American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with severe acute pancreatitis, when should enteral feeding commence?

1. 24 hours after presentation

2. 48 hours after presentation

3. 72 hours after presentation

4. As soon as symptoms resolve

The correct answer is: 72 hours after presentation

In patients with severe acute pancreatitis, the timing for initiating enteral feeding is critical for both nutrition support and overall recovery. Enteral feeding should typically commence as soon as it is safe to do so, generally within 72 hours after presentation. This timing is based on the understanding that early enteral nutrition can help maintain gut integrity, reduce infectious complications, and minimize metabolic stress. Initiating feeding within this timeframe, as opposed to waiting for complete resolution of symptoms or for a longer period, has been shown to correlate with improved outcomes. Studies suggest that enteral feeding within 72 hours can significantly reduce the risk of complications such as systemic infection and may lead to a shorter hospital stay. Starting enteral nutrition too early may exacerbate the condition, especially if the patient is still experiencing severe symptoms like persistent vomiting or significant abdominal pain. Therefore, the recommended window allows the clinical team to assess the patient's stability while ensuring that enteral feeding begins within a time frame that will still benefit the patient's recovery.