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animal nutrition > Exam 3 - Final exam Material > Flashcards

Exam 3 - Final exam Material Flashcards

1
Q

How can you prevent struvites in?

A

Infection specific strategies

  • Address uti’s
  • Continue monitoring
  • Address predisposition
  • Cranberry extract does not work
  • Urine dilution
  • precursor intake
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2
Q

What is important about sodium in patients with CKD?

A
  • Hypertension contributes to CKD progression
  • Avoid high salt diets
  • May want sodium reduction with hypertension
  • May want lower end if active hypertension
  • Over-reduction activates RAAS… not good either don’t go <0.3 g/1000 kcal…
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3
Q

How can you prevent refeeding syndrome?

A

Prevention:
◦ Identify patients at risk
◦ Supplement with a B complex (thiamin)
◦ Introduce food gradually
◦ Start with 25% RER while monitoring electrolytes ◦ Increase by 25% each day

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4
Q

What are the possible consequences of chronic enteritis?

A

 Protein-energy malnutrition (poor body condition scores, hypoabuminemia, ascites)

 Hypomagnasemia

 Anemia/ iron deficiency

 Cobalamin and folate deficiency

 Vitamin K deficiency ( can cause bleeding, inhibition of formation of some clotting factors)

 Antioxidant deficiencies (zinc, vitamin E, riboflavin)

(they will sometimes present like a hypocalecemic patient)

 Vitamin D and calcium deficiency

 Dysbiosis

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5
Q

How long can you feed SD?

A

Deficient in protein, no longer than 3 months.

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6
Q

What do you do if patient refuses appropriate CKD diet?

A

• Address underlying issues
• Diet rotation may be appropriate
• Ensure all diets offered are ok for patient
• Olfactory changes may affect
appetite day to day
• Assisted feeding (feeding tubes)
• provide appropriate diet, can still accept treats, etc
• provided additional water &
medications! (improve QOL

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7
Q

What is hepacutaneous syndrome?

A

 Hepatocutaneus syndrome is a rare syndrome that can occur as a result of a glucagonoma, liver disease (vacuolar hepatopathy), and rarely diabetes mellitus or
chronic phenobarbital treatment

 Skin lesions: bilaterally symmetric crusting and ulcerative lesions on mucocutaneous junctions and cutaneous regions where repeated pressure is applied
 footpads, ears, periorbital regions, and limb pressure points

 Often the patients will show hypoaminoacidemia (low plasma amino acid concentrations)

 Glucagon and liver dysfunction lead to a catabolic state which results in amino acid depletion

 Protein is vital for epithelial turn-over, especially in pressure points

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8
Q

When would we intervene in regards to nutrition?

A

Depends on several factors:
◦ Length of dysrexia:
◦ 1-2 days: monitor food intake ◦ 3-4 days: support is likely required if recovery is not imminent ◦ 5 days: intervention required
◦ Evidence of malnourishment ◦ Puppies/kittens

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9
Q

What is the treatment of Failure of passive transfer?

A
  • Surrogate colostrum
  • Plasma may be used for infusion of antibodies
  • Prevention of pathogen exposure
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10
Q

What does adiponectin and leptin do? What occurs with obesity?

A

Work synergistically to decrease food
intake and increase energy expenditure

• With obesity, there is an eventual
decrease in response to these hormones
(leptin) or a decrease in production
(adiponectin)

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11
Q

Which is most safe and effective in unclogging a feeding tube?

A

Water

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12
Q

What are the adipokines?

A
  • Steroid hormones
  • Growth factors
  • Cytokines
  • Eicosanoids
  • Complement proteins
  • Binding proteins
  • Vasoactive factors
  • Regulators of lipid and glucose metabolism
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13
Q

What is the appearence of a liver of a patient with hepacutaneous syndrome on ultrasound? What is the treatment? What is the prognosis for this syndrome?

A

 Typical appearance of the liver on ultrasound:
honeycomb liver

 Treatment:
 IV infusion of amino acids (Aminosyn 10% crystalline amino acid solution (100 mL contains 10 g of amino acids) can be given IV, 500 mL/dog, over 8–12 hr

 May need to be repeated as needed until lesions resolve

 High protein, high omega-6 fatty acid diet

 B vitamins and antioxidants is empirically recommended
 Some recommend to add egg yolk as a source of B vitamins, choline
 Prognosis- guarded to poor

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14
Q

What state are patients in when they have critical disease and what is the cause? In this state what is used for energy and what is at a negative energy balance?

A
  • Critical disease -> cytokines (TNFα etc)  catabolic state
  • Preferential use of amino acid oxidation for energy
  • Negative nitrogen and energy balance
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15
Q

What is colostrum banking? What is the issues with that? How is it stored?

A
  • Donor colostrum is collected 24 hours after whelping
  • The IgG concentration decreases from 3830 mg/dl to 1730 mg/dl after 24 hrs
  • The colostrum is frozen until use
  • Freezing/thawing has minimal effect on antibody activity
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16
Q

What are supplements that are used for patients with liver disease?

A
  • Zinc
     May have antioxidant and hepatoprotective effect independent of dose for reduction of copper absorption
  • Carnitine
     Involved in fat metabolism

 Generally not deficient but supplementation may be useful in cases of hepatic lipidosis…

  • SAMe
  • Milk thistle (sylimarin)
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17
Q

What are signs of Klotho deficiency?

A

Animals with Klotho deficiency show signs of FGF‐23 deficiency with high serum phosphate and calcitriol
concentration.

