Pancreatitis nutritional support

Enteral feedings may also prevent infection by decreasing translocation of bacteria across the gut wall. Preliminary data suggest that probiotics such as lactobacillus (along with a fiber supplement) may reduce bacterial translocation and possibly decrease pancreatic necrosis and abscess. If enteral feeding is not possible, total parenteral nutrition (TPN) should be implemented before protein and calorie depletion becomes advanced. Intravenous lipids should not be withheld unless the serum triglyceride concentration is greater than 500 mg/dL. At present, there is no clear evidence that nutritional support alters outcome in most patients with AP unless malnutrition exists. ... 

Lobo DN, Memon MA, Allison SP, et al. Evolution of nutritional support in acute pancreatitis. Br J Surg 2000 87 695-707. 

The gastrointestinal (Gl) tract is the optimal route for providing nutrients unless obstruction, severe pancreatitis, or other Gl complications are present (see Fig. 136-1). Other considerations that may have an impact on determination of an appropriate route for nutrition support include expected duration of nutrition therapy and risk of aspiration. Patients who have nonfunctional Gl tracts or are otherwise not candidates for enteral nutrition (EN) may benefit from PN. Use of the intravenous route for nutrition support is also commonly referred to as total parenteral nutrition (TPN) or hyperalimentation. Routine monitoring is necessary to ensure that the nutrition regimen is suitable for a given patient as his or her clinical condition changes and to minimize or treat complications early. 

Abou-Assi S, O Keefe SJ. Nutrition support during acute pancreatitis. Nutrition 2002 18 938-943. 

Comparative investigations of the rates of hydrolysis of various natural triglycerides by pancreatic lipase have been carried out by several workers (257-260), As a general rule it is found that vegetable fats, such as coconut oil, palm oil, peanut oil, and rice bran oil, are hydrolyzed more rapidly than animal fats, such as beef fat or whale oil. These studies do not shed much light on the mode of action of lipase, but tend to support the often quoted view that unsaturated fatty acids are split off more readily than saturated acids they are useful when the nutritional values of natural fats are under consideration. Castor bean lipase hydrolyzes coconut oil more rapidly than beef fat and certain other fats (261). 

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