PANCREATITIS

Understanding & Managing Pancreatitis through Nutrition

PURVA LALIT PAGARIYA

MSC CND STUDENT| 08
 ANATOMY OF PANCREAS

 The pancreas is an organ as well as a gland located in abdomen.

 Glands are organs in the body that generate and release chemicals.
 It lies behind the stomach and in front of the spine.
 It is positioned across the back of the abdomen, behind the peritoneum
(retroperitoneal space).
 The pancreas has the shape of a J' or a retort because it is positioned at an angle.
 The pancreas is divided into three main parts:
 Head: Nestled into the curve of the duodenum.
 Body: Extends across the midline of the abdomen.
 Tail: Near the spleen on the left side of the abdomen.
 FUNCTION OF PANCREAS

EXOCRINE FUNCTION:
 Produces digestive enzymes (amylase, lipase, and proteases) that are released
into the small intestine to aid in the digestion of fats, proteins & carbohydrates.
 The process of pancreatic secretion involves chemical work and is linked to an
increase in the amount of oxygen that is consumed.
 The pancreatic duct cells contain carbonic anhydrase, which allows them to
produce the hydrogen carbonate that is then expelled into the duct lumen.
ENDOCRINE FUNCTION:
 The pancreas also produces hormones, including insulin and glucagon, which
help to regulate blood sugar levels. Insulin promotes the uptake of glucose into
cells, while glucagon promotes the release of glucose from the liver.

Overall the pancreas plays a vital role in maintaining the body's metabolism and energy balance.
INTRODUCTION TO PANCREATITIS

DIAGRAMATIC REPRESENTATION
Normal Pancreas v/s Inflammed Pancreas
 INTRODUCTION TO PANCREATITIS

 Pancreatitis is an inflammatory condition of the pancreas, an organ located behind

the stomach that plays a vital role in digestion and blood sugar regulation.
 It occurs when digestive enzymes produced by the pancreas become activated
while still within the organ, leading to irritation and damage to pancreatic tissue
 Inflammation is immune system activity that can cause swelling, pain, and changes
in how an organ or tissues work.
 Treatment for pancreatitis usually focuses on easing pain and meeting the fluid and
nutritional needs of the patient.
 Also called as PANCREAS INFLAMMATION
 Pancreatitis may start suddenly.
 It last for days or it can occur over many years.
 TYPES OF PANCREATITIS

DIAGRAMATIC REPRESENTATION
Acute Pancreatitis v/s Chronic Pancreatitis
 TYPES OF PANCREATITIS

ACUTE PANCREATITIS
 Acute pancreatitis is characterized by a sudden inflammation of the pancreas,
which typically resolves within a few days to a week with appropriate treatment.
 Temporary, often resolves with treatment.
 Sudden and severe onset.
 It can range from mild discomfort to a severe, life threatning illness.
CHRONIC PANCREATITIS
 Chronic pancreatitis is a long-lasting inflammation of the pancreas that causes
permanent damage, leading to irreversible changes in the organ's structure and
function.
 Long-term, ongoing condition.
 It is Irreversible damage with ongoing management needed.
 ACUTE PANCREATITIS

CAUSES
 Gallstones
 Heavy alcohol consumption
 Certain medications
 Infections
 Trauma
 Genetic mutations
 Tumors
 High Calcium Levels
 High Triglyceride Levels
 ACUTE PANCREATITIS

SYMPTOMS
 Severe abdominal pain often radiating to the back.
 Nausea and vomiting
 Fever
 Rapid pulse
 Swollen and tender abdomen
 Upper Abdominal Pain
 CHRONIC PANCREATITIS

CAUSES
 Long-term alcohol abuse
 Genetic factors (e.g., cystic fibrosis)
 Chronic blockage of pancreatic ducts
 Autoimmune conditions
 Recurrent acute pancreatitis
 Smoking
 Elevated Triglycerides
 CHRONIC PANCREATITIS

