Sample Answers: 1. 1.

Factors that influence pancreatic secretion during a meal can be subdivided into three phases (cephalic, gastric, and intestinal). Describe the action of the pancreas within each phase. -The action of the pancreas starts with the cephalic phase in which the pancreas becomes stimulated by the vagus nerve. The vagus nerve sends signals to the acini tissue when the body is visually and physically stimulated by the presence of food causing the secretion of digestive enzymes. As the food enters the stomach the gastric phase is initiated. The acini tissue remains stimulated in this phase causing a buildup of digestive enzymes in the ducts of the pancreas. The enzymes remain inactive while in the ducts. The food from the stomach then progresses to the duodenum simultaneously starting the final intestinal phase. In this phase secretin and CCK automate the release of the enzymes from the ducts and they become activated allowing for further digestion of food. 2. What is the most common etiology for pancreatitis? Explain the physiological consequences of pancreatitis. -The most common etiology for pancreatitis is the lodging of a gallstone within the sphincter of Oddi or for children the occurrence of cystic fibrosis. However it is stated that in the U.S. excessive alcohol intake is the most common cause for adults. Pancreatitis causes the pancreas to decrease in function due to destruction of the exocrine and endocrine cells. The cells damage is attributed to the premature activation of trypsin and the inflammation of the pancreas. This destruction creates issues with the secretion of necessary enzymes to control blood glucose levels, fat absorption and serum lipase levels. It also disrupts the digestion of food since the exocrine cells are important for the release of digestive enzymes. 3. Using the Mifflin-St. Jeor equation, estimate Ms. Jordans energy needs at her current weight. 10 x (50.9 kg) + 6.25 x (172.72 cm) 5x (30 year)- 161= 1277.5 Stress Factor: 1.2x 1277.5= 1533 kcal 4. Hospital day 2: patient remains stable on IV fluid. Her pain has been somewhat controlled with parenteral analgesics, but she is still unable to eat. Dr. Bennett consults you to evaluate the parenteral nutrition she has suggested: a dextrosebased parenteral solution with 4.25% amino acids, 25% dextrose, electrolytes, vitamins, and trace elements at a rate of 85 cc/hr with 500 cc/day of 10% lipids. Will this meet the patients energy and protein needs? Fat: 500cc/day x 1.1 kcalcc= 550 kcal Pro: 2040cc/day x 0.0425= 87.6 g 87.6gx 4kcal/g= 346.8 kcal CHO: 2040 cc/day x 0.25= 510g 510g x 3.4 kcal/g= 1734 kcal 550 kcal+ 346.8 kcal+ 1734 kcal= 2630 kcal total This parenteral recommendation would greatly exceed the patients required energy needs. It also provides a little over 10 more grams of protein than the calculated need. 5. Select two high-priority nutrition problems and complete the PES statement for each.

-Excessive alcohol consumption related to lifestyle and work habits as evidenced by diet recall of 3 or more drinks a night and development of pancreatitis. -Inadequate energy intake related to low food intake as evidenced by recent unintended weight loss and low BMI of 17.07.