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Clinical Nutrition Flashcards

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1
Q

what are the 6 basic classes of nutrients?

A 
protein
fat
carbohydrate
minerals 
vitamins
water
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2
Q

why may dry food be prefurrable?

A

aids dental health

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3
Q

what is the most important nutrient?

A

water

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4
Q

how much water intake is required per day?

A

20-70 ml/kg/day

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5
Q

what is the correct urine output for animals?

A

1-2 ml/kg/hr

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6
Q

what must be available at all times?

A

water

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7
Q

what are vitamins?

A

organic compounds

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8
Q

what are the lipid soluble vitamins?

A

A, D, E, K

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9
Q

what are the non-lipid soluble vitamins?

A

B and C

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10
Q

what are vitamins used for?

A

energy metabolism

biochemical reactions

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11
Q

what can happen if an animal is receiving an inadequate number of vitamins?

A

deficiency syndromes

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12
Q

what are the macrominerals?

A 
calcium
phosphorus
magnesium
sodium
potassium
chloride
sulpher
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13
Q

what are the most important microminerals?

A 
iron 
copper
zinc
manganese
iodine
selenium
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14
Q

what is protein formed from?

A

chains of amino acids

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15
Q

how many amino acids to animals need?

A

all 23

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16
Q

what is formed from amino acids?

A 
hair
skin
muscle
hormones
antibodies 
(etc)
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17
Q

where can many amino acids be synthesised?

A

in the body

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18
Q

what are the essential amino acids?

A

those that cannot be synthesised within the body and so must be gained through the diet

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19
Q

why are cats obligate carnivores?

A

require taurine in their diet as they are unable to synthesise it

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20
Q

what are the functions of protein?

A

regulation of metabolism
tissue growth and repair
cell and muscle fibre structure
energy source

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21
Q

what are the essential amino acids?

A 
phenylalanine
valine
tryptophan
threonine
isoleucine
methionine
arginine
leucine
lysine
taurine (cats only)
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22
Q

what will deficiency in taurine cause?

A

blindness and heart problems

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23
Q

what is the biological value of protein?

A

a measure of the proportion of absorbed protein from a food which becomes incorporated into the proteins of the organism’s body - higher value is easier for the body to utilise

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24
Q

what are the issues caused by excess dietary protein?

A

liver and kidney problems

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25
Q

why must care be taken to to ensure dietary protein is at the right level at different life stages?

A

care that there is not excess in ageing animals as their kidney function is likely reduced
ensure high protein diet in growing young

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26
Q

what is caused by protein deficiency?

A 
poor growth, muscle and weight loss
dull hair
reduced immunity
oedema (due to hypoalbuminemia)
death
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27
Q

what are fats made up of?

A

triglycerides (glycerol and fatty acids)

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28
Q

what is the role of fats in the body?

A 
provide energy
aid absorption of fat soluble vitamins
enhance palatability
source of essential fatty acids
neural development (DHA)
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29
Q

what are the essential fatty acids?

A

linoleic
linolenic
arachidonic

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30
Q

what is DHA essential for?

A

neural development

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31
Q

what is the effect of inadequate intake of fats?

A

energy deficiency

EFA deficiency

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32
Q

what are the effects of EFA deficiency?

A 
impaired reproduction
impaired wound healing
dry coat
flaky skin
eczema
hot spots
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33
Q

what are the 3 main groups of carbohydrates?

A

monosaccharides
disaccharides
polysaccharides

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34
Q

what group do complex carbohydrates fall into?

A

polysaccharides

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35
Q

what are carbohydrates used for?

A

energy

metabolic requirement for glucose

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36
Q

what will happen to excess carbohydrates?

A

converted to fat

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37
Q

what is fibre?

A

indigestible polysaccharide

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38
Q

what are the main sources of fibre?

A

cellulose
lignin
pectin

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39
Q

where is fibre most commonly found?

A

plant cell walls

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40
Q

is fibre digestible in the intestine of dogs and cats?

A

no

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41
Q

what is the function of fibre?

A

bulk out faeces
prevent constipation and diarrhoea
role in correction of obesity (satiety)
role in regulating blood glucose levels in diabetes

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42
Q

when should animals be body condition scored?

