# Misconceptions of Acute Pancreatitis: Pancreatic Disease — GCMD Library Dr. Maisam Abu-El-Haija discusses common misconceptions in the management of acute pancreatitis. Type: video · 2 min · posted 2019-01-11 Canonical: https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974 ## Chapters - [0:00](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=0) Common NPO Practices and Opioid Misconceptions - [0:57](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=57) Standardized Early Feeding Protocol ## Statements - "There is no good data supporting the concern that opioids worsen pancreatitis by causing sphincter of Oddi spasm" (clinical) [0:18](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=18) - "Data on opioids and pancreatitis is conflicting" (clinical) [0:29](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=29) - "The majority of clinicians keep pancreatitis patients NPO until pain improves or lipase and amylase normalize" (epidemiological) [0:40](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=40) - "Clinicians are commonly afraid of aggravating the pancreas with feeding" (opinion) [0:51](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=51) - "Every mild pancreatitis case receives standardized management at the speaker's institution" (clinical) [1:07](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=67) - "The hospital is 659 beds or almost 700 beds with expansion" (epidemiological) [1:10](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=70) - "Standardizing pancreatitis management across a large hospital was very important" (opinion) [1:15](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=75) - "Pancreatitis patients are managed on multiple floors including HMO, trauma, cardiac, GI, and general pediatrics" (clinical) [1:23](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=83) - "If the pancreatic duct is not in continuity, patients probably cannot be fed" (clinical) [1:23](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=83) - "Allowing children with mild pancreatitis to eat and self-regulate was the easiest management change to implement" (opinion) [1:36](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=96) - "Data supports allowing pediatric pancreatitis patients to self-regulate their oral intake" (clinical) [1:44](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=104) - "The institution has not moved to aggressive feeding in mild pancreatitis" (clinical) [1:49](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=109) - "Patients with severe pancreatitis are probably not going to be able to eat" (clinical) [1:49](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=109) - "In severe pancreatitis, enteral nutrition can expedite healing without tipping things over" (clinical) [1:54](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=114) - "The electronic medical record makes it easy for providers to order standardized management" (clinical) [2:03](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=123) - "The standardized approach could be implemented with paper orders or other electronic medical record systems" (opinion) [2:11](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=131) - "The speaker has shared the standardized protocol with other institutions who found it helpful" (epidemiological) [2:22](https://library.globalcastmd.com/watch/misconceptions-of-acute-pancreatitis-pancreatic-disease-974?t=142) ## Transcript The other people were divided between NPO until their pain is improved or gone, which was my answer. That's what I was and, and so I already I've learned three things which I'm gonna tell you and then, um, NPO until they're off narcotics was another uh common answer. So can I ask you a question? So, so far I've learned that I was always afraid of opioids, so that's something I don't need to be afraid of anymore. I thought it's gonna cause, make the pancreas worse because the sphincter already spasm. No good data is what I just said. It's really conflicting. That's an important key point to. Send out to the OK. Second thing is, oh, and a new person just answered another one NPO until their lipase and amylase normalize, which is what I see a lot. I think the majority tends to do that, yeah, until pain is improved or lipase and amylase, so OK. In other words, they cooled down the pancreas. They cooled down. That's what I always thought, right? This is why this is so great for me. Everybody's afraid of aggravating the pancreas, right, right? That's right. So what about we keep getting new answers now. So what about how do you feed them? You said enteral nutrition. They're going to throw it right out. Yeah. So what do you do? I, I, I think I'll show you in a second how we incorporated standardized. Every mild pancreatitis case gets the standard management. We made it easy on providers hospital-wide, you know, we are 659 beds or almost 700 beds with the expansion, so it was very, very important to standardize how we manage the cases. Um, these patients are under HMO floors, um, trauma, and obviously that's a different case in some aspects because if the duct is not in continuity then you probably can't feed them, but. Cardiac kids, GI, general peds, so they go all over and it was very important just to say allow the kids to eat. They're going to self-regulate and I'll show you the data in a second, but that was the most easy one. We haven't gone to feed them aggressively now when you get into the severe. They're probably not going to be able to eat, and that's where the art comes to use some internal nutrition mode to really expedite the healing without tipping things over. OK, and so you're going to show us this algorithm on how you, I'll show you some things from our electronic medical record of how we make. Easy on providers to order the standardized management, but this could be again orders on papers elsewhere. This could be used in any other electronic medical record that the other institutions use. I've shared it with a lot of other institutions and I found it very helpful. I would love it. Yeah, sure, you've got to pay money though. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai