Dietary Sensitivity and Chronic Inflmmation Enteropathies

Question 1

What is a food intolerance ?

Answer 1

something that occurs repeatedly

Question 2

What is a non-repeatable diet sensitivity?

Answer 2

dietary indiscretion, intoxication or poisoning

Question 3

What are repeatable and non-repeatable sensitivies?

Answer 3

non-immunologically mediaated

Question 4

What are immunlogically mediated diet sensitivites?

Answer 4

food allergies

Question 5

Are food allergies repeatable or non-repeatable?

Answer 5

repeatable

Question 6

What are the most common food allergies in dogs?

Answer 6

beef, dairy products and wheat

Question 7

What are the most common food allergies in cats?

Answer 7

beef, dairy and fish

Question 8

What is ARF?

Answer 8

adverse food reactions

Question 9

What are immunologically mediated food sensntivites usually?

Answer 9

a protein component

Question 10

What are the cutaneous signs of a food allergy?

Answer 10

• pruritis/erythema

Question 11

What are the gastrointestinal signs of a food allergy?

Answer 11

vomiting, diarrhoea

Question 12

What is the most common food allergy reaction?

Answer 12

cutaneous - pruritis

Question 13

Are gastrointestinal signs non-specific or specific?

Answer 13

non-specifc

Question 14

What are the systemic signs of a food allergy?

Answer 14

anaphylaxis

Question 15

What age do food allergies usually present in?

Answer 15

younger pets however any age is possible

Question 16

What does dysorexia mean?

Answer 16

abnormal appetite

Question 17

What are chronic inflammatory enteropathies?

Answer 17

A ground of diseases with chronic gasto intestinal inflammation

Question 18

What symptoms would you see with chronic inflammatory enteropathies?

Answer 18

vomiting, diarrhoea, dysorexia, weight loss

Question 19

How long does it occur if it is a chronic inflammatory enteropathy?

Answer 19

more than >3 weeks

Question 20

What other causes must be involved for it to be a chronic inflammtory enteropathy?

Answer 20

exocrine, local abdonimal inflammtion, metabolic

Question 21

What exclusion testing would you do for CIE?

Answer 21

faecal, bloods, imaging (abdominal ultrasound)

Question 22

What are the causes of CIE?

Answer 22

food responsive disease, antibiotic responsive disease, idiopathic disease

Question 23

What would you recommend if a patient comes in with food responsive disease?

Answer 23

a diet trial

Question 24

What is another term for CIE?

Answer 24

Inflammatory Bowel Disease

Question 25

What type of disorder is idiopathic CIE?

Answer 25

immunological

Question 26

What causes gastrointestinal inflammation?

Answer 26

a shift in floral, causing loss of tolerance to mucosal flora

Question 27

How would you diagnose CIE?

Answer 27

biopsies

Question 28

What are the advatnages and disadvantages of doing an endoscope based approach to intestinal biopsies?

Answer 28

- minimally invasive - small mucosal biopsies - may not reflect jejunal disease

Question 29

What are the advantages and disadvatnages of doing a laparotomy aproach for intestinal biopsies?

Answer 29

- enables multiple full thickness biopsies - enables full exploration of other organs - surgical risk of dehiscence (~10%)

Question 30

What are the standard supportive therapies for CIEs?

Answer 30

- fluid balance - hydration, volaemia - nutritional balance - dietary modification; exclusion diet, tube feeding intitially in severely affected animals; dietary suitability - various anti-emetics, appetite stimulants, as required

Question 31

What are the principles for dietary trials?

Answer 31

- feed with water for minimum 3-10 weeks - NOT a sensitivity diet like Hill's I/D - other diseases may respond to dietary trials - dermatology signs respond in 10 weeks - GI responds in 3 weeks

Question 32

What are the dietary options for food intolerance/sensitivity trials?

Answer 32

- novel protein/carbohydrate (home cooked vs commercial) - hydrolysed protein

Question 33

Why might a patient need to have nutrtional support?

Answer 33

- less than 80% RER voluntary intake - more than 10% BW loss (after fluid balance) - more than 3 days hyporexia - severe underlying disease (trauma, sepsis, severe burns)

Question 34

What are other forms of dietary manipulation?

Answer 34

- feeding frequently/posutre - low fat - supplemented fibre

Question 35

What is a low fat diet good for?

Answer 35

- facilitates gastric emptying - good for reflux/regurgitation

Question 36

What drug you give if a patient is experiencing gastro-intestinal dilation?

Answer 36

omeprazole

Question 37

What drug can you give if a patient is experiencing gastro-intestinal ulceration?

Answer 37

sucralfate

Question 38

What can you do if a patient is experiencing reflux pain?

Answer 38

- manage oesophagitis - postural feeding

Question 39

What might opioids do if a patient is having abdominal discomfort?

Answer 39

may exacerbate/cause ileus

Question 40

What other medication can you give if a patient has abdomonial discomfort?

Answer 40

buscopan/spasmolytic

Question 41

What does a spasmolytic do?

Answer 41

relieves spasms of smooth muscle

Question 42

What per-anal management would you do for diarrhoea/faceal scald?

Answer 42

- keep bottom clean and dry - topical barrier such as cavilon spray or no sting barrier film +/- vaseline for extra barrier

Question 43

How would you manage the patient with diarrhoea/faecal scald?

Answer 43

- avoid patient grroming (provide distractions or use buster collar) - tail bandage - absorbent bedding (layers of inco sheets) - avoid vet beds as can be scratchy, use soft fleecy bedding

Question 44

Write down the consequences and considerations of CIEs

Answer 44

- dehydration - protein malabsorption 'protein losing enteropathy' - hypobilirubinaemia -effisions (pleural, respiratory comrpmise; peritoneal -oedema - throboemolic events - hypocobalminaemia - GI haemorrhage +/- anaemia - GI perforation

Question 45

Write down the standard therpies for CIEs

Answer 45

- immunosuppression - prednisolone (minimum effective dose) +/- adjuncts (handling care required) -+/- fenbendazole +/- metronidazole +/- vitamin B12 +/- anti-platelet drugs

Question 46

Write down the nursing considerations for CIE patient

Answer 46

- hydration status (replace deficits/ongoing losses) - inappetance/nausea - nutriton/malnutrtion status (tube feeding, B12/potassium - abdominal discomfort - hypoproteinaemia - diarrhoea/faecal scald - body/muscle condition score

Question 47

Write down the monitoring considerations for the CIE patient

Answer 47

- weight - appetite - demeanour - vomiting/diarrhoea (record nature, vomit/regurge vs small/large intestinal diarrhoea; try to quantify) - hydration/volaemic status - HR/ RR - comfort levels - bloods; electrolytes, proteins