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18
Q

What is preferred when feeding through different feeding tubes?

A

CRI preferred for J tube
CRI preferred where GI motility may be abnormal
Bolus or CRI both ok for NE, NG, e-tube, G-tube
No difference in residual and regurgitation rate

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19
Q

What are neonates susceptible to at birth? Why?

A
  • At birth, the neonate presents an increased susceptibility to infectious agents due to functional immaturity of the immune system
  • For example:
  • Neutrophils have a small storage pool at birth, and this cell lineage is less responsive to chemoattractants
  • Monocytes/macrophages are functionally adequate but have limitations in chemotactic responsiveness
  • produce less IFN-α, IFN-γ, and IL-12
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20
Q

What are calcium oxalate predispositions?

A

Hypercalcemia (Cancer, hyperparathyroidism, ect)
Increased absorption of calcium and oxalate
Increased excretion of calcium and oxalate excretion is ideal.

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21
Q

What conditions may increase energy/ protein requirements?

A

Seizures
Burns
Sepsis

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22
Q

Besides total amount of protein in HE what else should you be mindful of? Why? What protien should be avoided? Which is ideal?

A

 Not only total amount of protein in HE  but also type & quality

 –some better tolerated…

 –may also reduce incidence of urate
 Avoid:
 Meat based protein, especially liver

 Preferred:
 Vegetable, egg, dairy based proteins

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23
Q

Who is not likely to have stones?

A

Young animals

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24
Q

How can you prevent urolithiasis?

A
  • urine dilution
  • precursor excretion
  • urine composition/ environment modification (add inhibitors/ change ph)
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25
Q

What is important about hydration in terms of kidney disease? How can you maintain hydration?

A

Address/prevent dehydration
• Maintain renal perfusion

• How?
• Increase water consumption -> water fountains, canned food, etc
• Subcutaneous fluids -> also contains Na/K (may not be desired) patient tolerance…
• Feeding tube
• More physiologic than
subcutaneous fluids…

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26
Q

What are veterinary weight loss diets? What are the aspects they utilize to assist with weight loss?

A

• There are multiple veterinary weight
loss diets
• Not the same as ‘lite’ OTC diets • Unique aspects that help with weight
loss:
• Increased fiber
• Increased protein
• Increased sodium
• Kibble ‘shape’ ( usually more for owner so they dont feel bad like they are under feeding their pet)
• Nutrient density vs. energy density

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27
Q

How are B vitamins utilized / indicated in patients with kidney disease?

A

• Water-soluble
• Important in energy metabolism!
• Loss may be increased with
polyuria
• Most don’t have large body
stores -> depletion?
• Most renal diets empirically
supplemented
• Safe!
• oral over-supplementation
difficult

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28
Q

How is maternal immunity transferred via colostrum?

A

• Immunoglobulins represent the most important class of proteins in the colostrum
• In many species, IgG1 are the most important immunoglobulins present in colostrum
• The higher levels of IgG1 in colostrum than in serum corresponds to a selective transfer which becomes active in the weeks before parturition
• A class of Ig G1 receptors in the mammary epithelium having high affinity are present during the last 15 days of gestation
• The presence of these receptors decrease
immediately after the first suckling
• 2 days later, the concentration of IgG
decreases considerably
• Later, the milk proportion of IgA:igG increases

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29
Q

What other options are available for dogs with liver dysfunction?

A

 Transition to a liver diet is indicated if there is evidence of copper storage, hepatic encephalopathy or urate urolithiasis

 Not every dog with elevated liver enzymes or even liver dysfunction requires diet change!!

 When protein and/or copper reduction not indicated…
 Highly digestible commercial diet +/- supplementation

 Customized complete/balanced home cooked diet

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30
Q

Based on all the studies in this lecture what is the overall consensus?

A

Concentrations of P and Ca in many commercially available
cat foods are highly variable
• Very low and very high both exist as well as inverted Ca:P ratio (under 1)
- Future limits on P, its forms used and Ca:P should be considered.

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31
Q

How long should a diet trial last? If cause reintroduced, how long would it take for allergic signs to show up?

A

The diet should be fed eight to l0 weeks in dogs and four to six weeks in cats, with no other foods, treats, flavored supplements, bones, etc

 Called Challenge: When the offending food or ingredient is reintroduced to a food-allergic patient, the pet’s signs will flare-up anywhere from immediately to within three days

 Clients often administer medications in cheese, yogurt, or peanut butter and feel the amount given is too small to cause a problem

 Limited-ingredient over-the-counter (OTC) diets are not suitable as elimination diets, as they may contain undeclared proteins
 Cross contamination during petfood production

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32
Q

What must be done for patients with hepatic lipidosis? What is the ideal plan for refeeding?

A

 The key to managing feline is to provide nutrition and stop the catabolic process

 In addition, treat underlying disease, correct dehydration, manage hepatic encephalopathy (if present) and infection

 Placing a feeding tube is almost always required in these cases; starting to feed at 25% RER in the first day, increasing gradually as tolerated to full RER
 Dietary protein should not be restricted unless there are signs of hepatic encephalopathy

 Energy is key as it is important to reverse the negative energy balance and stop the catabolic state

 Ideally avoid high fat food; however, energy intake is more important

 Potassium may be decreased due to low intake

 Address refeeding complications if occur

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33
Q

What is the role in FIC as components of urethral plugs?

A

FIC cats you may want to put them on a diet that is preventative

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34
Q

What is the pancreas? What is its endocrine and exocrine function? What cells / enzymes are secreted?

