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Early Enteral Nutrition in Pancreatitis — RACP Adult Medicine MCQ

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EasyEmergency MedicineEarly Enteral Nutrition in PancreatitisRACP Adult Medicine

A 35-year-old man with no significant medical history develops severe abdominal pain after a heavy drinking session. His lipase is 2,500 U/L. CT at day 3 shows >30% pancreatic necrosis. He is managed in ICU. At what point should enteral nutrition be commenced?

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Correct answer: B — Within 24–48 hours if tolerated (early enteral nutrition)

Early enteral nutrition (within 24–48 hours of presentation, if the patient can tolerate it) is strongly recommended in acute pancreatitis, including severe cases. It maintains gut mucosal integrity, reduces bacterial translocation, infectious complications, and mortality compared to parenteral nutrition or prolonged fasting. Nasogastric or nasojejunal feeding is used if the patient cannot eat orally. Parenteral nutrition should only be used if enteral nutrition fails. Prolonged nil by mouth is NO longer recommended.

Reference: eTG – 2025 – Gastrointestinal; IAP/APA – 2024 – Acute Pancreatitis Guidelines