,\tsweet\trolls\tmade\nwith\tfat;\tpancakes,\tdoughnuts,\twaffles,\tfritters,\npopcorn\tprepared\twith\tfat;\tmuffins,\tnatural\tcereals\tand
|
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popcorn\tprepared\twith\tfat;\tmuffins,\tnatural\tcereals\tand\nbreads\tto\twhich\textra\tfat\tis\tadded\nCheese\nFat-free\tor\tlow-fat\tcottage\tcheese,\t¼\tc\tto\tbe\tused\tas\tsubstitute\nfor\t1\toz\tof\tcheese,\tor\tlow-fat\tcheeses\tcontaining\tless\tthan\t5%\nbutterfat\nWhole-milk\tcheeses\nDesserts\nSherbet\n\tmade\twith\tskim\tmilk;\tnonfat\tfrozen\tyogurt;\tnonfat
|
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0.06227455660700798,
0.09232695400714874,
0.03995353356003761,
0.10846914350986481,
0.0098416181281209
] |
Desserts\nSherbet\n\tmade\twith\tskim\tmilk;\tnonfat\tfrozen\tyogurt;\tnonfat\nfrozen\tnondairy\tdesserts;\tfruit\tice;\tsorbet;\tgelatin;\trice,\nbread,\tcornstarch,\ttapioca,\tor\tpudding\tmade\twith\tskim\tmilk;\nfruit\twhips\twith\tgelatin,\tsugar,\tand\tegg\twhite;\tfruit;\tangel\nfood\tcake;\tgraham\tcrackers;\tvanilla\twafers;\tmeringues
|
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] |
food\tcake;\tgraham\tcrackers;\tvanilla\twafers;\tmeringues\nCake,\tpie,\tpastry,\tice\tcream,\tor\tany\tdessert\tcontaining\nshortening,\tchocolate,\tor\tfats\tof\tany\tkind,\tunless\nespecially\n\tprepared\tusing\tpart\tof\tfat\tallowance\nEggs\nThree\tper\tweek\tprepared\tonly\twith\tfat\tfrom\tfat\tallowance;\tegg\nwhites\tas\tdesired;\tlow-fat\tegg\tsubstitutes
|
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] |
whites\tas\tdesired;\tlow-fat\tegg\tsubstitutes\nMore\tthan\tone/day\tunless\tsubstituted\tfor\tpart\tof\tthe\tmeat\nallowed\nFats
|
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] |
Choose\tup\tto\tthe\tlimit\tallowed\tamong\tthe\tfollowing\t(1\tserving\tin\nthe\tamount\tlisted\tequals\t1\tfat\tchoice):\n1\ttsp\tbutter\tor\tmargarine\n1\ttsp\tshortening\tor\toil\n1\ttsp\tmayonnaise\n2\ttsp\tItalian\tor\tFrench\tdressing\n1\tTbsp\treduced-fat\tsalad\tdressing\n1\tstrip\tcrisp\tbacon\n1/8\tavocado\t(4-inch\tdiameter)\n2\tTbsp\tlight\tcream\n1\tTbsp\theavy\tcream\n6\tsmall\tnuts
|
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2\tTbsp\tlight\tcream\n1\tTbsp\theavy\tcream\n6\tsmall\tnuts\n5\tsmall\tolives\nAny\tin\texcess\tof\tamount\tprescribed\ton\tdiet;\tall\tothers\nFruits\nAs\tdesired\nAvocado\tin\texcess\tof\tamount\tallowed\ton\tfat\tlist\nLean\tMeat,\tFish,\tPoultry,\tand\tMeat\tSubstitutes\nChoose\tup\tto\tthe\tlimit\tallowed\n\tamong\tthe\tfollowing:\tpoultry
|
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] |
Choose\tup\tto\tthe\tlimit\tallowed\n\tamong\tthe\tfollowing:\tpoultry\nwithout\tskin,\tfish,\tveal\t(all\tcuts),\tliver,\tlean\tbeef,\tpork,\tand\nlamb,\tall\twith\tvisible\tfat\tremoved—1\toz\tcooked\tweight\tequals\n1\tequivalent;\t¼\tc\twater-packed\ttuna\tor\tsalmon\tequals\n1\tequivalent;\ttofu\tor\ttempeh—3\toz\tequals\t1\tequivalent\nFried\tor\tfatty\tmeats,\tsausage,\tscrapple,\tfrankfurters,
|
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] |
Fried\tor\tfatty\tmeats,\tsausage,\tscrapple,\tfrankfurters,\npoultry\tskins,\tstewing\thens,\tspareribs,\tsalt\tpork,\tbeef\nunless\tlean,\tduck,\tgoose,\n\tham\thocks,\tpig’s\tfeet,\nluncheon\tmeats\t(unless\treduced\tfat),\tgravies\tunless\tfat\nfree,\ttuna\tand\tsalmon\tpacked\tin\toil,\tpeanut\tbutter\nMilk\nSkim,\tbuttermilk,\tor\tyogurt\tmade\tfrom\tskim\tmilk
|
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] |
Milk\nSkim,\tbuttermilk,\tor\tyogurt\tmade\tfrom\tskim\tmilk\nWhole,\t2%,\t1%,\tchocolate,\tbuttermilk\tmade\twith\twhole\nmilk\nSeasonings\nAs\tdesired\nNone\nSoups\nBouillon,\tclear\tbroth,\tfat-free\tvegetable\tsoup,\tcream\tsoup\tmade\nwith\tskim\tmilk,\tpackaged\tdehydrated\tsoups\nAll\n\tothers\nSweets\nJelly,\tjam,\tmarmalade,\thoney,\tsyrup,\tmolasses,\tsugar,\thard\tsugar
|
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] |
Jelly,\tjam,\tmarmalade,\thoney,\tsyrup,\tmolasses,\tsugar,\thard\tsugar\ncandies,\tfondant,\tgumdrops,\tjelly\tbeans,\tmarshmallows,\ncocoa\tpowder,\tfat-free\tchocolate\tsauce,\tred\tand\tblack\tlicorice\nAny\tcandy\tmade\twith\tchocolate,\tnuts,\tbutter,\tcream,\tor\tfat\nof\tany\tkind\nVegetables\nAll\tplainly\tprepared\tvegetables\nPotato\tchips;\tbuttered,\tau\tgratin,\tcreamed,\tor\tfried
|
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] |
Potato\tchips;\tbuttered,\tau\tgratin,\tcreamed,\tor\tfried\npotatoes\tand\tother\tvegetables\n\tunless\tmade\twith\nallowed\tfat;\tcasseroles\tor\tfrozen\tvegetables\tin\tbutter\nsauce\nDaily\tFood\tAllowances\tfor\t40-g\tFat\tDiet\nFood\nAmount\nApproximate\tFat\nContent\t(g)\nSkim\tmilk\n2\tc\tor\tmore\n0\nLean\tmeat,\tfish,\tpoultry\n6\toz\tor\t6\tequivalents\n18\nWhole\tegg\tor\tegg\tyolks\n3\tper\tweek
|
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] |