A

 Endocrine function: insulin, glucagon, somatostatin:

 The Endocrine Pancreas (Islets of Langerhans):

  • α cells – secrete glucagon – 15-20% of total islet cells
  • β cells – secrete insulin and amylin – 65-80% of total islet cells
  • δ cells – secrete somatostatin - 3-10% of total islet cells
  • PP cells secrete pancreatic polypeptide – 3-5% of total islet cells
  • ε cells – secrete ghrelin - < 1% of total islet cells.

 Exocrine function: Digestive enzymes (amylase, lipase, trypsin…)

  • Secretion of digestive enzymes
  • Secretion of bicarbonate in pancreatic juice
  • Secretion of colipase that facilitates the action of pancreatic lipase
  • Secretion of intrinsic factor (dog vs. cat) for absorption of cobalamin
  • Secretion of bacteriocidal peptide
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35
Q

What are calcium oxalate?

A
  • Oxalates typically come from plants
  • some can be formed by compounds in the body.
  • Non soluable cystals in water
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36
Q

How to achieve intentional weight loss?

A

• Step 1: Determine BCS, ideal BW
• Step 2: Determine current intake
(kcal)
• Step 3: Calculate RER= BW(kg)0.75 X70
• Step 4: Select diet
• Step 5: Calculate new daily energy
intake
• Check that protein intake is sufficient
• Step 6: Weigh every two weeks
• Bodyweight monitoring is crucial
• Step 7: adjust intake to reach desired
weight loss rate (1-2% BW per week in
dogs is typical)
- Remember to include treats.
- For weight loss, you can use the current RER in dogs, or 80% RER in cats OR decrease current intake by 20%
• Check that protein intake is sufficient
- Monitor body weight

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37
Q

Are there genetic tests for urolithiasis?

A

Yes, and there a may be some benefit to putting them on a diet that prevents urates.

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38
Q

What are the important parts of creating a nutritional support plan?

A

Meeting the energy needs- meeting RER is typically our goal
Achieving and maintaining ideal bodyweight/ BCS/ muscling Meeting nutrient requirements
Addressing electrolyte shifts
Addressing specific metabolic problems (HE, CKD, pancreatitis etc)

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39
Q

What would be the best option for a patient with prolonged anorexia and diagnosed idiopathic megaesophagus?

A

Best would be to place a gastrostomy tube and provide a liquid diet . This is so we can prevent chance of regurgitation as well as to control the speed of feeding and bypass the esophagus entirely. Make sure diet is highly digestible, short transit time, (low fiber, low fat), caloriclly dense (lower volume), and complete and balanced diet (for growth in this case).

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40
Q

When should a patient be offered parenteral nutrition?

A

A good option for patients that cannot tolerate enteral feeding
◦ Severe pancreatitis
◦ Not stable for anesthesia
◦ GI obstruction/ dysfunction
◦ Temporary support

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41
Q

What are concurrent diseases associated with diabetes?

A

Obesity is associated with an increased risk
for a variety of diseases in dogs and cats,
including:
• Neoplastic disease (chronic inflammation)
• Pancreatitis
• Diabetes mellitus
• Hyperlipidemia
• Dermatological disease (folds)
• Renal disease
• Urinary disease
• Cardiovascular/pulmonary disease
• Orthopedic disease

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42
Q

Based on a survey by the association of pet obesity prevention in 2018, what percentage of dogs are overweight? Cats?

A

56% of dogs are overweight or obese
59% of cats are overweight or obese

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43
Q

What are the predisposition for struvites?

A
  • Obesity (more skin folds/ micro environment, tend to empty bladder less, higher risk of compounds precipitate.
  • Sex (more common in females, proximity between anus and vulva)
  • Anatomical (hooded vulva)
  • Endocrinopathy (diabetes Mellitus, Cushings, glucosuria,
  • Immunosuppression
  • Dermatological disease
    Anything that predisposes to UTI
    Cats: unsure why?
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44
Q

What are cystine urolitiasis?

A

Cystine is disulfide AA
- Normally reabsorbed in the PCT, therefore genetic defect in the reabsorption mechanism is responsible.

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45
Q

How do you diagnose pancreatitis?

A

 Diagnosis can be challenging

 Medical history

 Serum pancreatic lipase
immunoreactivity (PLI)

 Abdominal US

 Histopathology

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46
Q

What is
Hematuria, pollakiuria, stranguria, periuria?

A

Hematuria- blood in urine
Pollakiuria- often urination (more incidences of urination)
Stranguria - painful or strenuous urination
Periuria- urination in inappropriate location.

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47
Q

How to determine if a pet is obese?

A

BCS
- Cats 5/9 is ideal
- Dogs 4-5/9
- Every point difference is 10% shift in weight.
Most used scale is purina bcs scale (9 point scale)

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48
Q

What is the link between obesity and CKD in humans? In dogs?

A

• In people = significant risk factor for development of
glomerulosclerosis & failure
• Degree of obesity also correlates with degree of proteinuria in people
In Dogs?
• Associated with mild hypertension in dogs
• Increased HR & increased Na+ resorption from renal tubules
• Glomerular hyperfiltration & renal hypertension, damage to parenchyma

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49
Q

What must you monitor with Parenteral nutrition?

