Exam 3 Flashcards
Regurgitation
Reflux of undigested food from mouth or esophagus before it has reached the stomach
Congenital megaesophagus (chronic regurgitation in immature animal) - what causes it?
Great Danes, Irish Setters, German Shepherds, etc. – due to impaired motor neuron function
Cricopharyngeal achalasia (chronic regurgitation in immature animal) - What causes it?
muscle doesn’t relax – prevents food from entering esophagus
Chronic regurgitation in adult animals (list of conditions)
megaesophagus
Neurologic diseases
Chaga’s disease
Megaesophagus
In a dog with megaesophagus, the esophagus muscles do not force food into the stomach. When gravity alone does not allow the food to enter the stomach, the food will simple regurgitate, or fall back out of the mouth
Management of Achalasia (A rare disorder making it difficult for food and liquid to pass into the stomach.), other Anomalies
Usually surgical correction, or
Bougienage (. A bougie is a thin cylinder of rubber, plastic, metal or another material that a physician inserts into or though a body passageway, such as the esophagus, to widen the passageway, guide another instrument into a passageway, or dislodge an object.) and treatment of esophagitis
Remove foreign bodies, and treat for esophagitis
Management of Megaesophagus
Feed the animal on stairs or from an elevated platform
Gravity helps move ingesta to stomach
Feed different forms of food/different feeding regimens to find what is best tolerated
Observe closely for aspiration pneumonia
Management of Reflux Esophagitis
Medical therapy for esophagitis
Withhold food for 3-4 days; then offer small amounts of a food slurry 3-6 times daily for several days. If this is well tolerated, feed a canned food for several more days; thereafter, gradually return to a normal diet.
Vomiting
Forceful ejection of the contents of the stomach and sometimes proximal small intestine – some delay after eating;
partially digested;
pH may be <4
common causes of vomiting`
obstruction of the bowels or stenosis. Various GI diseases.
Results of vomiting on the body
Electrolyte and acid-base imbalances
Dehydration
Management of Vomiting
Fluid therapy if dehydration present
Withhold all food 12-48 hours; withhold water 12-24 hours
Specific therapy for cause, if it can be identified
After vomiting has stopped, gradually return patient to full feed and water over a 3-5 day period
Highly digestible food is recommended
Gastric Dilatation with Volvulus (GDV) (Bloat)
Laxity of the gastrohepatic ligament
Gastric dilatation with gas
Obstruction to eructation and passage of gas from the stomach
Possible Causes of bloat Bloat
Consumption of large amounts of food in one feeding
Physical activity shortly after eating a large meal
Excessive dietary calcium
Rapid food consumption
Giant and large breeds of dogs predisposed
Clinical signs of Bloat
Sudden abdominal bloating Retching with inability to vomit Moaning in pain Dyspnea Collapse Death may occur within a few hours Due to absorption of endotoxins, acidosis, tissue hypoxia, spleen strangulation, shock
Management of Bloat (after it has occurred)
A true emergency
Decompress stomach
Treat for shock
Administer oxygen
If volvulus has occurred, correct surgically and perform gastropexy; feeding tube may be inserted at time of surgery
Withhold food and water 24 hours post-op. Start back on small amounts water and highly digestible food; gradually increase to normal requirement over several days
Prevention of Bloat
Feed smaller meals more often
Use mechanisms which prevent gulping food (and air)
No strenuous exercise for 2 hours after feeding
No excess calcium in diet
Some recommend elective gastropexy
Diarrhea
Passage of loose or liquid stools at increased frequency
clinical signs of small bowel diarrhea
Less frequent
Large volumes
If hemorrhagic, blood is dark red to black,tarry (melena)
clinical signs of small bowel diarrhea
Frequent
Small amounts
Often contains mucus and/or fresh blood
Effects of diarrhea
Fluid/electrolyte losses
Dehydration
Management of diarrhea
Fluid therapy if dehydrated
Withhold food, but not water for 1-4 days for more severe cases
Treat initiating cause if can be identified
Return slowly to food with highly digestible diet normal diet over several days
Colitis Causes
Parasitic Bacterial Stress Neoplasia Etc.