6\toz\tor\t6\tequivalents\n18\nWhole\tegg\tor\tegg\tyolks\n3\tper\tweek\n2\nVegetables\n3\tservings\tor\tmore,\tat\tleast\t1\tor\tmore\ndark\tgreen\tor\tdeep\tyellow\n0\nFruits\n3\tor\tmore\tservings,\tat\tleast\n\t1\tcitrus\n0\nBreads,\tcereals\nAs\tdesired,\tfat\tfree\n0\nFat\texchanges\n*\n4-5\texchanges\tdaily\n20-25\nDesserts\tand\tsweets\nAs\tdesired\tfrom\tpermitted\tlist\n0\nTotal\tFat\n38-43\n*
|
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] |
As\tdesired\tfrom\tpermitted\tlist\n0\nTotal\tFat\n38-43\n*\nFat\tcontent\tcan\tbe\treduced\tfurther\tby\treducing\tthe\tfat\texchanges.\t1\tfat\texchange\t=\t5\tg\tof\tfat.\nAfter\tcholecystectomy,\tpatients\tmay\texperience\tsymptoms\tof\tgastritis\tsecondary\tto\tduodenogastric\treflux\tof\tbile\nacids.\tThe\n\treflux\talso\tmay\tbe\tresponsible\tfor\tsymptoms\tin\tthis
|
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acids.\tThe\n\treflux\talso\tmay\tbe\tresponsible\tfor\tsymptoms\tin\tthis\t\npostcholecystectomy\tsyndrome\n.\tAt\tpresent,\tthere\nare\tno\twell-established\tpharmacologic\tapproaches\tin\tthe\tmanagement\tof\tpostcholecystectomy\tgastritis.\tThe\nsymptoms\tare\tnot\tcaused,\tbut\texacerbated,\tby\tthe\tcholecystectomy.\tThe\tuse\tof\tursodeoxycholic\tacid\tand\tvarious
|
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] |
Chinese\therbs\thave\tbeen\tsuggested\t(\nZhang\tet\tal,\t2017\n).\tHowever,\tefficacy\tof\ttheir\n\tuse\tis\tlimited.\tThe\taddition\tof\nsoluble\tfiber\tto\tthe\tdiet\tmay\tact\tas\ta\tsequestering\tagent\tand\tbind\tthe\tbile\tin\tthe\tstomach\tbetween\tmeals\tto\tavoid\ngastritis.\nChronic\tcholecystitis.
|
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] |
gastritis.\nChronic\tcholecystitis.\nPatients\twith\tchronic\tconditions\tmay\trequire\ta\tlong-term,\tlow-fat\tdiet\tthat\tcontains\t25%\tto\t30%\tof\ttotal\tkilocalories\nas\tfat\t(see\t\nTable\t28.7\n).\tStricter\tlimitation\tis\tundesirable\tbecause\tfat\tin\tthe\tintestine\tis\timportant\n\tfor\tsome\tstimulation
|
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for\tsome\tstimulation\nand\tdrainage\tof\tthe\tbiliary\ttract.\tAdditionally,\tsaturated\tfats\tshould\tbe\treplaced\twith\tfish\toil\tand\tpolyunsaturated\tfats\nto\treduce\tthe\trisk\tof\tgallstone\tformation\t(\nLee\tand\tJang,\t2012\n;\t\nStinton\tet\tal,\t2010\n;\t\nBerr\tet\tal,\t1992\n).\tThe\tdegree\tof
|
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-0.010322445072233677
] |
;\t\nStinton\tet\tal,\t2010\n;\t\nBerr\tet\tal,\t1992\n).\tThe\tdegree\tof\nfood\tintolerance\tvaries\twidely\tamong\tpersons\twith\tgallbladder\tdisorders;\tmany\tcomplain\tof\tfoods\tthat\tcause\nflatulence\tand\tbloating.\tFor\n\tthis\treason,\tit\tis\tbest\tto\tdetermine\twith\tthe\tpatient\twhich\tfoods\tshould\tbe\teliminated\n(see\t\nChapter\t27
|
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] |
(see\t\nChapter\t27\n\tfor\ta\tdiscussion\tof\tpotential\tgas-forming\tfoods).\tAdministration\tof\twater-soluble\tforms\tof\tfat-soluble\nvitamins\tmay\tbe\tof\tbenefit\tin\tpatients\twith\tchronic\tgallbladder\tconditions\tor\tin\tthose\tin\twhom\tfat\tmalabsorption\tis\nsuspected.\nCholangitis\nPathophysiology\tand\tmedical\tmanagement\nInflammation\n\tof\tthe\tbile\tducts\tis\tknown\tas
|
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] |
Inflammation\n\tof\tthe\tbile\tducts\tis\tknown\tas\t\ncholangitis\n.\tPatients\twith\tacute\tcholangitis\tneed\tresuscitation\twith\tfluids\nand\tbroad-spectrum\tantibiotics.\tIf\tthe\tpatient\tdoes\tnot\timprove\twith\tconservative\ttreatment,\tplacement\tof\ta\npercutaneous\tbiliary\tstent\tor\tcholecystectomy\tmay\tbe\tneeded.
|
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] |
Sclerosing\tcholangitis\tcan\tresult\tin\tsepsis\tand\tliver\tfailure.\tMost\tpatients\thave\tmultiple\tintrahepatic\tstrictures,\nwhich\n\tmakes\tsurgical\tintervention\tdifficult,\tif\tnot\timpossible.\tPatients\tare\tgenerally\ton\tbroad-spectrum\tantibiotics.\nPercutaneous\tductal\tdilation\tmay\tprovide\tshort-term\tbile\tduct\tpatency\tin\tsome\tpatients.\tWhen\tsepsis\tis\trecurrent,
|
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patients\tmay\trequire\tchronic\tantibiotic\ttherapy\t(see\t\nPrimary\tSclerosing\tCholangitis\n).\nComplementary\tand\tintegrative\tmedicine\tfor\tgallstones\nPatients\toften\tseek\tcomplementary\n\tand\tintegrative\tapproaches\tto\tgallbladder\tdisease,\tincluding\tvarious\tnutritional
|
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] |
supplements,\therbal\tmedications,\tand\tgallbladder\tflushes.\tVitamin\tC\tdeficiency\thas\tbeen\tlinked\tto\tgallstone\nformation\tin\tanimal\tmodels\t(\nJenkins,\t1978\n).\tThe\tdata\tin\thumans\tare\tlimited,\tbut\tvitamin\tC\tsupplementation\thas\tbeen\nassociated\twith\ta\tdecreased\trisk\tof\tgallstones\tin\tpostmenopausal\twomen\twho\tconsume\talcohol\t(\nSimon\tet\tal,\t1998\n)
|
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] |
Simon\tet\tal,\t1998\n)\nand\tmay\tprotect\tagainst\tgallstones\t(\nWalcher\tet\tal,\t2009\n).\tIn\ta\tcross-sectional\tstudy\tof\t582\telderly\tpeople,\thigher\ncirculating\tlevels\tof\tvitamin\tE\twas\tassociated\twith\ta\tlower\tprobability\tof\tgallstone\tdisease\t(\nWaniek\tet\tal,\t2018\n).
