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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute pancreatitis often results in a hyperdynamic, consumptive state. Hallmarks of this condition are decreased peripheral resistance with increased cardiac output. Hemodynamic and cardiovascular changes are accompanied by metabolic alterations. Increased protein catabolism, increased ureagenesis, glucose intolerance, increased lipolysis, and reduced servoregulation are metabolic changes commonly seen in this syndrome. To preserve organ structure and function, biochemical processes must be metabolically supported. Substrate needs change as stress level increases. The per cent of total calories provided as protein must increase. Branched-chain-enriched amino acid solutions have been shown to improve nitrogen utilization in hypermetabolic patients and may therefore be beneficial for the patient with acute pancreatitis. Glucose utilization decreases and free fatty oxidation increases. A mixed fuel system that provides fat, protein, and glucose is suggested for these patients. IV fat has been shown to be a safe energy substrate for patients with pancreatitis in the absence of hyperlipidemia. Failure to use fat as an energy substrate in conjunction with TPN may result in hepatic steatosis and excess carbon dioxide production. The decision of whether to use the parenteral or enteral route to nutritionally support the patient with pancreatitis remains controversial. TPN may allow maintenance of pancreatic rest. The role of enteral feedings is less clear. However, it has been shown that the further down the alimentary tract the feeding is infused, the less pancreatic stimulation occurs. Therefore, it seems wise to support the patient with TPN during severe acute pancreatitis. Jejunal enteral feedings should be initiated as a transitional feeding when the acute inflammatory episode begins to subside.
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PMID:Nutritional support in acute pancreatitis. 250 54

The study investigates amino acid homeostasis and nitrogen balance in patients with acute necrotizing pancreatitis. 10 patients received a parenteral nutritional regimen containing 1 g of amino acids/kg B.W./day and 6.5 g of carbohydrates/kg B.W./day. Parameters to define homeostasis were measured to characterize the patients. In addition we determined the plasma amino acids and the nitrogen balance. All those biochemical parameters measured to define homeostasis remained within the physiological reference range. The description of the relative amino acid pattern only demonstrated changes of the postoperatively typically altered amino acids, e.g. phenylalanine.
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PMID:[Homeostasis of plasma amino acids in standardized parenteral nutritional therapy in acute necrotizing pancreatitis]. 311 82

A series of studies was performed to test the efficacy and safety of a parenteral lipid emulsion, Lipofundin S, when given as part of a complete nutritive mixture from the three-liter bag total parenteral nutrition (TPN) delivery system. In vitro stability studies with mixtures corresponding to high and low nutritional intakes showed the fat emulsion to be stable during refrigerated storage for at least 6 days. The clinical use of Lipofundin S in 3-liter TPN bags was studied in 39 consecutive patients requiring TPN, and there were no untoward side-effects. Nitrogen balance was maintained in patients with pancreatitis, those recovering postoperatively, and those with miscellaneous conditions. However, patients with multiple trauma remained in negative balance. The ability of sera, from patients on TPN to agglutinate Lipofundin S was compared to that from healthy controls, and acutely ill patients not on TPN. Patients on TPN showed a higher degree of in vitro creaming than acutely ill controls, and this may have been related to the severity of the underlying illness. These studies suggest that this parenteral lipid emulsion can be safely administered to patients requiring TPN when given from the 3-liter bag delivery system.
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PMID:Administration of fat emulsions with nutritional mixtures from the 3-liter delivery system in total parenteral nutrition. 392 21

