Enteral Nutrition

Question 1

Enteral nutrition

Answer 1

Delivering food to gastrointestinal tract as much as possible

Question 2

Parenteral nutriton

Answer 2

Nutrition that is placed directly into vascular circulation
* Usually just at referral level
* Total or partial parental nutrition
* Liquid made up of amino acids, glucose and lipid components
* Centrally placed catheter (multi-lumened)
* Maintain fluid therapy and fluid electrolyte analysis

Question 3

Common problems with parenteral nutrition

Answer 3

Infection at site of catheter
Phlebitis
Hypoglycaemia
Hypertriglyceridaemia

Question 4

What is assisted feeding and when is it used?

Answer 4

• Used when animal is unable to obtain all nutrients needed to meet daily requirement so support is needed
• Animal may be unable to eat as normal or is unable to absorb the nutrition from specific sections of GIT

Question 5

What would make a good recovery diet?

Answer 5

○ Additional B vitamins
○ High protein
○ Moderate fat
○ Low carbohydrates

Question 6

How should nutrition be administered?

Answer 6

Via GIT wherever possible
Administered slowly
discontinued in controlled manner (over 6-12 hours)

Question 7

Why should nutrition be via GIT where possible?

Answer 7

Otherwise enteral villi will atrophy
Could lead to bacterial relocation

Question 8

Refeeding syndrome

Answer 8

• Sudden drops in sodium, potassium, magnesium and nutrient losses
  ○ Due to sudden increase in carbohydrate in food leading to sudden increase in insulin levels

Question 9

Types of tube feeding

Answer 9

Syringe feeding
Naso-oesophageal, naso-gastric
Oesophagostomy
Gastrostomy/PEG
Enterostomy

Question 10

Types of food

Answer 10

Liquid or mixed diets
Specific clinical diets
Critical care diets
For parenteral - usually specific to individual patient

Question 11

How do you know how much to feed?

Answer 11

1. Calculate patients RER
   ○ RER = (30 X BW) + 70
2. Look at food and find K/cal per ml or gram
3. Roughly 10ml/kg per meal is correct
   ○ Maximum of 50ml/kg/feed
   Giver over 8 hour day

Question 12

What should you consider when decided on placing a tube?

Answer 12

Time-frame it is in place
Toleration
Cost
Home care

Question 13

Oesophagostomy

Answer 13

Max 3-4 weeks
Well tolerated
Need GA so more expensive
Home care is possible with compliant owners
Can give a lot in one feed

Question 14

Naso-oesophageal/Naso-gastric

Answer 14

3-5 days
Well tolerated
Quite cheap
Can be used at home if owner can cope
Can’t give a lot in a short space of time
Good as supplementary

Question 15

Percutaneous Endoscopic

Answer 15

Months of potentially longer
Well tolerated
Home care with committed owners
Risks with post-op infection
Can give pretty much normal meals in liquid form

Question 16

Common problems with feeding tubes

Answer 16

• Blockages
• Dislodging of the tube, movement
• Trauma
• Infection
• Over-granulation

Question 17

Causes of problems with feeding tubes

Answer 17

• Forgetting to flush before and after feeding
• Coughing/sneezing/vomiting/movement
• Chewing/biting and pawing
• Poor care of the surgical site
• Movement, infection

Question 18

What sort of catheter should be used for parenteral nutrition?

Answer 18

Central venous catheter
Placed in jugular - reduces risk of phlebitis/infection
Multiples lines for fluid therapy as well

Question 19

Following repair to a simple fracture to the mandibular symphysis, Pumpkin will require 3 days of post operative nutritional support
What feeding method would you choose?

Answer 19

Naso-oesophageal

Question 20

Pumpkin will need a feeding guide developing, she weighs 4.3kg. Work out her RER and how much to feed her if you are using RCW recovery liquid at 1.1 k/cal per 1ml liquid. Remember to think about how much per meal and how many meals per day. Show your working.

Answer 20

○ RER = (30xBW) + 70
○ RER = (30x4.3) + 70= 199 kcals per day
○ 1.1kcal per 1ml liquid
§ 1kcal = 0.9091 ml (180ml per day)
○ 8 hour days
○ Roughly 8 feeds per day of 22ml