A

Magnesium, potassium and phosphorous: Within 24 hr of initiating PN, then EOD
BUN & albumin: Within 24 hr of initiating PN, then EOD Thiamin injection; if lack of B-vitamins in solution/ concern of Refeeding Syndrome
Thoracic radiographs: If signs of respiratory disease develop during administration
Triglycerides: If hypertriglyceridemia or lipemia is present
Blood culture: If evidence of sepsis
Blood glucose every 4 hours If hyperglycemia is present (>300 mg/dL) consider reducing rate, add insulin, or reduce dextrose in solution.

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50
Q

What is relative supersaturation?

A
  • Computer technique
  • precipitate vs. Stay in solution
    Based on thermodynamic behavior
  • concentration of solute compound
  • ph
  • temp
    -interaction with other compounds
    Supersaturated: high risk
    Meta stable: possible
    Unsaturated: unlikely to form
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51
Q

What is copper storage disease?

A

Dietary copper reduction/restriction indicated in these cases  May get reduction of copper absorption with long-term
ingestion of increased zinc (unreliable)

 Copper is essential, so must also avoid over-restriction

 Negative clinical consequences of deficiency (i.e. anemia)

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52
Q

What is the mechanism of allopurinol and how it prevents urate stone formation?

A

Xanthine oxidase is inhibited by allopurinol -> so it prevents stones, but it can cause xanthine stones ( if given too much)

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53
Q

What are potential diets that can be used for hospitalized patients?

A

Commercial veterinary diets: canned or liquid
Commercial human diets: liquid (may not be balanced for dogs and cats!)
Home-prepared die

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54
Q

What tends to be found in lower quantities in liver diets for both cats and dogs?

A

 Dog hepatic diets: relatively low protein, low copper, low
purine

 Cat hepatic diets: not available, use renal diets

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55
Q

What is important about protein reduction in patients with CKD?

A

Reduce bioavailable phosphorus…
• Reduce azotemia/uremia
• BUN is only a marker (other uremic toxins too)
• Proteinuria
• Independent of CKD/IRIS stage
• Reduction based on
• UPC/diet history!
• Response…
• Must provide enough digestible protein

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56
Q

How can you change dietary precursors?

A

Struvite- combination of ammonia and phosphate-> diet with less of these Precursors would be ideal
- in struvite acidify urine

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57
Q

What is glutamine? Arginine? Where is fat absorbed and what does it stimulate/ cause?

A
  • Glutamine: fuel source for mucosal lymphocytes
  • Arginine: metabolized to NO
  • Fat: absorbed through the lymphatics, stimulates CCK, peptide YY, GLP-1
  • Slows GI motility
  • Butyrate: fuel source for colonocytes, anti
    inflammatory
  • Fiber: soluble and insoluble
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58
Q

What are the common uroliths?Less common?

A

Struvite and calcium oxalate (cats calcium oxalate) dogs (struvite)

Urate, cystine, silicate, ect

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59
Q

When is it ideal to fast a patient? What is the new recommendations in regards to pancreatitis and severe enteritis?

A
  • NPO may be necessary in cases where uncontrolled vomiting is present or high risk of aspiration
  • BUT Early enteral feeding is beneficial even in conditions where ‘NPO’ was traditionally recommended
  • pancreatitis (Qin et al. 2002)
  • severe enteritis (Mohr et al. 2003)
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60
Q

What are the risk factors for CKD?

A

Risk factors for CKD:
• Age (estimated that up to 33% of cats above 13 years have
CKD)
• Body condition
• Hyperlipidemia
• Acute kidney injury
• Vaccination?
• Dietary??

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61
Q

What is important about potassium in dogs with renal disease?

A

• Dogs with renal disease -> Can be
• Normokalemic, hypokalemic,
hyperkalemic
• ACE-inhibitors may predispose to K+ retention…
• Canine renal diets
• Typically normal to decreased in K+
content
• Look at product guides for K+
concentration
• Important to choose best option for individual patient
• May need custom home-cooked formulation for severe hyperkalemia or refusal to eat appropriate diet

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62
Q

What are the energy requirements for orphaned puppies? How can you feed them? How often must they be fed? What else must you do to take care of them?

A

Age (weeks) -MER (kcal/kg/d)
0-1 : 140
1-2 : 150
2-3: 190
3-4 : 200
weaning: 130
• Treatment:
• Bottle/Dropper feeding
• Tube Feeding
• 5-8 fr catheter
• measure nose to last rib and mark tube • feed slowly (2 minutes) • 6-8 feedings a day best (4 may suffice) • massage perineal region with moist cotton ball
MER (kcal/kg/d) 140 150 190 200 130

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63
Q

What are diet options for patients with CKD? What resource should not be recommended?

A

Commercial
• Custom formulated home-cooked diet
• Consult veterinary nutritionist
• Do NOT used recipes on-line or in books…

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64
Q

What is needed for maternal antibody transfer? When does it begin? What is the trend of fetal to maternal abs?

A
  • transport requires a healthy placenta
  • Begins at 17 weeks (humans) increases with gestation
  • By week 40 (humans): IgG(fetal)> igG (maternal)
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65
Q

What must you do with PPN to meet energy requirements?

A

Must use higher fat solutions, which can cause issues with hyperlipidemia, or other issues with lipid metabolism. Studies also show risk for immune dysfunction in higher fat diets.

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66
Q

What is the correlation between excess weight and musculoskeletal disease?

A

• Osteoarthritis is more prevalent in
overweight dogs compared to lean
littermates (Kealy et al. 1992)
• Overloading the joints is the main driver
of clinical signs of OA in dogs
• Hormonal imbalances due to obesity such
as increase IGF-1 and decreased GH may
also contribute to OA

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67
Q

What are the kinds of feeding tubes and how are they placed?