SYMPTOMS
 Persistent abdominal pain
 Weight loss and malnutrition
 Steatorrhea (fatty stools)
 Diabetes
 Jaundice (if bile ducts are blocked)
 Diarrhea
 Shortness of Breath
 Unexplained Weight Loss
 Excessive Thirst & Fatigue
COMPLICATIONS

Kidney Failure

Breathing Problems

Infection

Pancreatic Cancer

Diabetes

Malnutrition

Pseudocyst
 DIAGNOSIS

LABORATORY TEST IMAGING STUDIES

Serum Amalyse & Lipase Abdominal Ultrasound

Complete Blood Count(CBC) Computed Tomography (CT) Scan

Liver Function Tests Magnetic Resonance Imaging

(MRI)

Blood Glucose Endoscopic Ultrasound (EUS)

Calcium and Triglycerides Endoscopic Retrograde
Cholangiopancreatography(ERCP)
Genetic Testing Abdominal X-ray
PANCREATITIS CASE STUDY
 PATIENT PROFILE

 Name: Rohit Shelar

 Age: 45 years
 Weight: 85 kg (187 Pounds)
 Height: 178 cm (5 feet 10 inches)
 BMI: 26.8 (Overweight)
 Gender: Male
 Occupation: Office Manager
 Type of Lifestyle: Sedentary
 Culture: MAHARASHTRIAN Living in Maharashtra
 CHIEF COMPLAINTS

 Severe abdominal pain after having food

 Pain in abdomen even on drinking liquids or water
 Backache & Rapid pulse
 Nausea & Vomitting
 Mild Fever
 History of alcholic consumption
 Severe epigastric pain radiating to the back
 Fatigue
 Tenderness on palpation
 Hypoactive Bowel Sounds
 Abdominal Distention
 Anxiety
 Sleep Disturbances
 MEDICAL & FAMILY HISTORY

 Type 2 diabetes mellitus for 10 years

 Hypertension for 5 years
 Hyperlipidemia currently diagnosed with DM
 Chronic alcohol use (10-15 drinks per week)
 Father had a history of chronic pancreatitis
 Mother had type 2 diabetes
 MEDICATIONS

MEDICATION DOSE PURPOSE

METFORMIN 1000 mg twice daily Improves insulin sensitivity

and glucose control.

ATENOLOL 50 mg once daily Beta- blocker to reduce

blood pressure & control
heart rate.

ATORVASTATIN 20 mg once daily Statin to lower LDL

cholesterol and manage lipid
levels.
MORPHINE Control severe pain
associated with acute
pancreatitis.
 ANTHROPOMETRY MEASUREMENTS

 Height -178 cm
 Weight - 85 kg
 Chest - 112cms
 Waist - 113 cm
 Hip - 116 cm
 Left arm- 35cms
 Right Arm - 35 cm
 Left Calf - 36 cm
 Right Calf - 36cm
 Left Thigh - 54 cm
 Right Thigh - 54 cm
 Body Fat Percentage – 25%
 BIOCHEMICAL PARAMETERS

PARAMETERS NORMAL VALUE PATIENT VALUE REMARKS

HB 13 – 17 g/dl 14 g/dl NORMAL
WBC 4,500 – 11,000 15,000 cells/ uL ELEVATED
cells/uL
PLATELETS 150,000 – 400,000 250,000 cells/uL NORMAL
cells/uL
SERUM AMYLASE 23-85 U/L 450 U/L ELEVATED
SERUM LIPASE 0-160 U/L 600 U/L ELEVATED
BILIRUBIN(Total) 0.1 – 1.2 mg/dl 2.5 mg/dl ELEVATED
ALT 7-56 U/L 80 U/L ELEVATED
AST 10-40 U/L 90 U/L ELEVATED
SODIUM 135-145 mmol/L 138 mmol/L NORMAL
POTASSIUM 3.5 – 5.0 mmol/L 4.2 mmol/L NORMAL
CALCIUM 8.5 – 10.2 mg/dL 8.0 mg/dL LOW
 BIOCHEMICAL PARAMETERS