One thousand intensive care digestive surgical cases are reviewed concerning continuous low-flow-rate enteral support (CLFRES), using Nutripompe: 607 males and 393 females, average age 51 years. The average duration of CLFRES is 21.5 days +/- 13, range 4 to 180 days. CLFRES was used postoperatively in 76 per cent, preoperatively in 10 per cent, and pre- and postoperatively in 14 per cent of cases, respectively. The enteral support route was 63 per cent nasogastric, 20 per cent gastrostomy and 17 per cent jejunostomy. Five hundred and ten patients required extensive digestive surgery with temporary exclusions. More than 100 patients with either temporary enterostomies or enterocutaneous fistulas have had continuous reinstillation of digestive chyme (CRDC) associated with their intensive care unit treatment management. CRDC in the lower end of an enterostomy has shown a specific retrograde inhibitory effect on the upper digestive secretions, particularly on the intestinal secretions during pathologies associated with one or several interruptions of the continuity of the gastrointestinal tract. This technique and its physiological implications were discussed. The principal pathologies in this important study group are: severe digestive fistulas, 24 per cent; acute diffuse peritonitis, 18 per cent; acute enterocolitis, 14 per cent; digestive tumours, 35 per cent; and acute necrotizing haemorrhagic pancreatitis, 9 per cent. A comparative analysis of nutritional energy nitrogen requirement was presented in view of the cancer, the septic, and the non-cancer non-septic patient groups. Enteral support nutritional solutions were primarily mixed non-degraded food, 70 per cent, and semi-elemental diets, 30 per cent. Certain pathology groups required variations in protein and lipid percentage. An up-to-date evaluation of nutritive formulas based on small peptides in normal and small bowel postoperative patients was discussed. Four CLFRES administration programmes were discussed: normal gastrointestinal tract, 38 per cent; abnormal gastrointestinal tract, 44 per cent; pancreatitis, 11 per cent; short bowel, 7 per cent. Nutrition evolution parameters (clinical), were: weight gain curve (minimum 10 days), local regional healing, biological positive changes in protein metabolism, nitrogen balance, lipid metabolism and glucose regulation. Impact on complications such as thrombosis, embolism and haemorrhage were discussed. Clinical and biological results using CLFRES were most satisfactory in more than 90 per cent of patients.
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PMID:Continuous high-energy low-flow-rate enteral support: a panoramic review of 1000 cases. 393 Aug 90

Oral feedings should be withheld in all patients with acute pancreatitis. A mild form of acute alcoholic pancreatitis does not necessarily require the administration of a nasogastric tube and central venous catheter, which should, however, be administered in all patients with more severe disease, with an unknown pathogenesis, and with complications. In most of those patients a central venous catheter is not only required for parenteral nutrition, but also for control of fluid administration. Glucose is recommended as the primary energy source (7-12 mg/kg/min); amino acids should be given at a calories (kcal/kg) to nitrogen (g/kg) ratio of 135:1. Fat is not recommended as the primary nonprotein energy source initially in the course of pancreatitis. Frequent serum controls of electrolytes and glucose are necessary to control electrolyte and insulin therapy. Calcium administration should be carried out with caution.
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PMID:[Parenteral nutrition in acute pancreatitis]. 393

Administration of total parenteral nutrition (TPN) solutions high in branched chain amino acids (BCAA) is thought to improve metabolic support during stress. This prospective, randomized, double blind study compared 45 per cent BCAA with 25 per cent BCAA in 12 patients. Seven patients had multiple trauma; two, gastrointestinal surgery; one, pancreatitis; and two, cirrhosis. The TPN regimen was 1.0-1.5 gm/kg/day amino acids and 30-45 glucose kcal/kg/day. The BCAA formula used was high in isoleucine and valine, but not leucine. Amino acid plasma levels, blood chemistries, 3-methylhistidine excretion, and nitrogen balance were studied. Control studies showed negative nitrogen balance (-7.1 +/- 2.9 gm) (mean +/- SEM), elevated insulin (61 +/- 21 microunit/ml), and elevated 3-methylhistidine (3MH) excretion (688 +/- 309 micromol); plasma leucine (93 +/- 11 nmol/ml) and isoleucine (37 +/- 23) were low, and valine (155 +/- 20) was elevated. Plasma methionine (40 +/- 9) and tyrosine (70 +/- 12) were high normal. Phenylalanine (85 +/- 5) was elevated. Both groups showed increased nitrogen excretion and positive nitrogen balance during the study (25 per cent, 2.0 +/- 1.4 gm/day; 45 per cent, 1.2 +/- 2.6 gm/day). Three-methylhistidine excretion changed little in either group (557 +/- 149, 414 +/- 91), insulin rose (135 +/- 27, 65 +/- 19), and plasma leucine (82 +/- 4, 71 +/- 9) changed little. Plasma isoleucine (51 +/- 3, 155 +/- 16) and valine (173 +/- 11, 691 +/- 23) both rose, more in the 45 per cent group. Methionine (67 +/- 12, 37 +/- 4) and tyrosine (51 +/- 6, 50 +/- 10) changed little.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of total parenteral nutrition with 25 per cent and 45 per cent branched chain amino acids in stressed patients. 393 93