|
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] |
Waniek\tet\tal,\t2018\n).\nCholeretic\t(substances\tthat\tincrease\tthe\tvolume\tof\tsecretion\tof\tbile\tfrom\tthe\tliver)\therbs\tsuch\tas\tmilk\tthistle,\ndandelion\troot,\tartichoke,\tturmeric,\tgreater\tcelandine,\n\tand\tOregon\tgrape\tstimulate\tbile\tflow\tand\treduce\tthe\tamount
|
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] |
and\tOregon\tgrape\tstimulate\tbile\tflow\tand\treduce\tthe\tamount\nof\tcholesterol\tin\tbile.\tVarious\therbs\thave\tbeen\tsuggested\tas\ttreatment\toptions\tfor\tcholestasis\tand\tother\thepatobiliary\ndisorders\t(\nSpiridonov,\t2012\n).\tHowever,\tdata\tfrom\twell-conducted\trandomized\tcontrolled\ttrials\tis\tlimited.
|
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] |
The\tuse\tof\tacupuncture\thas\tbeen\tproposed\tfor\tthe\ttreatment\tof\tgallstones\t(\nMoga,\t2003\n).\tIt\tis\tthought\tthat\nacupuncture\n\taids\tin\tthe\tremoval\tof\tstones.\tHowever,\tit\tmay\tbe\tthat\tacupuncture\taids\tin\tthe\trelief\tof\tpain\tmore\tso\nthan\tthe\tremoval\tof\tstones.\nPhysiology\tand\tfunctions\tof\tthe\texocrine\tpancreas
|
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] |
Physiology\tand\tfunctions\tof\tthe\texocrine\tpancreas\nThe\tpancreas\tis\tan\telongated,\tflattened\tgland\tthat\tlies\tin\tthe\tupper\tabdomen\tbehind\tthe\tstomach.\tThe\thead\tof\tthe\npancreas\tis\tin\tthe\tright\tupper\tquadrant\tbelow\tthe\tliver\twithin\tthe\tcurvature\tof\tthe\tduodenum,\tand\tthe\n\ttapering\ttail\nslants\tupward\tto\tthe\thilum\tof\tthe\tspleen\t(see\t\nFig.\t28.6
|
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] |
slants\tupward\tto\tthe\thilum\tof\tthe\tspleen\t(see\t\nFig.\t28.6\n).\tThis\tglandular\torgan\thas\tan\tendocrine\tand\texocrine\nfunction.\tPancreatic\tcells\tmanufacture\tglucagon,\tinsulin,\tand\tsomatostatin\tfor\tabsorption\tinto\tthe\tbloodstream\n(endocrine\tfunction)\tfor\tregulation\tof\tglucose\thomeostasis\t(see\t\nChapter\t29\n).\tOther\tcells\tsecrete\tenzymes\tand\tother
|
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] |
Chapter\t29\n).\tOther\tcells\tsecrete\tenzymes\tand\tother\nsubstances\tdirectly\tinto\tthe\tintestinal\tlumen,\n\twhere\tthey\taid\tin\tdigesting\tproteins,\tfats,\tand\tcarbohydrates\t(exocrine\nfunction).\nIn\tmost\tpeople,\tthe\tpancreatic\tduct,\twhich\tcarries\tthe\texocrine\tpancreatic\tsecretions,\tmerges\twith\tthe\tcommon
|
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bile\tduct\tinto\ta\tunified\topening\tthrough\twhich\tbile\tand\tpancreatic\tjuices\tdrain\tinto\tthe\tduodenum\tat\tthe\tampulla\tof\nVater.\tMany\tfactors\tregulate\texocrine\tsecretion\tfrom\tthe\tpancreas.\tNeural\tand\thormonal\n\tresponses\tplay\ta\trole,\twith\nthe\tpresence\tand\tcomposition\tof\tingested\tfoods\tbeing\ta\tlarge\tcontributor.\tThe\ttwo\tprimary\thormonal\tstimuli\tfor
|
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] |
pancreatic\tsecretion\tare\tsecretin\tand\tCCK\t(see\t\nChapter\t1\n).\nFactors\tthat\tinfluence\tpancreatic\tsecretions\tduring\ta\tmeal\tcan\tbe\tdivided\tinto\tthree\tphases:\t(1)\tthe\tcephalic\tphase,\nmediated\tthrough\tthe\tvagus\tnerve\tand\tinitiated\tby\tthe\tsight,\tsmell,\ttaste,\tand\tanticipation\n\tof\tfood\tthat\tleads\tto\tthe
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of\tfood\tthat\tleads\tto\tthe\nsecretion\tof\tbicarbonate\tand\tpancreatic\tenzymes;\t(2)\tgastric\tdistention\twith\tfood\tinitiates\tthe\tgastric\tphase\tof\npancreatic\tsecretion,\twhich\tstimulates\tenzyme\tsecretion;\tand\t(3)\tthe\tintestinal\tphase,\tmediated\tby\tthe\trelease\tof\nCCK,\twith\tthe\tmost\tpotent\teffect.\nDiseases\tof\tthe\texocrine\tpancreas\nPancreatitis
|
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] |
Diseases\tof\tthe\texocrine\tpancreas\nPancreatitis\nPathophysiology\tand\tmedical\tmanagement\nPancreatitis\n\tis\n\tan\tinflammation\tof\tthe\tpancreas\tand\tis\tcharacterized\tby\tedema,\tcellular\texudate,\tand\tfat\tnecrosis.\nThe\tdisease\tcan\trange\tfrom\tmild\tand\tself-limiting\tto\tsevere,\twith\ttissue\tautodigestion,\tnecrosis,\tand\themorrhage\tof
|
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] |
pancreatic\ttissue.\tVarious\tprognostic\tscoring\tsystems\thave\tbeen\tdeveloped\tsuch\tas\tRanson,\tacute\tphysiology\tand\nchronic\thealth\tevaluation\t(APACHE)-II,\tbedside\tindex\tfor\tseverity\tin\tacute\n\tpancreatitis\t(BISAP)\tscores,\tand\tcomputed\ntomography\tseverity\tindex\t(CTSI)\t(\nBanks\tet\tal,\t2013\n;\t\nRanson,\t1974\n;\t\nLarvin\tand\tMcMahon,\t1989\n;\t\nBalthazar\tet\tal,
|
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] |
;\t\nRanson,\t1974\n;\t\nLarvin\tand\tMcMahon,\t1989\n;\t\nBalthazar\tet\tal,\n1990\n;\t\nWu\tet\tal,\t2008\n;\t\nPetrov\tet\tal,\t2009\n).\tThese\tcan\thelp\tpredict\tthe\tmortality\tof\tacute\tpancreatitis\t(\nCho\tet\tal,\t2015\n).\nThere\tmay\tbe\tdifferences\tin\tthese\tscores\tbut\tthey\thelp\tto\tpredict\tthe\tseverity\tof\tthe\tdisease.\tPancreatitis\tis\tclassified\nas
|
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] |
as\n\teither\tacute\tor\tchronic,\tthe\tlatter\twith\tpancreatic\tdestruction\tso\textensive\tthat\texocrine\tand\tendocrine\tfunction\nare\tseverely\tdiminished,\tand\tmaldigestion\tand\tdiabetes\tmellitus\tmay\tresult.\nThe\tsymptoms\tof\tpancreatitis\tcan\trange\tfrom\tcontinuous\tor\tintermittent\tpain\tof\tvarying\tintensity\tto\tsevere\tupper
|
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] |