A

Feeding tubes types include:

  1. Nasoenterel: small lumen, temporary, no anesthesia or incision required
  2. Esophagostomy tube: larger lumen, can be long-term, requires anesthesia and incision
  3. Gastrostomy tube: Larger lumen, long-term, requires anesthesia and incision
  4. Jejunostomy tube: long-term, requires anesthesia, diet- liquid and highly digestible
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68
Q

What are comorbidities that have growing evidence in regards to CKD?

A

• Evidence accumulates for proteinuria and hyperlipidemia
being comorbidities
• Unknown whether treating one disorders impacts the other

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69
Q

What percent of dogs meet 95% of the resting energy requirements while hospitalized

A

under 30%
- 0.95XRER met only 27% of the time

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70
Q

What are some different histories prior to gi incidence and what it will indicate?

A

History of fat intolerance? Try low fat

History of ‘ingredient sensitivity’? Try novel/ hydrolyzed protein.

Bland diet improvement?/ more small bowel- Try highly digestible

High fiber improvement/ more large bowel - try high fiber.

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71
Q

What is the role of protein in liver disease?

A

 Supports liver regeneration

 Dysfunctional liver (or bypassing in portosystemic shunt)

 increased NH3 -> HE
Protein reduction indicated in cases of hepatic encephalopathy

 but otherwise not desired… unfortunately,
hepatic diets are low protein

 still want to feed as much as tolerated by
individual

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72
Q

How frequent are complications with feeding tubes?

A

Overall complications are common (up to 77%), but most of them are minor

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73
Q

Can food cause CKD?

A
  • May be related to form of phosphorous, and Ca:P ratio
    • A need to establish a safety limit for phosphorous
    • Acidifying diets, limited in potassium, can also lead to CKD
    (Dow et al. 1987)
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74
Q

What can be the results of adverse reactions to food?

A

Inappropriate immune response to dietary antigen
 Local cell mediation inflammation, may lead to IBD
 Local antibody production (non-IgA). IgE may lead to mast cell stimulation
 Systemic IgE production (dermatological signs? Other)

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75
Q

What is important about protein quality of patients with CKD?

A

Highly digestible
• Protein quality (AA profile)
• Less oxidation of AA -> less
uremic toxins
• Less undigested protein
reaching the lower GI tract

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76
Q

What level of IgG in a puppy is considered deficient? What puppies are more sensitive to deficiency? What is the issue with milk replacers?

A
  • Puppies w/ IgG below 230 mg/dl are deficient= increased 9X risk for mortality
  • Large breed puppies appear more sensitive
  • The proportion of IgA increases with time.
  • IgA have a role in mucosal immunity
  • Milk replacers can provide many nutritional needs; however, they do not provide immunity
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77
Q

What are potential causes of Dysorexia Anorexia relating to CKD?

A
  • Primary disease/ concurrent disease
  • gastritis/ enteritis.
  • Uremic toxins
  • Hormonal changes
  • Anemia
  • Dehydration, electrolyte disorders, metabolic acidosis.
  • Stomatitis/ oral ulcerations, altered smell
  • Unpalatable diet, Food aversion, Medications, Hospitalization.
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78
Q

What is canine plasma transfusion? Can it be used for IgG transfer?

A
  • Use of IV transfusion in neonates is done in people
  • Oral and Subcutaneous administration has been used with variable success in terms of IgG transfer
  • However, there are other benefits on growth and health
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79
Q

What are the other hunger hormones?

A

Other hunger hormones include
cortisol and orexin

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80
Q

What is important to know about formulas?

A

• Use a reputable product/brand
• Even the best products are not equal to natural bitch/queen milk, so a foster is always
preferred

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81
Q

Why is obesity considered an inflammatory condition?

A

• Other adipokines such as TNF-α and IL-
6 promote inflammation • Therefore chronic obesity is an inflammatory condition

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82
Q

What is the cause of lymphangiectasia? What is the potential consequences of it? What is the treatment?

A

 Can be a result of mucosal inflammation, extraluminal obstruction, intraluminal adhesions

 Leads to panhypoproteinemia, hypocholesterolemia, lymphopenia

 Treatment:
 Fat restriction- relieves lymphatic pressure

 Medium chain triglycerides- generally not recommended

 Elemental diets- temporarily

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83
Q

What hormones suppress hunger?

A

Multiple hormones suppress hunger
including leptin, insulin, CCK, GLP-1
and more

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84
Q

What is feline hepatic lipidosis? What cats does it commonly occur in? What is the pathophysiology of the condition?

A

 Imbalance between peripheral fat stores mobilized to the liver, de novo synthesis of fatty acids and hepatic use of fatty acids
 The fat accumulation overwhelms the hepatocytes and impairs liver function
 Inadequate energy intake can induce hepatic lipidosis in cats

 The degree of energy restriction needed to induce HL was
identified to be between 50% and 75% of the cat’s resting energy requirement
 Commonly occurs in overweight cats that are dysrexic due to concurrent disease
 Peripheral tissue lipolysis is stimulated by catecholamines, adrenaline and noradrenaline during fasting
 Lipolysis is inhabited by insulin

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85
Q

What are some exocrine pancreatic diseases?

A

EPI- Exocrine pancreatic insufficiency

  • pancreatitis
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86
Q

What possible factors are involved in urolith formation?