PARAMETERS NORMAL VALUE PATIENT VALUE REMARKS

CHLORIDE 98 – 106 mmol/L 100 mmol/L NORMAL
BUN 7-20 mg/dl 25 mg/dl ELEVATED

CREATININE 0.6 – 1.2 mg/dl 1.2 mg/dl NORMAL

BLOOD GLUCOSE 70 – 100 mg/dl 180 mg/dl ELEVATED

CRP LESS THAN 10 mg/L 100 mg/L ELEVATED
TGL <150 mg/dl 450 mg/dl ELEVATED
TOTAL CHOLESTEROL <200 mg/dl 250 mg/dl ELEVATED
pH 4.6 – 8.0 6.0 NORMAL
 IMAGING

 CT SCAN: Swelling and inflammation of the pancreas, with some

peripancreatic fluid collection. NO evidence of necrosis & pseudocysts.

 ABDOMINAL ULTRASOUND: No gallstones, mild pancreatic swelling.

 MRI: Confirmed CT findings, detailed visualization of pamcreatic

inflammation and fluid accumulation. NO ductal anomalities detected.
 DIAGNOSIS
 Elevated Serum Amylase and Lipase: Indicating acute pancreatitis.
 Elevated WBC Count: Suggesting inflammation or infection.
 Elevated Liver Enzymes and Bilirubin: Suggesting possible liver
involvement or biliary obstruction.
 Elevated Blood Glucose: Indicating potential exacerbation of
diabetes.
 Elevated Triglycerides: Could be a contributing factor to
pancreatitis.
 Imaging Findings: Consistent with acute pancreatitis without
complications such as necrosis or pseudocysts.
This detailed lab investigation helps in confirming the diagnosis
of ACUTE PANCREATITIS, understanding the severity, and
guiding appropriate treatment and dietary management for the
 TREATMENT OVERVIEW

 Rohit was admitted to the hospital for acute management.

 He was on NPO(Nothing by Mouth)for the first 48 hours to rest the
pancreas.
 After 48 hours, he was started on clear liquids(broths, gelatin, apple juice) as
symptoms improved.
 He was on IV Fluids & Intravenous analgesics to maintain hydration &
manage severe pain.
 He was on antibiotics due to suspicion of infections
 Regualar monitoring of vital signs & lab results.

GRADUAL REINTRODUCTION OF SLOW FAT SOFT FOODS

SHOULD BE INTRODUCED.
 POST-OPERATIVE DIET

 STAGE 1: CLEAR LIQUID DIET

 STAGE 2: FULL / THICK LIQUID
DIET
 STAGE 3: SOFT DIET
 STAGE 4: NORMAL DIET
 CALCULATIONS

BMI:
=WEIGHT/ (HEIGHT IN METER)^2
=85/1.78* 1.78
=26.8

WAIST TO HIP RATIO:

=Waist circumference/Hip circumference
=113/116
=0.97

By seeing BMI & Waist:Hip Ratio

Mr. Rohit is Morbidly Obese
 CALCULATIONS

 By Harris Benedict Equation of Men:

BMR = (10*Weight in kg) + (6.25*ht in cm) – (5*age in yrs) + 5

= (10*85) + (6.25* 178) – (5* 45) + 5

= 850+1112.5-225+5
= 1742.5

 IBW (By Brokas Index):

=Ht in cm - 100
=178-100
=78 cm

He is 7 kg overweight.
 CALCULATIONS

As he is obese.
Fats = 20%
Kcal = IBW*20
= 20*(1560/100)
(Energy) = 78*20
= 312/9
= 1560 kcals
=34.6g
Protein = 0.8g/BW (16%)
= 0.8g/78
= 62.4g

CHO = 50%
= 50*(1560/100)
=780/4
= 200g (approx.)
 Exchange List for the Menu Planning
Food Group No. of Energy Protein (g) Carbohydrates (g) Fat (g)
Exchang es (kcal)