abdominal\tpain,\twhich\tmay\tradiate\tto\tthe\tback.\tSymptoms\tmay\tworsen\twith\tthe\tingestion\tof\tfood.\n\tClinical\npresentation\talso\tmay\tinclude\tnausea,\tvomiting,\tabdominal\tdistention,\tand\tsteatorrhea.\tSevere\tcases\tare\ncomplicated\tby\thypotension,\toliguria,\tand\tdyspnea.\tThere\tis\textensive\tdestruction\tof\tpancreatic\ttissue\twith
|
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0.08151164650917053,
0.060437075793743134,
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0.040244437754154205,
0.03661022335290909,
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0.041511472314596176,
0.0637749657034874,
0.021058958023786545,
0.007463847752660513,
0.04236719012260437,
0.049817029386758804,
0.10577648878097534,
0.07126748561859131,
-0.008770037442445755
] |
subsequent\tfibrosis,\tenzyme\tproduction\tis\tdiminished,\tand\tserum\tamylase\tand\tlipase\tmay\tappear\tnormal.\tHowever,\nabsence\tof\tenzymes\tto\taid\tin\tthe\tdigestion\tof\tfood\tleads\tto\tsteatorrhea\n\tand\tmalabsorption.\t\nTable\t28.9\n\tdescribes\nseveral\ttests\tused\tto\tdetermine\tthe\textent\tof\tpancreatic\tdestruction.\nTABLE\t28.9\nSome\tTests\tof\tPancreatic\tFunction\nTest
|
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0.0510173961520195,
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0.09261082112789154,
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0.0009590062545612454,
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0.08631927520036697,
0.048078183084726334,
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0.08478377014398575,
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0.12265640497207642,
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0.02745210751891136,
0.0796043798327446,
0.046932753175497055,
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0.11463452875614166,
0.09833560138940811,
0.08900485932826996,
-0.059644632041454315
] |
TABLE\t28.9\nSome\tTests\tof\tPancreatic\tFunction\nTest\nSignificance\nSecretin\nstimulation\ntest\nMeasures\tpancreatic\tsecretion,\tparticularly\tbicarbonate,\tin\tresponse\tto\tsecretin\tstimulation\nGlucose\ntolerance\ntest\nAssesses\tendocrine\tfunction\tof\tthe\tpancreas\tby\tmeasuring\tinsulin\tresponse\n\tto\ta\tglucose\tload\n72-hr\tstool\tfat\ntest
|
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to\ta\tglucose\tload\n72-hr\tstool\tfat\ntest\nAssesses\texocrine\tfunction\tof\tthe\tpancreas\tby\tmeasuring\tfat\tabsorption\tthat\treflects\tpancreatic\tlipase\nsecretion\nFecal\telastase\nEnzyme\tmost\tcommonly\tused\tto\tdetermine\tpancreatic\tfunction;\tindirect\ttest.\tLevels\t>200\tmcg/g\tare
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0.10841917991638184,
0.058319997042417526,
0.13017474114894867,
0.056218549609184265,
-4.755488447472089e-8,
0.005734735168516636,
-0.059216734021902084,
0.025895949453115463,
-0.029932789504528046,
0.0253151748329401,
0.02553165890276432,
0.04875725880265236,
0.04910551756620407,
-0.016030682250857353,
-0.11723920702934265,
0.024932315573096275,
0.07013216614723206,
-0.05099644511938095,
-0.01797497645020485,
0.08404091745615005,
0.06525071710348129,
-0.08282435685396194,
0.05780651792883873,
-0.059515196830034256,
-0.07931406795978546,
-0.015050424262881279,
0.0652056336402893,
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0.039073605090379715,
0.019771497696638107,
-0.0038893483579158783,
0.026937277987599373,
0.08443470299243927,
0.03417760878801346,
-0.008354542776942253,
0.06401457637548447,
-0.055898267775774,
0.0002874248893931508,
-0.03168020397424698,
-0.020158713683485985,
0.0640939474105835,
-0.022688888013362885,
-0.04599893465638161,
-0.03136160224676132,
0.09413427114486694,
0.015585321001708508,
-0.0027385158464312553,
-0.04276750609278679,
0.053543899208307266,
0.047378648072481155,
-0.07907009869813919,
-0.05071283504366875,
0.08411286771297455,
-0.012778808362782001,
-0.04531605914235115,
0.011054948903620243,
0.1051444560289383,
-0.05044777691364288,
-0.001869369181804359,
-0.039255883544683456,
0.017068328335881233,
0.035239871591329575,
0.04954575374722481,
0.03815045207738876,
0.011260919272899628,
0.05055658891797066,
0.08794303983449936,
0.1274077594280243,
-0.06750395148992538
] |
considered\tnormal;\tconcentration\t<15\tmcg/g\tof\tfeces\tconsistent\twith\tpancreatic\texocrine\tinsufficiency\nMedical\tnutrition\n\ttherapy\nAlcohol\tuse,\tsmoking,\tbody\tweight,\tdiet,\tgenetic\tfactors,\tand\tmedications\taffect\tthe\trisk\tof\tdeveloping\tpancreatitis.
|
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0.04307613894343376,
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0.002754917833954096,
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0.0021563246846199036,
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0.032283615320920944,
0.004841198213398457,
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0.0758664458990097,
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0.07438423484563828,
0.08890519291162491,
0.050953228026628494,
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] |
Thus\tdiet\tmodification\thas\tan\timportant\trole\tafter\tdiagnosis.\tDietary\trecommendations\tdiffer,\tdepending\ton\twhether\nthe\tcondition\tis\tacute\tor\tchronic.\tObesity\tappears\tto\tbe\ta\trisk\tfactor\tfor\tthe\tdevelopment\tof\tpancreatitis\tand\tfor
|
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] |
increased\tseverity\t(\nMartinez\tet\tal,\t2004\n;\t\nKatuchova\tet\tal,\t2014\n).\nDepressed\tserum\tcalcium\tlevels\tare\tcommon.\tHypoalbuminemia\toccurs,\twith\tsubsequent\tedema\t(also\tknown\tas\nthird\tspacing\tof\tfluid).\tThe\tcalcium,\twhich\tis\tbound\tto\talbumin,\tis\tthus\taffected\tand\tmay\tappear\tartificially\tlow.