A

PH, mineral concentration of urine, inhibitors and promoters of urolith formation.

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87
Q

How can you provide nutritional management of pancreatitis?

A

 Parenteral nutrition allows to provide the body with energy
without pancreatic stimulation
 When no more vomiting, offer water

 Gradual feeding: increase calories to full RER

 Fat restriction- Dogs < 15% ME fat, < 25% ME fat in cats?
Chronic management/ recovery from acute pancreatitis: Diet history is KEY !!!

causative episode identified (treat, trash), possibility to feed
previous diet, unless chronic pancreatitis has resulted.

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88
Q

Important image

A
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89
Q

How can you confirm tube placement in patients?

A

Can be difficult! Direct visualization:
◦ Endoscopically placed
◦ Surgically placed
◦ Fluoroscopically placed Radiographs
◦ May provide limited information if tube ends in the esophagus Injection of water/ air through the tube may help (coughing/ borborygmus)

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90
Q

What are the benefits of CPN feeding? Where is the catheter placed in the animal?

A
  • Requires central vein access (through jugular or femoral veins)
  • Allows feeding a higher osmolarity solution (up to 1400 mOsm/L)
  • Allows for a highly concentrated solution, lower volume, or for a low- fat solution if desired
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91
Q

Why is the ingestion of maternal milk important in the first 24 hours after birth?

A
  • In the first 24 h after birth, the newborn must ingest immunoglobulin-rich colostrum which provides passively acquired immune protection throughout the neonatal period
  • Once the gastrointestinal tract matures, IgG can no longer transverse the intestines
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92
Q

What should you avoid in term of components of treats to prevent Calcium oxalates?

A

Increased vitamin C
Increased Calcium
Includes glycine

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93
Q

When should you consider a feeding tube? How do you select the right kind of tube?

A

When to consider a feeding tube?
◦ Failure to meet RER
◦ Patient unwilling to consume appropriate diet
◦ Need to provide many oral medications How to select the right type of tube?
◦ Type of food to be provided
◦ Length of time tube will need to be maintained
◦ Need for anesthesia
◦ Need for incision
◦ Desire to bypass the airways, mouth, esophagus, stomach, duodenum

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94
Q

What is the length of embryonic development in humans? Dogs? Cats? Chickens, Horses? Elephants?

A

Humans: 280 days
Dogs: 63 days
Cats: 62-72 days
Chickens: 21 days
Horses: 330-345 days
Elephants: 22 months

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95
Q

Is there a benefit to Omega -3 PUFAs in CKD? How can it help?

A

• Marine sourced (fish oil, krill, algae)
bioavailability
• EPA (eicosapentaenoic acid)
• DHA (docosahexaenoic acid)
• Incorporated into cell membranes -> compete
with Omega-6
• Produce less inflammatory eicosanoids
• May reduce renal interstitial fibrosis, slow GFR decline
• Improve survival
• Lower glomerular capillary pressure, decreased inflammation

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96
Q

Where does each tube terminate/ bypass?

A

Tube selection and where the tube terminates may also be impacted by what we want to bypass

  • Naso-enteric or nasogastric tube: does not bypass the airways or most of the GI
  • Esophageal feeding tube- bypass the mouth, upper airways
  • Gastric tube- bypass the esophagus
  • J tube- bypass the esophagus, stomach, pancreas, duodenum
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97
Q

How common is CKD in cats?

A

1/3 of cats above the age of 15 suffer from chronic renal
disease

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98
Q

What are diet options for pets with cystine urolithiasis?

A 
Commercial ( Vegetarian diet RC or Urinary UC ( low in Cystine as well as purine) 
Home cooked ( custom formulated)
99
Q

What is occurring in this image?

A

Immature cataract caused by canine milk replacer.

100
Q

What does a high folate and low cobalamin suggestive of?

Folate supplementation [in patients with chronic enteropathy]  Small intestinal bacterial overgrowth (SIBO)/ dysbiosis

 Exocrine pancreatic insufficiency

 All of the above may be possible

A

 All of the above may be possible

101
Q

What are some causes of mega esophagus?

A
  • Myesthenia Gravis, idopathic, vascular abnormalities, ect.
102
Q

What are the concerns associated with protein reduction?

A

Concerns with palatability or decreased intake
• Decreased E intake -> loss of BCS
• Decreased protein intake below MR -> muscle
loss, hypoalbuminemia
• Less aggressive if only reducing phosphorus…
• Generally more aggressive/restrictive with
• Stage 3/4 (azotemia/uremia)
- Proteinuria

103
Q

What is important to remember about treats?

A
  • Treats can be incredibly important to owners and to their pets
  • Treats are allowed, but have to be included in the overall intake calculations
  • Treats should not exceed 10% of the daily energy intake
  • Low calorie treats allow increasing the number of treats that can be given per day
104
Q

What is the potential drawbacks to assisted/ force feeding?

A

Assisted/forced feeding
◦ Aspiration
◦ Food aversion
◦ Trauma
Works well in rabbits and rodents

105
Q

Can you dissolve calcium oxalate?

A

No you cannot in dogs or cats

106
Q

What are lite foods? Are they weight loss food? What can they do?

A

• Lite food is NOT weight loss food
• Lower caloric density
• “lite” or “low calorie” dry dog food
cannot contain more than 3100
kilocalories per kilogram
• Canned foods contain much more
moisture, so the maximum allowable
calories are even lower 900 kcal/kg • Can help avoid overfeeding and
maintain weight post weight loss

107
Q

What are the other crystals that can be found in the urine? What is the treatment for them?