A

at all clinical exams

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43
Q

describe a BCS of 4 in a dog

A

Ribs easily palpable, with minimal fat covering. Waist easily noted, viewed from above. Abdominal tuck evident

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44
Q

describe BCS of 5 in a dog

A

Ribs palpable without excess fat covering. Waist observed behind ribs when viewed from above. Abdomen tucked up when viewed from side

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45
Q

describe BCS of 5 in a cat

A

Well-proportioned body. Ribs are not visible but easily felt. Waist obvious/ slight abdominal tuck. Small amount of abdominal fat.

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46
Q

describe BCS of 4 in a cat

A

Ribs not visible but are easily felt. Waist is obvious/ slight abdominal tuck. Minimal amount of abdominal fat.

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47
Q

what is metabolisable energy (ME)?

A

kcal per 100g of a diet - most accurate way to see what calories the animal will take in

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48
Q

why is gross energy a less reliable measure of energy intake?

A

not all available to the animal so less reliable

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49
Q

what is basal energy requirement (BER)?

A

amount of energy expended during sleep, 12-18 hours after food in a thermoneutral enviroment

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50
Q

what is resting energy requirement (RER)?

A

BER with energy expended for recovery from physical activity and feeding

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51
Q

what energy requirement is used to calculate food needs in hospitalised patients?

A

RER

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52
Q

what is maintenance energy requirement (MER)?

A

energy required by a moderately active animal

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53
Q

what is not included within MER?

A

energy for growth, lactation and work

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54
Q

what factors must be considered when calculating MER?

A

lifestage

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55
Q

what is the calculation for RER for animals under 2kg and above 45kg?

A

RER= 70 x (BWT/kg)0.75

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56
Q

what is the calculation for animals between 2 and 45kg?

A

RER = 30x BWT/kg + 70

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57
Q

how can calorie intake be calculated?

A

calculate RER
choose most beneficial diet
divide energy content of diet by RER to achieve daily food required
divide total for the day by total number of feeding times /max volume of each meal

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58
Q

what should be used to calculate calorie needs in the clinical environment?

A

RER

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59
Q

what should be used to calculate calorie needs in the healthy patient?

A

MER

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60
Q

what makes up the MER calculation?

A

RER x lifestage factor

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61
Q

what factors are now no longer considered appropriate to factor into calorie needs?

A

illness factors

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62
Q

what is obesity?

A

excess accumulation of body fat

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63
Q

what can cause obesity?

A

modern lifestyle
neutering
overfeeding
poor owner understanding

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64
Q

what can be used to give an indication of obesity?

A

BCS

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65
Q

what are the possible consequences of obesity in dogs and cats?

A 
hepatic lipidosis
joint disease
exercise intolerance
DM
skin disease
cardiorespiratory disease
impacts on surgery
FLUTD
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66
Q

what is a safe amount of weight loss per week?

A

1-2%

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67
Q

what is required in order to achieve safe weight loss?

A

diet changes
exercise plan
behavioural changes

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68
Q

what should the MER of an obese dog be calculated based on?

A

ideal weight not current weight

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69
Q

what should weight loss programmes be tailored to?

A

individual animal and owner

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70
Q

what are the key issues with starvation for weight loss?

A

ethically questionable
excessive loss of lean body mass (LBM)
body function problems
risks hepatic lipidosis in cats

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71
Q

what are the main features of obesity diets?

A

nutritionally balanced
high protein
joint health often supported
L- carnitine included

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72
Q

what is the benefit of a nutritionally balanced obesity diet?

A

pet receives correct levels of vitamins and minerals

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73
Q

what is the benefit of a high protein obesity diet?

A

preserves lean body mass
reduced net energy
satiety
palatability

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74
Q

why are joint health supplements often included in obesity diets?

A

obesity and joint issues linked

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75
Q

what is the benefit of joint supplements within an obesity diet?

A

helps maintain joint health in overweight pets

reduces the need to supplement

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76
Q

what are the main components of joint supplements?

A

glucosamine and chondroitin

77
Q

what is L-carnitine?

A

non essential amino acid

78
Q

what does L- carnitine do?

A

transports long chain fatty acids into the mitochondria for use in beta oxidation

79
Q

what are the benefits of including L- carnitine into obesity diets?