|
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] |
Another\toccurrence\tis\t“soap”\tformation\tin\tthe\tgut\tby\tcalcium\tand\tfatty\tacids,\tcreated\tby\tthe\tfat\tnecrosis\tthat\tresults\nin\tless\tcalcium\tabsorption.\tChecking\tan\tionized\tcalcium\n\tlevel\tis\ta\tmethod\tof\tdetermining\tavailable\tcalcium.\nAcute\tpancreatitis.
|
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Acute\tpancreatitis.\nPain\tassociated\twith\tacute\tpancreatitis\t(AP)\tis\tpartially\trelated\tto\tthe\tsecretory\tmechanisms\tof\tpancreatic\tenzymes\nand\tbile.\tTherefore,\tnutrition\ttherapy\tis\tadjusted\tto\tprovide\tminimum\tstimulation\tof\tthese\tsystems\t(\nInternational\nAssociation\tof\tPancreatology,\t2013\n)\t(see\t\nPathophysiology\tand\tCare\tManagement\tAlgorithm:
|
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] |
)\t(see\t\nPathophysiology\tand\tCare\tManagement\tAlgorithm:\n\tPancreatitis\n).\tThe\tbasis\nfor\tnutrition\ttherapy\tis\tto\tput\tthe\tpancreas\t“at\trest.”\tIn\tpatients\twith\tAP,\tearly\t(within\t24\thours)\toral\tfeeding\tas\ntolerated\tshould\tbe\tinitiated\trather\tthan\tkeeping\tthe\tpatient\tnil\tper\tos\t(NPO,\tnothing\tby\tmouth)\t(\nCrockett\tet\tal,\n2018\n;\t\nVege\tet\tal,\t2018
|
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] |
Crockett\tet\tal,\n2018\n;\t\nVege\tet\tal,\t2018\n).\tSuccess\tof\tearly\tfeeding\thas\tbeen\tdemonstrated\tusing\ta\tvariety\tof\tdiets,\tincluding\tlow\tfat,\nnormal\tfat\tcontent,\tand\tsoft\tor\tsolid\n\tconsistency,\tand\tthus\tstarting\twith\ta\tclear\tliquid\tdiet\tis\tnot\trequired\t(\nLankisch\tet\nal,\t2015
|
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Lankisch\tet\nal,\t2015\n).\tEarly\tfeeding\tis\tnot\tsuccessful\tin\tall\tAP\tdue\tto\tpain,\tvomiting,\tor\tileus\t(lack\tof\tperistalsis\tin\tthe\tgut),\tand\nfeeding\tmay\tneed\tto\tbe\tdelayed\tbeyond\t24\thours\tin\tsome\tcases.\tSome\tpatients\twho\tare\tintolerant\tof\toral\tfeeding\nmay\trequire\tplacement\tof\tan\tenteral\ttube\tfor\tnutritional\tsupport.\tThe\tdiet\tusually
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0.0734516829252243,
0.09100055694580078,
0.045634426176548004,
0.003994053695350885
] |
is\tprogressed\tas\ttolerated\tto\teasily\ndigested\tfoods\twith\ta\tlow-fat\tcontent\twith\tmore\tfat\tadded\tas\ttolerated.\tFoods\tmay\tbe\tbetter\ttolerated\tif\tthey\tare\ndivided\tinto\tsix\tsmall\tmeals\t(see\t\nTable\t28.8\n).\nSevere\tacute\tpancreatitis\t(SAP)\tresults\tin\ta\thypermetabolic,\tcatabolic\tstate\twith\timmediate\tmetabolic\talterations
|
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] |
in\tthe\tpancreas\tand\tin\tremote\torgans.\tMetabolic\tdemands\tare\tsimilar\tto\tthose\tof\tsepsis.\n\tAmino\tacids\tare\treleased\nfrom\tmuscle\tand\tused\tfor\tgluconeogenesis.\tThese\tpatients\toften\texhibit\tsigns\tof\tstress-induced\tmalnutrition\tsuch\tas\ndecreased\tserum\tlevels\tof\talbumin,\ttransferrin,\tand\tlymphocytes\treflecting\tthe\tinflammatory\tresponse\t(see\t\nChapter\n7
|
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] |
Chapter\n7\n).\tSAP\tis\tassociated\twith\tsignificant\tmorbidity\tand\tmortality.\tThese\tpatients\toften\tdevelop\tcomplications\tsuch\tas\nfluid\tcollections,\tpseudocysts,\n\tpancreatic\tnecrosis,\tand\tinfection\tor\tmultisystem\torgan\tfailure.\nThe\toptimal\troute\tand\ttiming\tof\tnutrition\tin\tSAP\thas\tbeen\tthe\tsubject\tof\tmuch\tcontroversy.\tPN\tand\tEN\tare\tequally
|
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] |
effective\tin\tterms\tof\tdays\tto\tnormalization\tof\tserum\tamylase\tlevels,\tdays\tto\tresumption\tof\toral\tfeeding,\tdays\tto\tclear\nnosocomial\tinfections,\tand\tthe\tclinical\toutcome\tin\tpatients\twith\tmild\tto\tmoderate\tpancreatitis\t(\nWu\tet\tal,\t2014\n).\tThe\nfavorable\teffect\tof\teither\tEN\tor\tPN\ton\tpatient\toutcome\tmay\tbe\tenhanced\tby\tsupplementation\twith\tmodulators\tof
|
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] |
inflammation\tsuch\tas\targinine,\tglutamine,\tomega-3\tfatty\tacids,\tor\tprobiotics\tand\tsystemic\timmunity\t(\nMcClave\tet\tal,\n2006\n;\t\nMcClave\tet\tal,\t2016\n)\t(see\t\nChapter\t7\n).\tHowever,\tfailure\tto\tuse\tthe\tGIT\tin\tpatients\twith\tSAP\tmay\texacerbate\tthe\nstress\tresponse\tand\tdisease\tseverity,\tleading\tto\tmore\n\tcomplications\tand\tprolonged\thospitalization;\tthus\tEN\tis
|
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] |
complications\tand\tprolonged\thospitalization;\tthus\tEN\tis\npreferred\tfor\tnutrition\ttherapy\t(\nAl-Omran\tet\tal,\t2010\n;\t\nMcClave,\t2013\n;\t\nMirtallo\tet\tal,\t2012\n;\t\nCrockett\tet\tal,\t2018\n;\t\nVege\net\tal,\t2018\n).\tSome\tdata\tsupport\tthe\tuse\tof\tearly\tEN\tin\tAP\t(\nZou\tet\tal,\t2014\n).\tIn\ta\tmeta-analysis\tof\tobservational\tdata
|
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] |
Zou\tet\tal,\t2014\n).\tIn\ta\tmeta-analysis\tof\tobservational\tdata\nfrom\tindividuals\twith\tAP,\tstarting\tEN\twithin\t24\thours\tafter\thospital\tadmission,\tcompared\twith\tafter\t24\n\thours,\twas\nassociated\twith\ta\treduction\tin\tcomplications\t(\nBakker\tet\tal,\t2014\n).\tEarly\tEN\tin\tpatients\twith\tAP\tmay\treduce\tlength\tof
|
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).\tEarly\tEN\tin\tpatients\twith\tAP\tmay\treduce\tlength\tof\nhospital\tstay\twithout\tadverse\tevents\tfor\tpatients\twith\tmild\tto\tmoderate\tpancreatitis\t(\nVaughn\tet\tal,\t2017\n).\tIn\tanother\nmeta-analysis,\tearly\tEN\twas\tassociated\twith\ta\tsignificant\tdecrease\tin\tthe\tincidence\tof\tmultiple\torgan\tfailure\tbut\twas\nnot\tsignificant\tfor\tother\tcomplications
