Ch.6 Metabolism and Nutritional support of the Surgical Patient

Question 1

How long can a healthy adult horse go without food for?

Answer 1

3-4 days

Question 2

What triggers lipid mobilisation

Answer 2

Alterations in insulin or glucagon levels
and the activity of hormone sensitive lipase.

Question 3

What is the metabolic response to injury

Answer 3

Increased metabolism
Onset of catabolic processes leading to excessive breakdown of tissue proteins

Question 4

What increases the resting metabolic rate and lipolysis in horses post injury

Answer 4

1) Interactions of inflammatory cytokines released at the site of injury

2) Circulating hormones in response to stress/injury - hypothalamic-pituitary- adrenal axis

3) and neurotransmitters.

4) Infusion of cytokines stimulates
corticotrophin, cortisol, epinephrine, glucagon

Question 5

What stimulates the proteolytic pathways

Answer 5

TNF-Alpha activation of nuclear factor kappa (NFk-Beta)

Question 6

Calculate the DEm for horse under 600kg

Answer 6

DEm(Mcal/day) = 1.4 + (BW X 0.03)

Question 7

Calculate the DEm for horse over 600kg

Answer 7

DEm(Mcal/day) = 1.82 + (BW X 0.0383) - (BW X 0.000015)

Question 8

Kcal req for horses

Answer 8

33kcal/kg/day

Question 9

Energy req of pregnancy mare over last 3 months of gestation

Answer 9

1.1
1.13
1.2 times the DEm

Question 10

Calculate DEm for 300-900kg mare in first 3 months of lactation

Answer 10

DE (Mcal/day) = DEm + (0.03 x BW x 0.792)

Question 11

Calculate DEm for 300-900kg mare after 3 months of lactation

Answer 11

DE (Mcal/day) = DEm + (0.02 x BW x 0.792)

Question 12

Kcal content of mare’s milk

Answer 12

500-600kcal/liter

Question 13

What % of its body weight does a 1 week old foal consume per day

Answer 13

20-30%

Question 14

What volume of mares milk does a 1 week old 45kg foal consumer per day

Answer 14

9-13.5 litres of mare’s milk

Question 15

How many calories does a 1 week old 45kg foal consume via milk per day

Answer 15

4500 - 7800 kcal

Question 16

What is the resting metabolic rate of a healthy foal

Answer 16

45-50kcal/kg/day

Question 17

What level of requirement should a sick foal be started on

Answer 17

DEr = 10% of foals body weight of mares milk

Question 18

When does the largest growth rate occur

Answer 18

First month of life

Question 19

DEr (resting energy requirement)

Answer 19

DEr (Mcal/day) = (BW x 0.021) + 0.975

(It’s about 70% of the DEm)

Question 20

CP crude protein req in horse

Answer 20

CP in grams = 40 x DEm (in Mcal/day)

0.5 - 1.5g of protein per kg per day

Question 21

Which vitamins are synthesised in the horse’s large colon and caecum?

Answer 21

K, all the B vits minus niacin

Question 22

Which vitamins need to be ingested

Answer 22

Precursor to Vit A - Beta carotene
and Vit E

Question 23

Which are the fat soluble vitamins

Answer 23

A, K, D and E

Question 24

How does a lack of enteral feeding affect the gut

Answer 24

Mucosal atrophy, increased gut permeability and enzymatic dysfunction

Question 25

What does EEN early enteral nutrition refer to

Answer 25

Initiation of enteral feeding within 48 hours after surgery

Question 26

What is Glutamine an essential amino acid for?

Answer 26

As a fuel for lymphocytes, hepatocytes and mucosal cells of the gut.

Question 27

Describe how to prepare a slurry diet from pellets

Answer 27

1kg pellets into 4L water, once soaked add 2 more L of water

Question 28

How to begin feeding a patient with prolonged anorexia

Answer 28

Start with 50% over 24 hours then increase over days if tolerated.

Question 29

When using PN/TPN/PPN how are carbohydrates most commonly delivered?

Answer 29

With 50% dextrose solutions (2525mOsm/L) that contain 1.7Kcal/ml

Question 30

Isotonic lipid emulsions come in what % formulations and what do they typically contain

Answer 30

10% or 20% Safflower Soybean oil Egg yolk phospholipids Glycerin

Question 31

What % preparations of amino acids are most commonly used

Answer 31

8.5% and 10%

Question 32

Why can dextrose not be used as long term support

Answer 32

Less calorie dense than lipids No amino acids for protein production

Question 33

When would trace element supplementation be required

Answer 33

Sick animals on PN for >7days

Question 34

What DE and CP requirements are needed for animals receiving PN

Answer 34

DEr Maintenance cp - 0.5-1.5g protein per kg bw per day

Question 35

What should the ration of nonprotein calories to nitrogen be in the final solution

Answer 35

100:1

Question 36

How long can PN fluids be used before disposing of them due to bacteria growth concerns

Answer 36

24 hours

Question 37

At what rate should PN be started

Answer 37

25-50% of calculated req for first 24 hours

Question 38

Complications of PN

Answer 38

Hyperglycemia Hyperammonemia Hyperlipemia Elevation of serum urea nitrogen Thrombophlebitis Sepsis Lipid infusions have been associated with allergic rxns hyperlipemia alterations in liver function fat embolism Rebound hypoglycaemia when rates are altered too rapidly

Question 39

What extra caution should be used if using lipids in PN

Answer 39

Triglyceride levels and platelets should be checked regularly Don't use in horses with preexisting or predisposed to hyperlipemia or underlying liver dysfunction

Question 40

What daily monitoring should be performed on horses on PN during the acclimation period

Answer 40

1. Electrolytes 2. Blood urea nitrogen 3. TriG 4. Ammonia 5. Liver function

Question 41

How often should blood glucose be checked on a horse on PN

Answer 41

Every 4-6 hours

Question 42

What precautions should be taken when ceasing PN

Answer 42

Over 24 hours Freq glucose monitoring

Question 43

Difference btw grade 2 and grade 3 BCS

Answer 43

2 Spinous processes, ribs, tailhead, hooks and pins prominent 3 Pin bones not distinguishable, tail head prominent but individual vertebrae not visually identified, transverse processes cannot be felt

Question 44

Nutritional content of equine senior

Answer 44

CP 14% Fat. 4% Fiber 16% kcal/kg feed 2695

Question 45

Nutritional content of strategy

Answer 45

CP 14% Fat. 6% Fiber 8% kcal/kg feed 3300

Question 46

Nutritional content of purina horse chow

Answer 46

CP 10% Fat. 2% Fiber 30% kcal/kg feed 454

Question 47

Nutritional content of Vital NH and Osmolite

Answer 47

Cal/L. 1000 Protein 41.7g/dl Fat 10.8g/dl Carbohydrate 185 g/L Osmolite Cal/L. 1008 Protein 40g/dl Fat 34g/dl Carbohydrate 135.6 g/L

Answer 48

Cal/L. 1000 Protein 41.7g/dl Fat 10.8g/dl Carbohydrate 185 g/L