TITLE: THE IMPORTANCE OF NUTRITIONAL INTERVENTION IN THE

MANAGEMENT OF CHRONIC PANCREATITIS.

Author(s): Christina Kalafsky, BS

Affiliation(s): NFSC Dietetic Internship, Department of Nutrition and Food Science,
University of Maryland, College Park, MD.

Learning Outcome(s): The participant will be able to describe one new piece of
information gleamed from this abstract that can be used in their practice.

Text: Chronic pancreatitis (CP) is caused by the repeated inflammation of the
pancreas, resulting in irreversible damage to its exocrine and endocrine functions,
thereby affecting normal nutrient digestion, absorption and utilization. Patients
with CP are at high risk for malnutrition. For this reason, dietitians must be aware of
the nutritional implications and play an active role in the management of chronic
pancreatitis. A 36-year old black female, following two weeks of home-based
Parenteral Nutrition, was admitted to a community hospital for a planned Whipple
procedure to relieve severe, intractable CP-associated pain. The laparoscopic
Whipple was converted to an open-cholecystojejunostomy and gastrojejunostomy
due to significant inflammation of the pancreas. The patients BMI was 34,
consistent with obesity. Estimated nutrition needs were 1580-1880 kcal/day
(Mifflin St. Jeor equation, stress factors of 1.1-1.3 for obesity), 60-70 grams of
protein/day (1.3-1.5 gm/kg IBW), and 1580-1880 ml of fluid/day (1 ml/kcal). The
patient remained NPO/clear liquids x 5 days following surgery, and then began
clears. The diet was advanced to a cardiac, carbohydrate-controlled diet in small,
frequent meals. This diet order was consistent with CP recommendations for
frequent, small meals with the highest amount of fat that can be tolerated without
severe abdominal pain, steatorrhea or signs of malabsorption. Pancreatic Enzyme
Replacement Therapy, a vital tool in preventing CP-associated malnutrition, was
also initiated. This report will review this unusual case of severe, intractable CP
requiring a Whipple procedure and its subsequent care as this case is relevant to
dietitians in acute care and community based practice.

FUNDING DISCLOSURE: None

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