Clinical signs of colitis
Large bowel diarrhea
Constipation or Tenesmus causes
Obstructive neoplasms Megacolon Pelvic abnormalities Fungal Dietary – eating bones Etc.
management of constipation
Enemas, manual evacuation of stool, surgery as appropriate
High fiber diets generally best for recurrent problems
Exercise frequently, manage medically as warranted
sources of intestinal gas
Swallowed air
Gas diffusion from blood to gut lumen
Acid-base neutralization reaction produces CO2
Bacterial fermentation of nutrients – methane, CO2, etc.
Management of flatulence
Feed free choice or several times daily in quiet location alone; adding water to food may help
Feed highly digestible, low fiber, moderately low protein, soy free, wheat free diet
Do not feed any vegetables, milk, table scraps, or vitamin mineral supplements
Coprophagy
Eating feces, not generally harmful, boredom or habit
Coprophagy management
Difficult to eradicate behavior
For-Bid® - food additive if eating own feces
Treat feces with hot pepper sauce, etc. to cause animal to have unpleasant experience
If dog is eating cat feces, barring access to litter boxes prevents
Habit usually returns
clinical signs of hepatic disease
Lethargy, anorexia, depression, weight loss, vomiting, diarrhea, ascites, icterus, CNS signs, bleeding tendencies
Management of hepatic disease
Symptomatic therapy for clinical signs
Feed highly digestible diet moderately restricted in salt, fat, and high-quality protein, high in B vitamins
For encephalopathy where clinical signs not relieved by above diet, use more protein restrictive diet, as for renal disease
Anorexia
Loss of appetite before caloric needs have been met`
Drive to eat is controlled by
Hunger – physiologic state resulting from lack of food
Appetite – desire for food
Satiety – lack of desire to eat because caloric needs have been satisfied
Adverse effects of inadequate food
Impaired immunity Decreased resistance to infection, shock Slower recovery from surgery, cytotoxic drugs Decreased wound strength Muscular weakness Organ failure Death Severity of signs increases over time
Nutrient Precedence and Needs
Water – highest priority
Energy – 2nd priority
Protein
Vitamins/Minerals
Causes for nutritional support based on history
Recent loss of >10% BW/below optimal BW (BCS 1 or 2)
Restricted food intake/infusion of simple IV fluids for > few days
Increased losses
NVD or malabsorption from any cause
Surgical absence of portion of GI tract
Draining abscesses/wounds/burns
Causes for increased need of nutritional support
Extensive burns, infection, trauma, or recent surgery
Fever
Chronic disease or organ dysfunction
How to identify anorexia from physical examination
General Appearance
Cachexia, edema
Skin
Thin, dry, scaly, easily pluckable hair, decubital ulcer, non-healing wounds
Musculoskeletal
Muscle weakness/atrophy, growth retardation, bone or joint pain, epiphyseal swelling
Organ Systems
Hepatomegaly, splenomegaly, ascites, small bowel distention, tumors, pregnancy
Fluid/Electrolyte Therapy
Proper fluid balance has primary importance Goals Rehydration or treatment of shock Electrolyte replacement Normalization of acid-base balance
Routes Preferred for fluid therapy
Oral preferred - “If the gut works, use it!”, If not oral, SQ/IV/intraosseous/intraperitoneal
If dehydrated >6%, best to give at least ½ IV
Contraindications to oral fluid tx:
Vomiting
>8% dehydration (mesenteric blood flow inadequate for fluid absorption)
Pre-anesthesia
Subcutaneous fluid therapy
Warmed to body temperature fluids
Never > 2.5% dextrose/glucose
Give <20-30 mL/kg BW at one time in several sites
Absorbed over 6-8 hours
intravenous fluid therapy if:
Dehydration > 8%
Fluid losses faster than GI or SQ absorption
Shock or electrolyte imbalances present
GI tract can’t be used
Intraosseus fluid therapy
Primarily in the neonate, when vein inaccessible
Intraperitoneal Fluid therapy
Rarely used
Dialysis
Used in Pig, when veins not easily accessible
Fluid types
Lactated Ringer’s Solution (LRS) Normal saline (0.9%) Isotonic Dextrose (5% or 2.5% Dextrose in water (D5W; D2.5W))
Feeding
Should begin AFTER fluid volume, electrolyte, and acid-base abnormalities have been corrected
Use GI tract when possible
Growth foods best unless contraindicated by uremia, etc.