A

Crystals: Silicate, calcium phosphate/ brushite, calcium carbonate.
- Dilution is the solution, limiting intake of urolith components.

108
Q

What are the nutition requirements during lactation of both dogs and cats?

A
  • 5-10% increase in BW pre-breeding to post whelping
  • More not necessary due to capacity for increased food intake
  • Obesity at whelping may predispose to dystocia
  • Nutrient requirement is proportional to milk • Production energy costs may reach 4-8X RER (depending on # puppies)
  • At peak bitch’s milk production may reach 8% BW = to average dairy cow
  • Bitch milk is higher in fat and protein than cow milk
  • Free feed during lactation- high protein, high fat diet
  • Typically recommended using puppy diet ad lib or to maintain BCS
  • Don’t forget water!
109
Q

What are the appetite stimulant medications?

A

• Mirtazapine (antidepressent)
• Capromorelin
• Ciproheptidine
• (Valium)
- midazolam
• (Propofol)

110
Q

How to unclog a feeding tube?

A

In vitro study-
Water is at least as effective as soda, cranberry juice
Water + ¼ tsp pancreatic enzyme and 325 sodium bicarbonate most effective (Parker and Freeman 2013)

111
Q

What forms uroliths?

A

Uroliths form with sustained alterations in urine that promote supersaturation of certain compounds.
Once crystals form they can become stones.

112
Q

What is important about potassium in cats with renal disease?

A

Cats -> more prone to hypokalemia
- Signs: plantigrade ( neuro signs appear in cats)
• Whole body potassium depletion
• Feline renal diets typically supplemented with K+
• May also need to supplement even more
• Cats can develop hyperkalemia (rare)
• Home-cooked renal diet only good option

113
Q

Why is it important to recognize obesity?

A
  • Obesity has a lower longevity ( 2 years less than the control in the study)
  • There is also earlier signs of aging and age related disease ( such as osteoarthritis)
114
Q

What percentage of food consumption increase should you see for a queen in gestation? Pre-weaning ? reconstitution of reserves?

A

Gestation : 30-70% increase
Pre- weaning: 100-300% increase
Reconstitution of reserves: intake will decrease rapidly between week 7-11 back to maintenance.

115
Q

What is hyperimmune egg powder?

A

Hyperimmune egg powder
• Hens vaccinated against canine microbes
• The yolk is rich in canine antibodies
• May improve growth

116
Q

How do antioxidants benefit CKD patients?

A

• Renal oxidative stress (ROS)
• Possible contributor to progression
• May trigger fibrosis or glomerulosclerosis
• Scarce data on antioxidant use in cats & dogs
• Vit E, carotenoids, lutein may slow GFR decline
in dogs…

117
Q

What is important to remember about fish oil? What can it help?

A
  • Fish oil does improve inflammation. It can help alot in dogs with orthopedic disease.
  • Products vary considerably in quality,
    concentration, purity, and concentration of
    fat-soluble vitamins (Vit D)
    • Products that undergo third party QC are
    recommended
    • The amount may be considerable [310 mg
    *BW^0.75]
118
Q

What is FGF-23’s role in P regulation and how does it interact with Klotho?

A

FGF-23 reduces P in the serum by increasing renal secretion and decreasing
intestinal absorption
• FGF-23: The N‐terminal peptide binds to tissue receptors, and the C‐terminal
binds to Klotho.

119
Q

What are metabolic implications found in obese animals?

A
  • Altered lipid metabolism
  • Changes in membrane fluidity
  • Microbiome differences?
120
Q

What is the goal with reducing phosphorus in stage 3/4 kidney disease? What should we decrease phosphorus to?

A

Phosphorus restriction
• More severe restriction to
deal with hyperphosphatemia
-> decreased below NRC RA
• Stage 2 (late)
• Stage 3/4

121
Q

When is a pet obese?

A

A body condition score 8/9 or 9/9 is considered obese and corresponds to 30% excess body weight.

122
Q

What is heterologous immunity?

A

Heterologous immunity- the induction of an immune response to an unrelated pathogen/antigen upon exposure to a different pathogen/antigen.
- would not protect against canine specific pathogens

123
Q

When we have kidney disease what is occuring in terms of phosphorus?

A
  • decrease 1,25 vitamin D
  • increase phosphate
  • Decrease in calcium
    This increases PTH levels
    FGF-2 is link between phosphate load and decreased 1,25 vitamin D levels
    This decreased calcium levels cause increased PTH secretion, increased PTH synthesis, and increased cell proliferation
124
Q

What is Klotho’s role in longevity?

A

More klotho-> longer life

125
Q

What is the outcome of weight loss as a treatment for musculoskeletal disease?

A

A decrease in bodyweight in obese
dogs by 11-20% provides a significant
improvement in force plate analysis ( measures how much weight they are placing on their joints) ( they will place more weight on joints when less painful)
(Burkholder et al. 2000)
• Improved locomotion can be visually
assessed in a weight loss of 6%,
improved Force plate measurable at
9% (Marshall et al 2010)

126
Q

What is important to monitor in neonates post birth? What is the rate of mortality? when do deaths normally occur? What are concerns for neonates? When could these issues occur?