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] |
not\tsignificant\tfor\tother\tcomplications\n\tand\tmortality\tcompared\twith\tdelayed\tEN\t(\nFeng\tet\tal,\t2017\n).\nNasogastric\tEN\thas\tbeen\tshown\tto\tbe\tefficacious\tin\tSAP\t(\nNally\tet\tal,\t2014\n).\tHowever,\tto\tminimize\tpancreatic\nstimulation\tit\tis\tbest\tto\tplace\tjejunal\tfeeding\ttubes\tendoscopically\tas\tfar\tdown\tthe\tintestine\tas\tpossible,\tgenerally
|
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] |
more\tthan\t40\tcm\tpast\tthe\tligament\tof\tTreitz\t(\nO’Keefe\tet\tal,\t2001\n).\nEN\tresults\tin\ta\tsubstantial\tcost\tsavings\twith\n\tfewer\tseptic\tcomplications\tand\toverall\treduction\tof\tmorbidity\tand\nmortality\t(\nPetrov\tet\tal,\t2008\n;\t\nSun\tet\tal,\t2013\n).\tThe\tlocation\tof\tthe\tfeeding\tand\tthe\tcomposition\tof\tthe\tformula\tis
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).\tThe\tlocation\tof\tthe\tfeeding\tand\tthe\tcomposition\tof\tthe\tformula\tis\nthought\tto\tdetermine\tthe\tdegree\tof\tpancreatic\tstimulation.\tInfusion\tinto\tthe\tjejunum\teliminates\tthe\tcephalic\tand\ngastric\tphases\tof\texocrine\tpancreatic\tstimulation\twhich\tis\toptimal\tin\tAP.\tThe\tuse\tof\tjejunal\tfeedings\n\tmay\tbe\tbetter
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may\tbe\tbetter\ntolerated\tand\tallow\tfor\tan\tincrease\tin\tthe\tamount\tof\tnutrition\tthat\tis\tdelivered\tin\tthe\tface\tof\tAP.\tHowever,\tno\ncontrolled\ttrial\thas\tclearly\tdemonstrated\ta\tsignificant\timprovement\tof\tfeeding\ttolerance,\tmortality,\tor\tlength\tof\nintensive\tcare\tunit\t(ICU)\tstay\twith\tthe\tuse\tof\tjejunal\tfeeding\tcompared\twith\tgastric\tfeedings\t(
|
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] |
Zhang\tet\tal,\t2013\n).\nBecause\tthe\tplacement\tof\ta\tnasogastric\tfeeding\n\ttube\tis\teasier\tthan\ta\tjejunal\ttube,\tit\tis\treasonable\tto\tconsider\tgastric\nfeedings\tfor\tAP\tand\treserve\tjejunal\tfeedings\tfor\tthose\twho\tare\tintolerant\tto\tgastric\tfeeding\t(\nPetrov,\t2014\n).\tFor\tthose
|
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] |
Petrov,\t2014\n).\tFor\tthose\npatients\twith\tSAP\tcomplicated\tby\torgan\tfailure,\tpancreatic\tnecrosis,\tor\tfluid\tcollections,\tnasojejunal\tfeeding\tis\tthe\npreferred\tmethod\tof\tdelivery\t(\nSeminerio\tand\tO’Keefe,\t2014\n)\tto\tminimize\tpancreatic\tstimulation\n\t(see\t\nChapter\t12\n\tfor\njejunal\tfeeding\tdetails).
|
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] |
(see\t\nChapter\t12\n\tfor\njejunal\tfeeding\tdetails).\nAlthough\tvarious\tformulations\thave\tbeen\tused\tin\tpancreatitis,\tno\tstudies\thave\tdetermined\tthe\trelative\tmerits\tof\nstandard,\tpartially\tdigested,\telemental,\tor\t“immune-enhanced”\tformulations.\tPolymeric\tformulas\tinfused\tat\tvarious
|
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] |
sections\tof\tthe\tgut\tstimulate\tthe\tpancreas\tmore\tthan\telemental\tand\thydrolyzed\tformulas.\tPeptide-based\tformula\tcan\nbe\tused\tsafely\n\tand\tstandard\tformulas\tcan\tbe\ttried\tif\tthe\tpatient\tis\ttolerant\t(\nMirtallo\tet\tal,\t2012\n).\tClose\tobservation\nfor\tpatient\ttolerance\tis\timportant.\tTolerance\tmay\tbe\tenhanced\twith\tthe\tuse\tof\tsupplemental\tpancreatic\tenzymes
|
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] |
during\tenteral\tfeeding\t(\nBerry,\t2014\n).\tThese\tcan\tbe\tprovided\tby\tmouth,\tmixed\twith\twater\tand\tdelivered\tvia\tthe\nfeeding\ttube,\tor\tadded\tdirectly\tto\tthe\tenteral\tformula.\tAn\tenteral\tin-line\n\tlipase\tcartridge\tis\talso\tavailable\twhich\thas\nbeen\tshown\tto\thydrolyze\ta\tmajority\tof\tthe\tfat\tin\tEN\tformulas\tto\tmonoglycerides\tand\tfree\tfatty\tacids\t(\nFreedman,\n2017
|
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] |
Freedman,\n2017\n).\tWhen\tthe\tpatient\tis\tallowed\tto\teat,\tsupplemental\tpancreatic\tenzymes\tmay\talso\tbe\trequired\tto\ttreat\nsteatorrhea.\tIn\tsevere,\tprolonged\tcases,\tPN\tmay\tbe\tnecessary.\nPatients\twith\tmild\tto\tmoderate\tstress\tcan\ttolerate\tdextrose-based\tsolutions,\n\twhereas\tpatients\twith\tmore\tsevere
|
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] |
whereas\tpatients\twith\tmore\tsevere\nstress\trequire\ta\tmixed\tfuel\tsystem\tof\tdextrose\tand\tlipid\tto\tavoid\tcomplications\tof\tglucose\tintolerance.\tLipid\temulsion\nshould\tnot\tbe\tincluded\tin\ta\tPN\tregimen\tif\thypertriglyceridemia\tis\tthe\tcause\tof\tthe\tpancreatitis\t(\nPatel\tet\tal,\t2014\n).\tA
|
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] |
Patel\tet\tal,\t2014\n).\tA\nserum\ttriglyceride\tlevel\tshould\tbe\tobtained\tbefore\tlipid-containing\tPN\tis\tinitiated.\tLipids\tmay\tbe\tshould\tonly\tgiven\tto\npatients\n\twith\ttriglyceride\tvalues\tless\tthan\t400\tmg/dL.\tBecause\tof\tthe\tpossibility\tof\tpancreatic\tendocrine\nabnormalities\tand\ta\trelative\tinsulin\tresistance,\tclose\tglucose\tmonitoring\talso\tis\twarranted.\tH\n2
|
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] |
2\n-receptor\tantagonists\nmay\tbe\tprescribed\tto\tdecrease\thydrochloric\tacid\tproduction,\twhich\treduce\tstimulation\tof\tthe\tpancreas.\tThe\thormone\nsomatostatin\tis\tconsidered\tthe\tbest\tinhibitor\tof\tpancreatic\tsecretion\n\tand\tmay\tbe\tused\tin\tconjunction\twith\tPN.\nChronic\tpancreatitis.