Coaxing to eat
Hand feed Warm food to enhance aroma Have owner visit and feed, or take home for a few hours to feed Use highly palatable foods Try different foods Drug tx – Diazepam in cats and puppies
Force Feeding
Place food in pharyngeal area
Use syringe or “meatballs”
Hills’ A/D, etc. or human baby food meats
Can add high calorie supplement such as Nutrical™
If feeding > few days, tube feeding better
orogastric of nasogastric tube feeding
Least invasive Orogastric – replaced for each feeding Nasogastric – may be left in place Liquids only Can swallow with tube in place
Pharyngostomy or esophagostomy
Requires general anesthesia for placement
Esophagostomy tube generally preferred today
Tube bandaged in place; may leave in for weeks; swallow with tube in place
Gastrostomy tube feeding
Used less often; Post-operative in GDV cases
Diets for tube feeding
Commercial foods blended with water
Liquid diet, such as CliniCare™
Rate and volume for tube feeding
Normal dogs can tolerate about 90 mL/kg BW at one time without regurgitation
Adult cats 45mL/kg; kittens 100 mL/kg
If have been anorectic > 2 days, have decreased stomach capacity
Start with half amount and gradually increase volume over several feedings
Minimum three feedings/day
Problems/complications of tube feeding
Mechanical
Placement of tube – check prior to each feeding
May get regurgitation/aspiration from improper placement or administering excessive quantities
Tube may become occluded if coarse food materials used or not flushed properly
Tightly cap tube when not in use
GI problems
Too rapid administration
Administration of poorly absorbed solutes
Metabolic problems
Hyperglycemia if give too much glucose
Obesity
> 10-15% over optimal weight
Incidence of obesity in pets increases with:
Age, gender (female), breed Neutering (2X higher) Overweight owners, feeding habits Middle-aged to older owners Reduced physical activity
Effects of obesity
Shortens life span Joint and locomotion problems Respiratory, cardiovascular difficulties Liver disease Skin disease Digestive problems, i.e. constipation Increased risk of diabetes Increased anesthetic and surgical risks
Diagnosis of obesity
Complete physical examination Rule out medical causes (5%): Cushing’s disease Hypothyroidism Congestive heart failure Diabetes mellitus Etc.
Assessment of Degree of obesity
Compare present weight to non-obese weight from medical history
Assess based on amount of fat over ribs, ventral abdomen, over tailhead, over hips, etc. – give body condition score
Evaluate for waddling, sluggishness, poor mobility, lack of grooming in the cat due to inflexibility
Management of obesity
Psychological Encouragement
Convince ALL persons associated with pet of the necessity for wt. loss
Detrimental effects of obesity
Benefits of weight reduction/maintenance
Exercise for Weight Reduction
Loss of 1 pound requires energy deficit of about 3,500 kcal
Benefits of exercise for weight reduction
Exercise increases energy expenditure Prevents decrease in RMR that would occur normally when caloric intake decreases Prevents losses of lean body mass Improves cardiovascular function Helps maintain weight loss
Dietary Management – Weight Loss
Obtain complete client cooperation
Evaluate patient thoroughly
Weigh animal – set goal
Estimate time to reach goal
Decrease caloric intake to 60-70% of that required for maintaining optimum body weight
Feed 3-4 X daily, or as often as practical – increases energy lost as heat
Instruct owner to keep animal out of room when food being prepared or eaten
Change to a weight reduction diet food
Client must follow instructions, and feed only the specific amount of food prescribed
Recommend beginning exercise program gradually
Examine/weigh animal every 1-2 weeks
Starvation for Weight Reduction
Weight loss of adipose tissue is only 3-5% greater after 7 weeks of fasting than it is when a low calorie reducing diet is fed
Many consider inhumane
Recurrence of obesity more likely
Starvation of obese cats may result in severe hepatic lipidosis and death—always gradually reduce energy intake
Drug Use for Weight Reduction
Slentrol™ introduced by Pfizer in January 2007 – FDA approved for dogs
Decreases appetite
Decreases fat absorption
Vomiting, diarrhea, lethargy may be side effects
Surgery for Weight Reduction
Seldom done in veterinary medicine
Bougienage
A bougie is a thin cylinder of rubber, plastic, metal or another material that a physician inserts into or though a body passageway, such as the esophagus, to widen the passageway, guide another instrument into a passageway, or dislodge an object.
Causes of Diarrhea
Results from any intestinal malfunction
Types of Diarrhea
Motility
Active secretory
Passive secretory or osmotic
Malabsorption/maldigestion