A

helps encourage use of fat for energy and reduce fat storage

reduces risk of hepatic lipidosis in cats

80
Q

what is one of the key areas where owners can make a significant difference to their pet’s health?

A

diet

81
Q

what are the key GI issues that may be managed through nutrition?

A

acute and chronic GI issues

EPI and uncderweight

82
Q

what acute and chronic GI issues may be managed with diet?

A 
diarrhoea
gastritis/enteritis
IBD
maldigestion/malabsorption
bacterial overgrowth
cholangiohepatitis (cats)
83
Q

what is cholangiohepatitis?

A

inflammation of liver and bile duct

84
Q

what are the ingredients found in diets for GI disease?

A 
highly digestible proteins and starch
mannon oligosaccharrides
FOs
EPA/DHA
Psyllium
high or low fat
supplementation for EPI or absorption syndromes
85
Q

what do highly digestible proteins have?

A

high bioavailablity (easy to break down)

86
Q

what does MOS stand for?

A

mannan oligasaccharide

87
Q

what does FOS stand for?

A

fructose oligasaccharides

88
Q

where do MOS come from?

A

cell wall of yeast

89
Q

where does FOS come from?

A

beet pulp, grains, barley and wheat

90
Q

what is the role of MOS and FOS?

A

enhances good gut bacteria

91
Q

what does EPA stand for?

A

eicosapentaenoic acid

92
Q

what does DHA stand for?

A

docosahexeanoic acid

93
Q

what are EPA and DHA?

A

omega 3 essential fatty acids (unsaturated)

94
Q

what is the role of EPA and DHA?

A

increase digestion

95
Q

what is the role of psyllium in GI diets?

A

aids toxin and waste removal
bulks faeces and absorbs water
relieves constipation
aids peristalsis

96
Q

where does psyllium come from?

A

plant husk

97
Q

what will the decision to feed high or low fat diets depend on?

A

individual patient

98
Q

what my be included in GI diets to support EPI or malabsorption syndromes?

A

supplementation e.g. Lypex

99
Q

how does Lypex deliver pancreatic enzymes to the small intestine?

A

coated so that they are unaffected by the gastric environment

100
Q

what does Lypex provide?

A

artificial pancreatic enzymes for patients with EPI

101
Q

why may a patient need a hypoallergenic diet?

A

allergic to a component or ingredient of normal diets

102
Q

what can food allergy lead to?

A

skin and GI diseases

103
Q

what is the role of hypoallergenic diets?

A

nutritional management of dogs and cats with food allergy/hypersensitivity/intolerance

104
Q

what may be involved in diagnosis food allergy/hypersensitivity?

A

food elimination

105
Q

what other conditions aside from allergy are hypoallergenic diets useful for?

A

inflammatory bowel disease
EPI
as it increases the digestibility of food

106
Q

what are some common protein allergies?

A

chicken

beef

107
Q

what can be done to prevent food allergy but still be able to feed protein?

A

hydrolysed proteins

108
Q

how does hydrolysation of proteins prevent allergic reaction?

A

change the protein surface so that immunoglobulins in the body no longer recognise and bind to the protein. This means mast cells no longer degranulate and histamine is not released (no symptoms)

109
Q

how are proteins hydrolysed to prevent allergic reaction?

A

using enzymatic hydrolysis by hydrolysates

110
Q

what immunoglobulin is involved in hypersensitivity reactions?

A

IgE

111
Q

what happens during a hypersensitivity reaction that causes symptoms?

A

IgE binds, mast cells are stimulated to degranulate

histamine released

112
Q

how long can a hypersensitivity diet take to have effect?

A

several weeks - up to 6

113
Q

what are hypoallergenic diets made from?

A

hydrolysed proteins

novel source of protein (e.g. duck)

114
Q

what is included within hypoallergenic diets to improve the skin barrier?

A

B vitamins
amino acids
zinc
linolenic acid

115
Q

what fatty acids are found in hypoallergenic diets?

A

EPA and DHA

116
Q

why are the essential fatty acids EPA and DHA needed in hypoallergenic diets?

A

support skin and GI mucosal integrity so the animal is less prone to upset

117
Q

what is included in hypoallergenic diets to improve digestive security?