|
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] |
and\tmay\tbe\tused\tin\tconjunction\twith\tPN.\nChronic\tpancreatitis.\nIn\tcontrast\tto\tSAP,\tchronic\tpancreatitis\t(CP)\tevolves\tinsidiously\tover\tmany\tyears.\tCP\tis\tcharacterized\tby\trecurrent\nattacks\tof\tepigastric\tpain\tof\tlong\tduration\tthat\tmay\tradiate\tinto\tthe\tback.\tThe\tpain\tcan\tbe\tprecipitated\tby\tmeals.
|
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] |
Associated\tnausea,\tvomiting,\tor\tdiarrhea\tmake\tit\tdifficult\tto\tmaintain\tadequate\tnutrition\tstatus\t(\nVerhaeqh\tet\tal,\n2013\n).\nPatients\twith\tCP\tare\tat\tincreased\trisk\tof\tdeveloping\tprotein-calorie\tmalnutrition\tbecause\tof\tpancreatic\ninsufficiency\tand\tinadequate\toral\tintake.\tPatients\twith\tCP\tadmitted\tto\ta\ttertiary\tcare\tcenter\tusually\thave
|
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] |
malnutrition,\tincreased\tenergy\trequirements,\tweight\tloss,\tdeficits\tof\tlean\tmuscle\tand\tadipose\ttissue,\tvisceral\tprotein\ndepletion,\timpaired\timmune\tfunction,\tand\tvitamin\tdeficiencies\t(\nDuggan\tet\tal,\t2014\n).
|
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] |
The\tobjective\tof\ttherapy\tfor\tpatients\tis\tto\tprevent\tfurther\tdamage\tto\tthe\tpancreas,\tdecrease\tthe\tnumber\tof\tattacks\nof\tacute\tinflammation,\talleviate\tpain,\tdecrease\tsteatorrhea,\tand\tcorrect\tmalnutrition.\tDietary\tintake\tshould\tbe\tas\nliberal\tas\tpossible,\tbut\tmodifications\tmay\tbe\tnecessary\tto\tminimize\tsymptoms.
|
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] |
The\tfirst\tgoal\tof\tMNT\tis\tto\tprovide\toptimal\tnutrition\tsupport,\tand\tthe\tsecond\tis\tto\n\tdecrease\tpain\tby\tminimizing\nstimulation\tof\tthe\texocrine\tpancreas.\tBecause\tCCK\tstimulates\tsecretion\tfrom\tthe\texocrine\tpancreas,\tone\tapproach\tis\nto\tdecrease\tCCK\tlevels.\tIf\tpostprandial\tpain\tis\ta\tlimiting\tfactor,\talternative\tenteral\ttherapies,\tsuch\tas\tfeeding\tbeyond
|
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the\tligament\tof\tTreitz,\tthat\tminimally\tstimulate\tthe\tpancreas\tare\twarranted.\tNutrition\tcounseling,\tantioxidants,\tand\npancreatic\tenzymes\n\tmay\tplay\ta\trole\tin\teffective\tmanagement\tof\tCP\tas\twell\t(\nAfghani\tet\tal,\t2014\n).\nWhen\tpancreatic\tfunction\tis\tdiminished\tby\tapproximately\t90%,\tenzyme\tproduction\tand\tsecretion\tare\tinsufficient;
|
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] |
maldigestion\tand\tmalabsorption\tof\tprotein\tand\tfat\tthus\tbecome\ta\tproblem.\tIn\tgeneral,\tlarge\tmeals\twith\thigh-fat\nfoods\tand\talcohol\tshould\tbe\tavoided.\tHowever,\tthere\tis\ta\tlot\tof\tvariation\tamong\tthese\tpatients\tand\n\tthe\tdiet\tshould\tbe\nliberalized\tas\tmuch\tas\tpossible.\tFor\texample,\ta\tgradual\tincrease\tin\tthe\tamount\tof\tfat\tand\tsize\tof\tthe\tmeal\tis\tpossible
|
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] |
in\tsome\tpatients.\nThe\tpatient\tmay\tpresent\twith\tweight\tloss\tdespite\tadequate\tenergy\tintake\tand\twill\tcomplain\tof\tbulky,\tgreasy\tstools.\nThis\tis\tdefinitely\tthe\tcase\twith\tidiopathic\tCP\tassociated\twith\ta\tcystic\tfibrosis\tgene\tmutation;\ttherapies\tdirected\ntoward\tcystic\n\tfibrosis\tmay\tbenefit\tthese\tpatients\t(see\t\nChapter\t33
|
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] |
toward\tcystic\n\tfibrosis\tmay\tbenefit\tthese\tpatients\t(see\t\nChapter\t33\n).\tOf\tthese\ttherapies,\tpancreatic\tenzyme\nreplacement\thas\tbeen\tshown\tto\tbe\tefficacious\t(\nde\tla\tIglesia-Garcia\tet\tal,\t2016\n).\tPancreatic\tenzyme\treplacements\tare\ngiven\torally\twith\tmeals;\tthe\tdosage\tshould\tbe\tat\tleast\t30,000\tunits\tof\tlipase\twith\teach\tmeal.\tTo\tpromote\tweight\tgain,
|
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] |
the\tlevel\tof\tfat\tin\tthe\tdiet\tshould\tbe\tthe\tmaximum\ta\tpatient\tcan\ttolerate\n\twithout\tincreased\tsteatorrhea\tor\tpain.\nAdditional\ttherapies\tto\tmaintain\tnutrition\tstatus\tand\tminimize\tsymptoms\tin\tpatients\twith\tmaximum\tenzyme\nsupplementation\tinclude\ta\tlower-fat\tdiet\t(40\tto\t60\tg/day)\t(see\t\nTable\t28.7\n)\tor\tsubstitution\tof\tsome\tdietary\tfat\twith
|
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] |
Table\t28.7\n)\tor\tsubstitution\tof\tsome\tdietary\tfat\twith\nMCT\toil\tto\timprove\tfat\tabsorption\tand\tweight\tgain\t(see\t\nChapter\t12\n).\tA\tlower-fat\tdiet,\tprimarily\tfrom\tvegetable-based\noils\tsuch\tas\tolive\n\toil\tmay\thelp\treduce\tpain\tand\tease\tnausea\tas\twell\tas\teating\tsmall\tfrequent\tmeals.\tTrans\tfatty\tacids,
|
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0.06633147597312927,
0.07435783743858337,
0.004218170884996653
] |
found\tin\tcommercially\tbaked\tgoods\tand\tother\tprocessed\tfoods,\tcan\tincrease\tinflammation\tand\tare\tnot\trecommended.\nMalabsorption\tof\tthe\tfat-soluble\tvitamins\tmay\toccur\tin\tpatients\twith\tsignificant\tsteatorrhea.\tAlso,\tdeficiency\tof\npancreatic\tprotease,\tnecessary\tto\tcleave\tvitamin\tB\n12\n\tfrom\tits\tcarrier\n\tprotein,\tpotentially\tcould\tlead\tto\tvitamin\tB\n12
|
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] |
12\n\tfrom\tits\tcarrier\n\tprotein,\tpotentially\tcould\tlead\tto\tvitamin\tB\n12\ndeficiency.\tAppropriate\tsupplemental\tenzyme\ttherapy\twill\timprove\tvitamin\tabsorption;\thowever,\tthe\tpatient\tshould\ncontinue\tto\tbe\tmonitored\tperiodically\tfor\tvitamin\tdeficiencies.\tWater-miscible\tforms\tof\tthe\tfat-soluble\tvitamins\tor\nparenteral\tadministration\tof\tvitamin\tB\n12
|
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] |
parenteral\tadministration\tof\tvitamin\tB\n12\n\tmay\tbe\tnecessary.\tSome\tevidence\tindicates\tthat\tincreasing\tintake\tof\nantioxidants\n\t(found\tin\tfruits\tand\tvegetables)\tmay\thelp\tprotect\tagainst\tpancreatitis\tor\talleviate\tsymptoms\tof\tthe\ncondition\t(\nAhmed\tet\tal,\t2014\n).