This study set out to investigate the alteration of amino acid (AA) and protein metabolism in patients with malnutrition, sepsis, acute pancreatitis and liver diseases. The results showed that in preoperative patients with malnutrition or protein catabolism (decreased levels of plasma proteins, increased urea production rate) the postoperative complications were significantly increased. An increased postoperative infusion of branched chain AA did not improve postoperative nitrogen retention nor plasma protein syntheses in patients with colon or rectum CA. Patients with sepsis or acute pancreatitis had drastically reduced levels of total muscular free AA, mainly due to a fall in muscle glutamine. In septic patients also the hepatic levels of free AA were decreased. These changes of AA metabolism found in clinical situation were not always reflected by results found in experimental rat models (sepsis, pancreatitis, burn injury). The parenteral administration of a synthetic dipeptide containing glutamine and alanine decreased the muscular decrease of glutamine and alanine and increased the hepatic uptake of these two AA in a catabolic dog model. In critically ill patients changes in amino acid and protein metabolism lead to a protein catabolic situation. Urea production rate and muscle glutamine levels seem to be closely related to the prognosis of catabolic patients.
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PMID:[Amino acid and protein metabolism in critically ill patients]. 393 9

The purpose of this study is to elucidate the pathophysiology of the acute pancreatitis and set up the criteria for assessing the severity of this disease. One hundred and fifty seven cases of acute pancreatitis were treated at the First Surgical Department of Tokyo University Hospital and its affiliated hospitals. They consisted of 24 severe cases, 76 moderate cases, and 57 mild cases according to our classification. In early stage ten parameters, namely, abnormalities of white cell count, platelet count, hematocrit, lactic acid dehydrogenase, blood urea nitrogen, serum calcium, base excess, PaCO2 and fasting blood glucose and age within 24 hours after admission and X-ray CT scan within 48 hours as early prognostic signs, enabled us to predict severe, moderate, or mild pancreatitis. More than 4 weeks later than the onset of acute pancreatitis, X-ray CT scan, white blood cell count, elevation of serum FDP level, endotoxemia and fall of plasma opsonic index served as good indicators to evaluate the severity of abdominal sepsis. In experimental pancreatitis, CH50 and opsonic index were remarkably decreased at 6 and 12 hours after induction of acute pancreatitis. As the above results, determination of early prognostic signs immediately after onset and late prognostic signs 3-4 weeks after onset is very important to evaluate and manage the acute pancreatitis patients.
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PMID:[Pathophysiology and prognosis of acute pancreatitis--early and late prognostic signs]. 408 48

Preliminary experience with elemental diet therapy in 30 patients is presented. Positive nitrogen balance and nutritional recovery can be achieved in patients with fistulas, inflammatory bowel disease and pancreatitis, and after extensive resection of the small bowel (short gut syndrome). The mode of administration and rare complications are described.
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PMID:Clinical uses of an elemental diet: preliminary studies. 504 34

Eleven patients with acute pancreatitis who received a lipid-based system of total parenteral nutrition were studied. The safety and efficacy of the intravenous feedings were assessed by comparing the clinical course and serum amylase and urinary diastase levels before treatment and during total parenteral nutrition. Lipid profiles were determined in four of the patients, and nutritional indices including nitrogen balance data were obtained in three patients. No exacerbations of pancreatitis were attributable to the intravenous feedings and the manifestations of the disease resolved or improved in eight patients. Nutritional indices stabilized or improved during total parenteral nutrition, and positive nitrogen balance was achieved in each of the three patients in whom it was measured. Significant hyperlipemia was not observed before or during the lipid infusions. The lipid-based system of parenteral nutrition was well tolerated and effective in this series of patients with pancreatitis.
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PMID:The safety and efficacy of a lipid-based system of parenteral nutrition in acute pancreatitis. 617 87


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