The Japanese Journal of Clinical Dialysis Vol.23 No.12(2-4)

Theme Nutritional Managements for Maintenance Dialysis Patients with Clinical Complications
Title Nutritional management for pancreatitis and cholecystitis
Publish Date 2007/11
Author Keiko Shiratori Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University Hospital
Author Eiji Tatematsu Division of Nutrition Support, Tokyo Women's Medical University Hospital
[ Summary ] Acute pancreatitis is an inflammatory process that presents different degrees of severity ranging, from mild to severe disease associated with multiple organ failure (MOF). Abnormal calcium (Ca) metabolism, due to long term-hemodialysis as well as alcohol intake, may induce acute pancreatitis. Evaluation of severity using scoring system is very important, and severe cases should be treated in the ICU. Protease inhibitors are infused continuously with antibiotics. Nutritional support via the enteral route is recommended rather than the parenteral route, if administration is required for over a week, because of a lower incidence of severe infection, including sepsis and peritoneal abcesses. Low-fat meals are initiated after recovery. Chronic pancreatitis is associated with fibrosis resulting from pancreatic endocrine and exocrine failure. Although acute attacks occur in the early stages, malnutrition due to digestive failure and diabetes may appear in the later stages. The former is treated as a form of acute pancreatitis, and replacement therapy with digestive enzymes and insulin are required for the latter. Acute cholecystitis is primarily caused by gallstones (cholesterol type) in the gallbladder. Most patients recover without surgery, but patients with a perforations of the gallbladder require emergency cholecystectomies. After recovering, low-fat diets are provided.
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