1. PANCREATIC DISORDERS
THE PANCREAS IS A GLAND BEHIND THE STOMACH AND IN FRONT OF THE SPINE. IT
PRODUCES JUICES THAT HELP BREAK DOWN FOOD AND HORMONES THAT HELP
CONTROL BLOOD SUGAR LEVELS. PROBLEMS WITH THE PANCREAS CAN LEAD TO
MANY HEALTH PROBLEMS. THESE INCLUDE
PANCREATITIS, OR INFLAMMATION OF THE PANCREAS: THIS HAPPENS WHEN
DIGESTIVE ENZYMES START DIGESTING THE PANCREAS ITSELF.
CYSTIC FIBROSIS, A GENETIC DISORDER IN WHICH THICK, STICKY MUCUS CAN ALSO
BLOCK TUBES IN YOUR PANCREAS.
Pancreatitis is inflammation of the pancreas. It happens when digestive
enzymes start digesting the pancreas itself. Pancreatitis can be acute or
chronic. Either form is serious and can lead to complications.
3. ACUTE PANCREATITIS
Acute pancreatitis is a sudden inflammation of the pancreas.
The pancreas is the large gland located in the upper part of the abdomen, behind the stomach. It
produces digestive enzymes and hormones.
In pancreatitis, enzymes that normally are released into the digestive tract begin to damage the pancreas
itself. The gland becomes swollen and inflamed. More enzymes are released into the surrounding tissues
As a result, digestion slows down and becomes painful. Other body functions can be affected. The
pancreas can become permanently damaged and scarred if attacks are severe, prolonged or frequent.
It is not known exactly why the enzymes start to damage the pancreas. But there are several known
trigger of acute pancreatitis.
One of the most common causes of acute pancreatitis is gallstones.
Gallstones that escape from the gallbladder can block the
pancreatic duct. (The pancreatic duct delivers digestive enzymes
from the pancreas to the small intestine.) When the pancreatic duct
becomes blocked, enzymes can't flow properly. They can back up
into the pancreas. This causes the pancreas to become inflamed.
The other leading cause of pancreatitis is heavy alcohol use. Most
people who drink alcohol never develop pancreatitis. But certain
people will develop pancreatitis after drinking large amounts of
alcohol. Alcohol use may be over a period of time or in a single
binge. Alcohol combined with smoking increases the risk of acute
Another common cause of acute pancreatitis is a complication of a
medical procedure called ERCP. ERCP is performed through an
endoscope. This is a flexible tube with a small camera and a light
on one end and an eyepiece on the other. ERCP is used to identify
stones and tumors and to view ducts in the pancreas, liver and
5. Other factors that sometimes can cause pancreatitis include:
•Use of any of a wide variety of medications, such as
• Sulfa drugs
• Water pills (hydrochlorothiazide, others)
• Immunosuppressants (azathioprine)
• Drugs used to treat HIV
•Metabolic conditions, such as high blood levels of calcium or triglycerides
•Some infections, such as mumps or viral hepatitis
The most common symptom of acute pancreatitis is upper abdominal pain. It can range from tolerable
The pain usually occurs in the middle of the body, just under the ribs. But it is sometimes felt on either
the left or right side. This is a steady, drilling or "boring" pain. It can radiate to the back, flank, chest or
Pain reaches a maximum intensity quickly, often within 30 minutes. In alcohol-induced pancreatitis, the
pain tends to begin one to three days after a binge.
It may be difficult to find a comfortable position. Bending over or lying on your side may reduce the
pain. Eating usually makes the pain worse.
Other symptoms of acute pancreatitis include:
•Nausea and vomiting
•Loss of appetite
Your doctor will diagnose acute pancreatitis based on:
•A physical examination
•Certain laboratory tests
Blood tests usually reveal high levels of two pancreatic enzymes.
In some cases, a computed tomography (CT) scan may be done. The scan can identify swelling of the
pancreas and accumulation of fluid in the abdomen.
Avoiding heavy alcohol use will help to prevent pancreatitis. Anyone who already
has had one episode of pancreatitis caused by alcohol should stop drinking entirely.