A

beet pulp
FOS and MOS
zeolite

118
Q

what is the role of beet pulp in a hypoallergenic diet?

A

promote motility

119
Q

what is the role of FOS, MOS and zeolite in hypoallergenic diets?

A

support a healthy intestinal environment

120
Q

what is zeolite?

A

mineral that removes toxic elements

121
Q

who are convalescent required for?

A

hospitalised patients / those with anorexia

122
Q

how much of total energy provision in convalescent diets is from protein sources?

A

30-50%

123
Q

why must care be taken when feeding high protein convalescent diets?

A

if patient is in renal failure or has hepatic encephalopathy as these animals are less able to manage protein safely in the body

124
Q

what should happen before feeding a convalescent diet to patients?

A

check with vet

125
Q

what are the most widely available forms of convalescent diets?

A

liquid diets
powdered diets
solid wet diets

126
Q

can all convalescent diets be given via feeding tube?

A

yes but care must be taken to ensure correct calories if diluting and that they will not get stuck in the tube

127
Q

what are critically ill patients at risk of?

A

malnutrition

128
Q

why are critically ill patients at risk of malnutrition?

A

energy is not conserved as normal due to catabolism and rapid breakdown of energy stores that occurs in the stress state of metabolism

129
Q

what is one of the most marked features of critically ill patients?

A

catabolic depletion

130
Q

what will be improved by proper nutrition of the critically ill patient?

A

tissue repair
wound healing
immune function

131
Q

what should be encouraged in all sick patients as soon as is safe?

A

oral nutrition considering possible complications (e.g. aspiration)

132
Q

what should not be introduced in a hospital setting?

A

new diet (if long term use planned) as there is risk of food aversion

133
Q

what is the first option when feeding animals?

A

voluntary eating

134
Q

how can an animal be encouraged to eat?

A 
calm environment
warm food
strong smelling
palatable
remove any physical barriers
ensure fresh
offer one food type at a time
leave patients without food
135
Q

what are the physical barriers that may prevent a patient from eating?

A

buster collars
injury to face
too small bowl (esp. cats)

136
Q

what can be used if voluntary feeding is not achieving adequate calorie intake?

A

enteral feeding tubes

137
Q

what type of diet is judged to be better for dental health in dogs and cats?

A

hard kibble

138
Q

what 3 things can be included in the diet to improve dental health?

A

phosphate salts - anti calculus properties
Igy-GP - blocks bacterial formation
omega 3 - controls inflammation caused by periodontal disease

139
Q

what is the exocrine function of the pancreas?

A

synthesis and excrete digestive enzymes

140
Q

what causes pancreatitis?

A

premature activation of digestive enzymes within acinar cells - leads to pancreas autodigestion

141
Q

what does the inflammatory cycle of pancreatitis begin with?

A

addition of neutrophils

142
Q

what are the clinical signs of pancreatitis?

A

vomiting
abdominal pain
anorexia
lethargy

143
Q

what can severe pancreatitis lead to?

A 
renal failure
acute lung injury
DIC
chronic pancreatitis
EPI
144
Q

how is pancreatitis treated?

A 
IVFT
antiemetics
analgesia
gastro-protectants
nutrition
145
Q

what is involved in nutritional support of pancreatitis patients?

A

no fasting

eat as early as possible once nausea and vomiting are under control

146
Q

what are the benefits of early nutrition for pancreatitis patients?

A

reduced villi damage and so less bacterial translocation
reduced villus atrophy
reduced pancreatic inflammation

147
Q

is enteral or parenteral nutrition more beneficial for pancreatitis patients?

A

enteral

148
Q

what type of diet should be avoided in pancreatitis patients?

A

high fat

149
Q

why should a high fat diet be avoided in pancreatitis patients?

A

concurrent hyperlipidaemia which is a risk factor for pancreatitis

150
Q

what enteral feeding methods can be used in pancreatitis patients?

A

oral

pre-pyloric (NG, NO)

151
Q

when feeding an anorexic patient what must be considered?

A

introducing food slowly over a number of days to prevent refeeding syndrome

152
Q

what elements of the diet need to be carefully managed to ensure normal skeletal development/maintenance?

