Chapter 28: Pancreatitis questions with correct answers

A nutrition support clinician was consulted on the second day of hospitalization about a patient who presented with severe acute pancreatitis and required mechanical ventilation. A recent, dynamic contrast-enhanced computed tomography (CT) scan revealed necrosis involving 30% of the pancreatic gland and a small (4 cm) pseudocyst in the tail of the gland. Which of the following should the clinician recommend? A. Continue NPO status with no enteral tube feeding, noting that the necrosis may require surgical intervention B. Start the patient on PN because the patient is mechanically ventilated and has a pseudocyst C. Place a nasojejunal tube and begin enteral feeding, providing no more than 10 to 20 mL/hr. D. Place a nasojejunal tube, begin tube feeding, and advance to the nutrition goal over the first 24-48 hours CORRECT ANSWER D. Place a nasojejunal tube, begin tube feeding, and advance to the nutrition goal over the first 24-48 hours Complications such as pancreatic ascites, fistulas and pseudocysts are part of the natural disease course of acute pancreatitis. Retrospective case series indicates that the use of the enteral route is safe and allows for the resolution of these complications in most circumstances. Patient has severe pancreatitis and should therefore benefit from EN. Which of the following nutrition regimens is appropriate for a patient with less than 2 Ranson criteria and an APACHE II score of less than 9 (nonsevere) who has no pancreatic necrosis on a CT scan? A. Begin volume resuscitation, prov