Brenda, a 36 y.o. patient is on your floor with acute pancreatitis. Treatment for her includes:
A. Continuous peritoneal lavage.
B. Regular diet with increased fat.
C. Nutritional support with TPN.
D. Insertion of a T tube to drain the pancreas.
Correct Answer: C. Nutritional support with TPN.
With acute pancreatitis, you need to rest the GI tract by TPN as nutritional support. In cases of severe pancreatitis or where peroral intake is not tolerated, nasojejunal feeding is superior to parenteral nutrition as it helps to minimize bacterial translocation by maintaining the intestinal barrier.
Option A: The foundation of management for acute pancreatitis remains early aggressive fluid resuscitation. Lactated Ringer’s solution is the recommended fluid with an initial bolus of 15 to 20 mL/kg and following rates of 3 mL/kg per hour (usually approximately 250 to 500 mL per hour) for the first 24 hours if no other contraindications are present.
Option B: Common practice is to keep nothing by mouth until abdominal pain, nausea, vomiting, appetite, and ileus improve. Early feeding in mild pancreatitis is safe and does not exacerbate symptoms. Soft, low residue, low-fat diet is recommended for initial feeding and advanced to regular consistency as tolerated.
Option D: Further management depends upon the etiology of pancreatitis. In gallstone pancreatitis, early cholecystectomy is strongly recommended. Early ERCP (within 24 hours of presentation) is of benefit in cases of concurrent cholangitis and obvious biliary obstruction.
No comments:
Post a Comment