This is crucial to prevent the condition from coming back or becoming chronic.
Most people who develop pancreatitis are admitted to the hospital. They are treated
with pain relievers and intravenous fluids.
You will not be allowed to eat or drink until your symptoms begin to improve. In
most cases, nothing can be done to speed healing or shorten an episode. If the
episode is prolonged, and a patient cannot eat for longer than a week, nutrition may
be given intravenously.
In some cases, antibiotics may be prescribed. These will help to prevent or treat
infection in the pancreas or surrounding tissues. Most cases do not need any
AVOID SOLID FOODS TO MINIMISE
THE LOAD ON PANCREAS
SIX SMALL MEALS
HIGH FRUITS AND VEGETABLES
ENERGY- 25 TO 35 KCAL/KG/DAY
FAT - 2G/KG/DAY
PROTEIN – 1.5 TO 2 G/KG/DAY
9. CHRONIC PANCREATITIS
Chronic pancreatitis is an inflammation of your pancreas that doesn’t improve over time.
Chronic pancreatitis can lead to permanent scarring and damage. Calcium stones and cysts may develop in
your pancreas, which can block the duct, or tube, that carries digestive enzymes and juices to your
stomach. The blockage may lower the levels of pancreatic enzymes and hormones, which will make it
harder for your body to digest food and regulate your blood sugar. This can cause serious health problems,
including malnutrition and diabetes.
There are numerous different causes of chronic pancreatitis. The most common cause is long-term alcohol
abuse. Other causes include:
•autoimmune disease, which occurs when your body mistakenly attacks your healthy cells and tissues
•a narrow pancreatic duct, which is the tube that carries enzymes from the pancreas to the small intestine
•a blockage of the pancreatic duct by either gallstones or pancreatic stones
•cystic fibrosis, which is a hereditary disease that causes mucus to build up in your lungs
•high blood levels of calcium, which is called hypercalcemia
•a high level of triglyceride fats in your blood, which is called hypertriglyceridemia
•pain in your upper abdomen
•fatty stools, which are loose, pale, and don’t flush away easily
•nausea and vomiting
•shortness of breath
•unexplained weight loss
•excessive thirst and fatigue
You may experience more severe symptoms as the disease progresses, such as:
•pancreatic fluids in your abdomen
•jaundice, which is characterized by a yellowish discoloration in your eyes and skin
Imaging tests are the most reliable way for your doctor to make a diagnosis. Your doctor might request that the
following studies be done on your abdomen to look for signs of inflammation:
Your doctor may also recommend an endoscopic ultrasound. During an endoscopic ultrasound, your doctor inserts a
long, flexible tube into your mouth and down through the stomach and small intestine. The tube contains an
ultrasound probe, which emits sound waves that create detailed images of your pancreas.
Treatment for pancreatitis can include medication, endoscopic therapies, or surgery.
Several studies have found an increase in oxidative stress in patients with chronic
pancreatitis. One possible contributor is the deficiency of fat-soluble vitamins (A, D, E, and K)
that is common in patients with chronic pancreatitis due to chronic malabsorption.
intravenous glutamine or a combination of glutamine and long-chain omega-3 fatty acids significantly reduces the risk
of infectious complications, mortality, and length of hospital stay when compared with controls.
LOW SUGAR AND FAT
CALCIUM AND IRON SUPPLEMENTATION
ENERGY- 25 TO 35 KCAL/KG/DAY
FAT - 2G/KG/DAY
PROTEIN – 1.5 TO 2 G/KG/DAY
The cause of pancreatic cancer is unknown. This type of cancer occurs when abnormal cells begin
to grow within the pancreas and form tumors.
Pancreatic cancer often doesn’t show symptoms until it reaches the advanced stages of the
disease. For this reason, there typically aren’t any early signs of pancreatic cancer.