|
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] |
condition\t(\nAhmed\tet\tal,\t2014\n).\nBecause\tpancreatic\tbicarbonate\tsecretion\tis\tfrequently\tdefective,\tmedical\tmanagement\talso\tmay\tinclude\nmaintenance\tof\tan\toptimal\tintestinal\tpH\tto\tfacilitate\tenzyme\tactivation.\tAntacids,\tH\n2\n-receptor\tantagonists,\tor\tproton\npump\tinhibitors\tthat\treduce\tgastric\tacid\tsecretion\n\tmay\tbe\tused\tto\tachieve\tthis\teffect.
|
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] |
may\tbe\tused\tto\tachieve\tthis\teffect.\nIn\tCP\twith\textensive\tpancreatic\tdestruction,\tthe\tinsulin-secreting\tcapacity\tof\tthe\tpancreas\tdecreases,\tand\tglucose\nintolerance\tdevelops.\tTreatment\twith\tinsulin\tand\tnutrition\ttherapy\tis\tthen\trequired\t(see\t\nChapter\t29\n).\tManagement\tis\ndelicate\tand\tshould\tfocus\ton\tcontrol\tof\tsymptoms\trather\tthan\tnormoglycemia.
|
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Effort\tshould\tbe\tmade\tto\tcater\tto\tthe\tpatient’s\ttolerances\n\tand\tpreferences\tfor\tnutritional\tmanagement;\thowever,\nalcohol\tis\tdiscouraged\tbecause\tof\tthe\tpossibility\tof\texacerbating\tthe\tpancreatic\tdisease.\tThere\tis\tevidence\tthat\tthe\nprogressive\tdestruction\tof\tthe\tpancreas\twill\tbe\tslowed\tin\tthe\talcoholic\tpatient\twho\tabstains\tfrom\talcohol\t(\nNordback
|
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Nordback\net\tal,\t2008\n;\t\nYadav\tet\tal,\t2009\n).\nComplementary\tand\tintegrative\tmedicine\tfor\tpancreatic\tdisorders\nThe\trole\n\tof\tcomplementary\tand\tintegrative\tmedicine\tin\tthe\ttreatment\tof\tpancreatic\tdisorders\tremains\tunclear\n(\nSaxena\tet\tal,\t2014\n).\tOver\tthe\tcounter\tdigestive\tenzymes\tare\tsometimes\tused\twith\tpancreatic\tdisease,\tbut\ttheir\tuse
|
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is\tnot\tsupported\tby\tevidenced-based\tresearch,\tthe\tcomposition\tis\toften\tnot\tguaranteed\tdue\tto\tthe\tway\tthey\tare\nregulated,\tthey\tcan\tbe\tcostly,\tand\tthey\tare\toften\tinactivated\tin\tthe\tstomach\n\tdue\tto\tthe\tpH.\tThe\tstandard\tof\tcare\tin\npancreatic\tdisease\tis\tprescription\tpancreatic\tenzymes\tsuch\tas\tCreon\t(\nNatural\tMedicines\tDatabase,\t2019\n).\tThere\tis
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] |
Natural\tMedicines\tDatabase,\t2019\n).\tThere\tis\nlittle\tto\tno\tresearch\ton\tintegrative\tapproaches\tfor\tpancreatic\tdisease.\tIn\tChina,\tthere\tare\tsome\tstudies\tinvolving
|
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] |
herbal\tpreparations,\tmany\tof\twhich\tare\tnot\treadily\tavailable\tin\tother\tcountries.\tSome\tof\tthe\tstudies\tare\tnon-\nrandomized\tand\tnon-controlled.\n\tFor\ttraditional\tChinese\tinterventions,\tconsider\treferring\tpatients\tto\ta\tlicensed\nChinese\tmedicine\tprovider\tor\tlicensed\tacupuncturist.\tBecause\tchronic\tpancreatitis\tis\tan\tinflammatory\tcondition,\tone
|
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of\tthe\tmost\tcommon\tintegrative\tapproaches\tis\ta\tnutritionally\tadequate\tanti-inflammatory\tdiet\t(see\t\nAppendix\t22\n\tand\nchapter\t7\n),\talthough\tthere\tis\tno\tdirect\tscientific\tevidence\tsupporting\tits\tuse\tin\tthe\n\tmedical\tliterature.\tSome\tstudies\nsuggest\tmelatonin\tmay\thave\ta\tprotective\teffect\tand\tmay\talter\tthe\tdisease\tprogression\t(\nBelyaev\tet\tal,\t2011\n;
|
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] |
Belyaev\tet\tal,\t2011\n;\t\nJaworek\net\tal,\t2012\n;\t\nJin\tet\tal,\t2013\n).\tSee\t\nchapter\t11\n\tfor\tmore\tinformation\tabout\tsafely\trecommending\tdietary\tand\therbal\nsupplements.\nPancreatic\tsurgery\nA\tsurgical\tprocedure\toften\tused\tfor\tpancreatic\tcarcinoma\tis\ta\t\npancreaticoduodenectomy\t(Whipple\tprocedure)\n,
|
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] |
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