Cereals/Millets 4 400 12 80 3.2

Pulses 2 200 12 30 1.4
Egg 1/2 42.5 3.5 - 3.5
Chicken 1/2 50 4.5 - 3.7
Nuts/Oilseeds 1 100 5 5 9
Milk (Low Fat) 2 140 6 10 -
Paneer 1 100 6 15 0.6
Roots and Tubers 1 1/4 100 1.6 22.5 -

Green Leafy veg 3 135 10.6 - 1.2

Other Veg 1 30 1.7 - 0.2

Fruits (a) 2 1/2 100 - 25 -

Sugar 4 80 - 20 -
Fats/Oils 3 135 - - 15
TOTAL 1612.5 62.9 207.5 37.8
 Distribution Table
Food Group Breakfast Breakfast Mid Meal Mid Meal Lunch Lunch
Exchange Energy Exchange Energy Exchange Energy
(kcal) (Kcal) (kcal)
Cereals/Millets 1 100 1 100
Pulses 2 200
Egg
Chicken 1/2 50
Nuts/Oilseeds 1/4 25
Milk (Toned) 1 70
Paneer 1/2 50
Roots/Tubers 1/4 20 1/4 20
Green leafy veg 1/4 11.25 1/2 22.5 1 45
Other Veg 1/4 7.5 1/4 7.5 1/4 7.5
Fruits (a) 1/2 20
Sugar 1/2 10 1 20
Fats/Oils 1/2 22.5 1 45
Total 211.25 285 357.5
 Distribution Table
Food Group Snacks Snacks Mid-snack Mid snack Dinner Dinner
Exchnge Energy Exchange Energy Exchange Energy
(kcal) (Kcal) (kcal)

Cereals/Millets 1 100 1 100

Pulses
Egg 1/2 42.5
Chicken
Nuts/Oilseeds
Milk low fat 1 70
Paneer
Roots/Tubers 1/2 40 1/4 40
Green leafy veg 1/4 11.25 1 45
Other Veg 1/4 7.5
Fruits (a) 1½ 60
Sugar 1½ 30
Fats/Oils 1/2 22.5 1 45
Total 216.25 60 317.5
 Menu Planning
BREAKFAST:

Name of the Ingredients Amt No of Energy Protein Carbohy Fat

Recipe (g) Exchange s (kcal) (g) drate (g) (g)

Stuffed Ragi Ragi 20 ¾ 66.3 2 20 0.8

Pancake

With Rice flour 10 ¼ 33.3 1

Green Tea Paneer 15 ½ 50 3 7.5 0.3
(Added lemon
drops)

Onion 10 8 -
Potato 10 ¼ 8 0.3 4.5
Carrot 5 4 -
Cabbage 15 6.7 0.9 0.1
Spinach 10 ¼ 4.5 -
Peas 10 3 0.4
French bean 15 ¼ 4.5 -
Oil 2.5 ½ 22.5 - 2.5
Total 211.25 7.6 32 3.7
 MID MEAL
Name of the Ingredients Amt No of Energy Protein Carbohydrat Fat
Recipe (g) exchanges (kcal) (g) e (g)
(g)
Tossed Rajma 60 2 200 12 30 1.4
Rajma Til Seeds 20 1 100 1.5 10 0.4
Salad Lettuce 25
Cabbage 15 ½ 22.5 1.8 0.2
Broccoli 10
Peas 10 ¼ 7.5 0.4
French Bean 15

Guava 25 ¼ 10 2.5
Pineapple 25 ¼ 10 2.5

Sugar 2.5 ½ 10 2.5

Lime juice 5ml

Total 285 9.7 32.5 1.3

LUNCH
Name of the Ingredients Amt No of Energy Protein Carbohydra Fat
Recipe (g) Exchanges (kcal) (g) te (g)
(g)

Chicken Chicken 25 ½ 50 4.5 - 3.5

and Onion 25 ¼ 20 0.3 4.5 -
Broccoli Broccoli 75 ¾ 33 2.7 - 0.3
Saute Capsicum 25 ¼ 7.5 0.4 - -
Oil 5 1 45 - - 5
Total 155.5 7.9 4.5 8.8