A

calcium
phosporus
vitamin D

153
Q

what is the benefit of regulating calcium, phosphorus and vitamin D in growing animals?

A

reduction in orthopoedic issues in later life

154
Q

when is diet management of orthopedic issues particularity important?

A

large breeds while they’re growing

155
Q

what is osteoarthritis?

A

articular cartilage degradation

156
Q

what animals is osteoarthritis seen in?

A

ageing cats and dogs

some rabbits

157
Q

in what breeds is joint dysplasia most commonly seen?

A

medium to large

158
Q

what makes joint dysplasia more likely?

A

genetic predisposition

159
Q

what are the main orthopedic issues that can be supported by diet?

A

osteoarthritis
joint dysplasia
cranial cruciate ligament rupture/luxating patella

160
Q

what must be managed in young dogs (especially large and medium)?

A

growth rate through diet

exercise

161
Q

what is the key area of nutrition for dogs with arthritis?

A

weight management

162
Q

how can reducing weight lead to improved arthritis?

A

reduces pain as weight and so force through joints is reduced

163
Q

what are the key ingredients in arthritis diets?

A

omega 3 fatty acids (EPA/DHA)
green lipped mussel
glucosamine and chondroitin sulphate

164
Q

what is the role of omega 3 fatty acids in arthritis management?

A

reduces inflammation

165
Q

what is the required amount of omega 3 needed to have an effect on arthritis?

A

230-370 mg/kg

166
Q

what is the role of glucosamine and chondroitin sulphate?

A

cartilage formation and repair
reduce inflammation
slow cartilage degeneration

167
Q

what are the aims of diabetic diets?

A

support in achieving normal glucose levels
decrease postprandial glucose peaks
achieve normal metabolism of carbs, fats and proteins
normalise body weight

168
Q

what is the effect of high fibre on DM?

A

regulation of glucose spikes

169
Q

what % DMB of a diabetic diet should be made up of protein in dogs?

A

15-25%

170
Q

what % DMB of a diabetic diet should be made up of protein in cats?

A

28-50%

171
Q

why should fat be controlled in diabetic diets?

A

high fat will increase insulin resistance

172
Q

what % DMB of a diabetic diet should be made up of fat?

A

<20%

173
Q

what is an important dietary factor in DM management?

A

insoluble carbohydrate (fibre)

174
Q

what blood parameter is moderated by diabetic diets?

A

fructosamine

175
Q

what must be avoided when feeding diets in cats while hospitalised?

A

food aversion - do not feed new diet while in hospital

176
Q

what is often seen alongside hyperthyroidism?

A

chronic renal failure

177
Q

why may kidney disease only become apparent after treatment of hyperthyroidism?

A

renal perfusion is increased in hyperthyroidism

as thyroid resolves this will drop and so CKD will become obvious

178
Q

what is required in the diet for the production of thyroid hormones?

A

iodine

179
Q

what level of iodine should be seen in a diet for hyperthyroid cats?

A

0.2ppm DMB

180
Q

what is the issue with hyperthyroid diets (e.g. Hills y/d)?

A

must be exclusively fed

poisonous to euthyroid cats

181
Q

is there a single diet appropriate for all cardia cases?

A

no - holistic approach and discussion with vets

182
Q

what are the main considerations for nutrition of the cardiac patient?

A

mild sodium restriction to maintian BP
maintain optimal BCS
monitor muscle mass in severe cases (cardiac cachexia)

183
Q

what are the main things that can be added to the diet to support cardiac health?

A

amino acids

184
Q

what amino acids can support cardiac function?

A

taurine
lysine and methionine to synthesise L-carnitine
arginine

185
Q

what is taurine deficiency linked to?

A

dilated cardiomyopathy

cats especially needed as they cannot synthesise

186
Q

what is the role of L-carnitine in cardiac health?

A

myocardial energy production

187
Q

what is the role of arginine in cardiac health?

A

normal vasular tone

188
Q

what is the role of omega 3 fatty acids in cardiac health?

A

reduces muscle loss - cardia cachexia

anti-arrhythmatic effects

189
Q

what should never be restricted in pet diets unless specifically required by condition?

A

protein - especially in older animals

X Clinical Veterinary Nursing Theory (70 decks)

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