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Tube Feedings Formulas and Methods
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Underlying bowel diseases such as Crohn’s and ulcerative colitis may be present. Bowel ischemia due to mesenteric artery stenosis could be present. In addition, recovery from intestinal obstruction and/or surgery can be a cause of hospital diarrhea. Pancreatitis and the resulting pancreatic insufficiency may be another cause.
Cystic Fibrosis and Pancreatic Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Elissa M. Downs, Jillian K. Mai, Sarah Jane Schwarzenberg
Due to pancreatic insufficiency or the potential to develop pancreatic insufficiency over time, a review of gastrointestinal symptoms should be completed. An assessment of baseline stool frequency, consistency, and appearance, in addition to gastrointestinal symptom review, may help identify malabsorption. If malabsorption is noted and/or poor weight gain is documented, confirming PERT doses and timing (i.e., at beginning of meal), and identifying any potential barriers to adherence will be critical.
Medical Problems in Alcoholics
Published in Frank Lynn Iber, Alcohol and Drug Abuse as Encountered in Office Practice, 2020
Chronic pancreatitis means many different syndromes. Recurrent acute pancreatitis, chronic pain believed to originate in the pancreas without recurrent attacks of pancreatitis, and pancreatic insufficiency are all included in this designation but require different management. Recurrent acute pancreatitis in the nondrinking alcoholic requires evaluation to identify and treat surgically correctable causes such as gallstones, stricture, and trauma to the pancreas. Pancreatic insufficiency requires identification (fat malabsorption, Bentiomide test) and treatment with pancreatic supplements and special diet. When chronic pancreatitis is manifest by fat malabsorption and weight loss, it is usually necessary to use pancreatic supplements with each intake of food (one to three capsules of Pancrease® is a typical dose), and treatment of diabetes mellitus may be required. Recurrent pain associated with chronic pancreatitis is frequent and a major problem in management.21 Narcotic analgesics should not be employed for more than a month or so because of the high addiction potential. The pancreatic duct is usually evaluated by ERCP and based upon these findings some sort of surgical treatment undertaken.
Diet and bowel symptoms among colon cancer survivors
Published in Acta Oncologica, 2022
Mette Borre, Janne Fassov, Therese Juul, Søren Laurberg, Peter Christensen, Annette Boesen Bräuner, Ole Thorlacius Ussing, Michael Bødker Lauritzen, Asbjørn Mohr Drewes, Pia Møller Faaborg, Klaus Krogh
Patients having undergone right-sided resection mainly suffer from increased frequency of defecation and loose stools, while patients having undergone left-sided resection may have fragmentation and a feeling of obstructed defecation [5,6,8,13,14]. The underlying pathophysiology behind colorectal dysfunction in CC survivors remains incompletely understood and several factors coexist. The main causes appear to be a small intestinal bacterial overgrowth and bile-acid malabsorption, but excessive fiber intake and pancreatic insufficiency have also been reported [38]. Phillips et al. found that 40% of patients surviving right-sided CC had bile acid malabsorption [39]. Treatment of bile acid diarrhea includes bile acid sequestrants [12,13,40,41] and reduced dietary intake of fat [12–14,40,42]. In our study, 39 (8.5%) patients with right-sided resection and 21 (6%) patients with a left-sided resection reported poor or very poor bowel function. This is less than in the study by the study by Bulchi et al. reported that 20.6% of patients with a right-sided resection and 15.7% of those with a left-sided resection had bowel dysfunction [43].
Emerging medicines to improve the basic defect in cystic fibrosis
Published in Expert Opinion on Emerging Drugs, 2022
Isabelle Fajac, Isabelle Sermet-Gaudelus
The main principles of CF treatment were established as early as the 1960s and steadily evolved with the better understanding of the disease and the availability of new drugs. They are based on a holistic approach to care and intensive symptomatic treatment. Specialized CF centers formed by a multidisciplinary team experienced in CF have become the model of care for patients with CF [5]. The principles of symptomatic treatment are maintenance of good nutrition, compensation of pancreatic insufficiency with pancreatic enzymes, enhancement of mucociliary clearance, prevention, and aggressive treatment of pulmonary infection, and early identification and treatment of complications. CF has benefited from the development of new and effective treatments, such as antibiotics against P. aeruginosa, including inhaled antibiotics. As a result of this structured follow-up in dedicated centers and implementation of aggressive and complex treatments, projected life expectancy for patients with CF has increased from a matter of a few years to nearly 50 years [6]. Similarly, in several countries, the number of adults with CF is currently larger than the number of children with CF [7].
Trypsinogen and chymotrypsinogen: potent anti-tumor agents
Published in Expert Opinion on Biological Therapy, 2021
Aitor González-Titos, Pablo Hernández-Camarero, Shivan Barungi, Juan Antonio Marchal, Julian Kenyon, Macarena Perán
The pancreas plays a very important role in the digestive function through the secretion of several enzymes necessary for the degradation of nutrients. These enzymes are secreted by acinar cells as zymogens (inactive forms also known as (pro)enzymes) [3]. Once secreted, they are transferred to the small intestine where they are activated. The most studied zymogens are Trypsinogen and Chymotrypsinogen. In the case of Trypsinogen, it is activated to Trypsin in the small intestine by enterokinase. Once activated, it is capable of activating the rest of the pancreatic zymogens, including Chymotrypsinogen into Chymotrypsin [4]. A failure in the production of these proteins can cause poor absorption of nutrients, the most common diseases that lead to exocrine pancreatic insufficiency are chronic pancreatitis and cystic fibrosis [5].