Phulka Wheat flour 30 1 100 3 20 0.8

Total 100 3 20 0.8

Mint Curd 100 1 70 3 5 3
Raita Mint Leaves 25 ¼ 11.25 0.9 - 0.1
Sugar 5 1 20 - 5 -
Total 101.25 3.9 10 3.1
Total for 356.75 14.8 34.5 12.7
Lunch
MID-SNACK

Name of Ingredien Amt No of Energy Protein Carbohy Fat

the ts (g) Exchange (kcal) (g) drate (g)
Recipe s (g)
A whole Orange 150 1 ½ 60 - 15 -
fruit
Total 60 - 15 -
DINNER
Name of Ingredients Amt No of Energy Protein Carbohydr Fat
the Recipe (g) Exchanges (kcal) (g) ate (g)
(g)

Phulka Wheat flour 30 1 100 3 20 0.8

With Spinach 100 1 45 3.6 - 0.4
Spinach-B Onion 25 ¼ 20 0.3 4.5 -
road beans

Sabzi Broad beans 25 ¼ 7.5 0.4 - -

Oil 5 1 45 - - 5

Curd Curd 100 1 70 3 5 3

(Low fat)

Sugar 7.5 1½ 30 - 7.5 -

Total 317.5 10.3 37 9.2

 ACUTE PANCREATITIS DIET RESTRICTIONS
FOOD ITEMS TO LIMIT

White bread, pasta, sugar, and other refined foods are a strict no.
Avoid red meat and organ meat.
Stay away from commercial foods that contain trans fats.
Avoid tea, coffee, and packaged drinks.
Fried foods, pizzas, butter, eggs, potato chips, cheese,should be avoided
Alcohol and smoking should be avoided.
Avoid butter, margarine, ghee, full-fat dairy, and mayonnaise.

The above mentioned foods are rich of simple carbs and fat which put
pressure on pancreas for the secretion of pancreatic juices which may cause
severe abdominal pain and may worsen the condition.
 Food Items You Can Eat If You Have Acute
Pancreatitis
Whole grains and cereals should be consumed as they work to protect your
digestion and fight the free radicals that damage your pancreas.
Low fat yogurt should be an important part of your daily diet, whether you
have it with your meals or as a light snack.
Veggie soups are great as well.
Spinach is rich in iron, so consume loads of this veggie. Blueberries are great
as they are rich in antioxidants that combat free radicals.
Vitamin B is important, so keep foods such as dark leafy veggies, whole grains,
etc. in stock.
Fluids are a must.
 Water, juices, and soups are a big yes.
 LIFESTYLE CHANGES

 Increase Physical Activity

 Improve Diet
 Alcohol Reduction
 Stress Management
 Improve Sleep Hygeine
 Family & Social Engagement
 GUIDELINES THROUGHOUT THE LIFE

 Sip water throughout the day to prevent dehydration.

 All liquids should be caffeine-free.
 Don’t overeat.
 Eat small and frequent meals .
 Eat slowly and chew small bites of food thoroughly.
 Avoid concentrated sugars, trans fats, fried foods, processed, and fast foods.
 Take vitamin and mineral supplements as prescribed.
 Avoid alcohol.
 Reduce the secretion of pancreatic enzymes to allow the pancreas to heal.
 Ensure the patient recieves necessary nutrients without overburdening the digestive
system.
 Avoid strenuous exercises and lifting heavy weights until approved by your surgeon.
 Do not use straws, drink carbonated beverages or chew ice. They can introduce air into your
pouch and cause discomfort.
 Follow all of the Golden Rules Of Surgery (including follow-up appointments,
exercise, dietary guidelines.
 ANALYSIS

 This case highlights the critical role of dietary management in the treatment and
recovery from acute pancreatitis.
 The phased approach, starting from NPO status and progressing to a low-fat,
nutrient-rich diet, aims to rest the pancreas while ensuring nutritional adequacy.
 Regular monitoring and patient education are essential to manage symptoms,
prevent recurrence, and promote long-term health.
 Through a personalized diet plan and comprehensive care, patients can achieve a
successful recovery and maintain their health.