Stress hyperglycemia after pancreatobiliary surgeries

Background: Diabetes mellitus is a common problem and stress hyperglycemia occurring in patients undergoing surgery without history of diabetes mellitus has been shown to have a poorer clinical outcome. Effective glycemic control in the perioperative period results in marked improvement in clinical outcome.Methods: This prospective study was conducted among 100 cases of the pancreatobiliary postoperative patients admitted in General Surgery Department, Government Medical College Kottayam during November 2015 to November 2016. The post-operative blood sugar values, age, sex, BMI, family history of diabetes mellitus, anemia, hypoproteinemia, intraoperative blood loss, intraoperative blood transfusion, duration of surgery, and type of surgery were studied with respect to occurrence of stress hyperglycemia.Results: The total incidence was 35%. The incidence in pancreatic surgery (87.5%), other biliary surgeries (77.8%), open cholecystectomy (31.2%) and laparoscopic cholecystectomy (18%). Significant association was found in malnourished and obese persons, anemia, hypoalbuminemia, duration of surgery more than 3 hours, intraoperative blood loss of more than 500 ml and intraoperative blood transfusion and pancreatic surgery. Independent predictors of stress hyperglycemia were found to anemia, hypoproteinemia, duration of surgery more than 3 hours and underweight and obese individuals.Conclusions: Stress hyperglycemia incidence in pancreatobiliary postoperative patients was found to be 35%. Independent predictors of stress hyperglycemia were anemia, hypoproteinemia, duration of surgery more than 3 hours and BMI <18.5 and >30. Hence correction of anemia, improving the nutritional status preoperatively and minimising the duration of surgery will improve the clinical outcome.

Effect of early enteral feeding on recovery profile in mild acute pancreatitis

Background: Acute pancreatitis is a pestilent disease with severity ranging from mild and self-limiting to a rapidly progressive illness leading to multi organ failure. Mild acute pancreatitis is inflammation of the pancreas with minimal remote organ involvement. Since the disturbance in the homeostasis is minimal, the treatment aims at supporting the native reparative processes of the body. One of the main supportive mechanisms is adequate nutritional supplementation. Gut barrier damage in the early phase of acute pancreatitis accounts for the bacterial translocation, initiation of sepsis, infected pancreatic necrosis and SIRS. Aim of the study was to determine the feasibility, advantages and disadvantages of early enteral nutrition in mild acute pancreatitis.Methods: 40 patients taken consecutively from units which start enteral feeds before 48 hours (study group) were compared against 40 patients taken consecutively from units where patients will be kept fasting for 48 hours (control group) to determine whether early enteral feeding is better in determining the recovery in terms of duration of hospital stay, reduction in abdominal symptoms and use of analgesics.Results: There was significant reduction in the duration of hospital stay (p=0.011), intensity and duration of abdominal pain, need for analgesics, and risk of oral food intolerance in the study group.Conclusions: Patients with mild acute pancreatitis can safely be started on early enteral feeds. It reduces gastro intestinal adverse effects, abdominal pain and need for analgesics and improves oral food tolerance causing shorter hospital stay.