Even once the cancer has grown, some of the most common symptoms can be subtle. They
•loss of appetite
•unintentional weight loss
•abdominal (stomach) or lower back pain
•jaundice (yellow skin and eyes)
To make a diagnosis, your doctor will review your symptoms and medical history. They may order
one or more tests to check for pancreatic cancer, such as:
•CT or MRI scans to get a complete and detailed image of your pancreas
•an endoscopic ultrasound, in which a thin, flexible tube with a camera attached is inserted down
into the stomach to obtain images of the pancreas
•biopsy, or tissue sample, of the pancreas
•blood tests to detect if tumor marker CA 19-9 is present, which can indicate pancreatic cancer.
Once a diagnosis has been made, your doctor will assign a stage based on the test results:
•stage 1: tumors exist in the pancreas only
•stage 2: tumors have spread to nearby abdominal tissues or lymph nodes
•stage 3: the cancer has spread to major blood vessels and lymph nodes
•stage 4: tumors have spread to other organs, such as the liver
Some lifestyle changes and overall health approaches may reduce your risk. These include:
•Quit smoking: Smoking increases your risk for several types of cancer, including pancreatic
•Drink less: Heavy drinking may increase your risk for chronic pancreatitis and possibly pancreatic
•Maintain a healthy weight: Being overweight or obese is a leading risk factor for several types
Treatment for pancreatic cancer depends on the stage of cancer. It has two goals: to kill cancerous
cells and to prevent the spread of the disease.
Weight loss, bowel obstruction, abdominal pain, and liver failure are among the most common
complications during pancreatic cancer treatment.
Evidence indicates that the major dietary determinants of increased pancreatic cancer risk include
meat and other sources of animal fat, while fruits, vegetables, and whole grains appear to reduce
risk. Weight control and limiting alcohol should also be followed.
19. CYSTIC FIBROSIS
Cystic fibrosis (CF) is a serious genetic condition that causes severe damage to the
respiratory and digestive systems. This damage often results from a buildup of thick,
sticky mucus in the organs.
The most commonly affected organs include the:
A sudden mutation, or change, in the CFTR gene causes your mucus to become
thicker and stickier than it’s supposed to be. This abnormal mucus builds up in
various organs throughout the body, including the:
It also increases the amount of salt in your sweat.
The symptoms of cystic fibrosis can vary depending on the person and the severity
of the condition. The age at which symptoms develop can also differ.
Symptoms may appear at infancy, but for other children, symptoms may not begin
until after puberty or even later in life. As time passes, the symptoms associated
with the disease may get better or worse.
One of the first signs of cystic fibrosis is a strong salty taste to the skin.
The diagnosis of CF requires clinical symptoms consistent with CF in at least one organ system and evidence of CFTR
dysfunction usually based on an abnormal sweat chloride test or the presence of mutations in the CFTR gene.
Clinical symptoms aren’t required for infants identified through newborn screening.
A CT scan creates detailed images of the body by using a combination of X-rays taken from many different directions.
These images allows your doctor to view internal structures, such as the liver and pancreas, making it easier to assess
the extent of organ damage caused by cystic fibrosis.
MEDICATIONS AND SURGERY
A high-energy diet is commonly recommended, along with nutritional supplements. Additional calories and protein
from enteral nutrition may be indicated to improve nutritional status and growth in both adults and children and
should be used if necessary.
ENERGY – 110 to 200%
Biochemical evidence of deficiency of both the essential omega-6 fatty acid linoleic acid and docosahexanoic acid, a
derivative of the essential omega-3 fatty acid alpha-linolenic acid, is common in patients with CF, although clinical signs
and symptoms are rare. Patients should be monitored for evidence of vitamin deficiency and treated accordingly.
Patients with CF require supplemental nutrients for various reasons. The fat-soluble vitamins A, D, E, and K are a
priority, mainly because pancreatic enzyme insufficiency often results in malabsorption of these nutrients.
HIGH CALCIUM, IRON AND ZINC
BALANCED DIET WITH PLENTY OF FRUIT AND
VEGETABLES AND WHOLE GRAINS.
WOMEN- 2500 TO 3000 CALORIES
MEN- - 3000 TO 3700 CALORIES