A

• Mortality varies between species and
breeds, but can reach 10-30%
• About 1/3 of deaths occur in the first
week, and ~2/3 in the two weeks after
• Important to diagnose problems early
Monitor
• Activity
• weight gain
• body temp
• hydration
• stool quality
• muscle tone

• Hypoglycemia, Hypothermia, Dehydration

• Time period- first week especially first 3
days (in toy breeds risk may be for
longer)

127
Q

What maternal antibody is transferred across the placenta? What is the neonatal receptor that transports IgG?

A
  • Of the five antibody classes, only significant amounts of IgG are transferred across the placenta
  • transport of IgG is carried out by the neonatal Fc receptor (FcRn)
128
Q

How do you feed the reproducing queen? Lactation? Pregnancy?

A

• Queens should be kept at an ideal BCS
• Excess body fat may result in decreased
conception rates and increased risk of dystocia
• Low BCS could risk fewer kittens, poor kitten body condition score, poor conception rate
• During pregnancy queens increase in bodyweight is almost linear
• Different from dogs
• Energy requirements increase and peaks at 6-7
weeks (1.6 RER at breeding- 2 RER at parturition)
• Lactation: All kittens should nurse within 6-8 hours of
birth
• Energy requirements for the queen peak 6-8 weeks
after parturition (2-6 RER)

129
Q

What is urate urolithiasis?

A

 With liver disease, protein metabolism can be affected

 Decreased conversion of uric acid to allantoin

 As a result, uric acid is excreted instead of allantoin

 Uric acid can form crystals and stones

130
Q

What other supplements may help in management of orthopedic disease?

A

Glucosamine - Limited proof
Chondroitin S
EPA and DHA- studies showing this is helpful.
Green Lipped Muscle - sourced from new Zealand.

131
Q

What are the most common food sensitivities in dogs?

 Chicken  Beef  Pork  Fish  Turkey

A

Beef is number one

  • followed by chicken in dogs, and fish in cats.
132
Q

What is their a higher risk for with PPN? What factors must we be conservative with and mindful of?

A

Higher risk for phlebitis
◦ Max mOsm/L is 700
Must be mindful of :
◦ pH
◦ Flow rate

133
Q

Can diet cause hypercalcemia?

A
  • Some anecdotally recommend feeding a diet with moderately reduced calcium and vitamin
    D in addition to added
    insoluble fiber for all-cause
    hypercalcemia

• High dietary calcium on its
own does not appear to be a
cause of hypercalcemia

• Some cats with CKD may
develop hypercalcemia due to
excessive phosphorus
restriction

134
Q

What is the potential predispositions in cats for calcium oxalate?

A

Neutered male
Older adults
Persian, himalayin
Upper urinary ( usually nephroliths are calcium oxalate )

135
Q

what happens when a patient has 50% or more excess?

A

The Healthy Weight Protocol/ Morphometric System allows determine the adiposity of patients with a BCS exceeding 9/9

136
Q

How is immunity transferred to offspring?

A
  • Transfer of immunity from mother to offspring:
  • transplacental immunity
  • colostral immunity
137
Q

What is pancreatitis?

A

 Inflammation of the acinar tissue of the pancreas

 Involvement of pancreatic enzymes that exacerbate the
inflammation and tissue damage

 Can be acute or chronic

 Variable severity

138
Q

Is chronic GI signs easily treated?

A

No, not every patient responds to the same thing and make judgements/ decisons based on history and the patient. There is no fix all, and it requires alot of trial and error

139
Q

Why is nutrition important in regards to hospitalized patients?

A

Prognosis of frail, muscle wasted patients is poor

140
Q

What are the benefits of canine plasma transfusion in neonates?

A
  • oral plasma supplementation (twice within the first 8 hr of life and since Day 2 of life, every 2 days until 56 days)
  • greater weight gain, increased intestinal microbiota diversity
141
Q

What are causes of hypercalcemia, what is the prognosis? When are clinical signs typically seen?

A

Hypercalcemia can be the result of dietary, metabolic,
neoplastic, renal, and idiopathic causes in dogs and cats
• In cats, idiopathic hypercalcemia is most common
• The degree of hypercalcemia and its chronicity impacts
prognosis
• clinical signs of hypercalcemia are usually most severe when the
increase in calcium is rapid
• Most often, clinical signs are noted when usually serum total calcium is higher than 14.0 mg/dL and ionized calcium is greater than 6.5 mg/dL (1.6 mmol/L)
• If serum total calcium increases to 16.0 mg/dL or if ionized calcium increases above 7.5 mg/dL (1.9 mmol/L) -> require hospitalization and immediate care

142
Q

What can be said about older dogs prognosis that have a higher initial bcs and vomiting at admission? What about dogs that consumed RER and had higher initial BCS at admission?

A

Older patients, higher initial BCS and vomiting at admission were associated with a decrease of BCS status during hospitalization

Dogs that consumed their energy requirements, and had a higher initial BCS had lower odds of dying

143
Q

What are the potential causes of an AKI in a patient?

A

Acute kidney failure can be secondary to CKD but can also occur as a result of another primary cause:

  • Toxicity
  • Infectious disease
  • Neoplasia
  • Trauma
  • Heat stroke/ dehydration etc.
144
Q

When should we start restricting phosphorus?

A 
Stage 2 (early) 
• Stage 1? (no clear evidence, still makes sense to avoid a higher phosphorus 
diet when possible…)
145
Q

Which of the following hormones promotes hunger? Where is it secreted from?

A

Ghrelin
- Ghrelin is a hormone secreted from
the enteroendocrine cells in the
stomach and small intestines and
acts on cells in the pituitary and the
thalamus to increase food intake

146
Q

What is IBD? Is IBD a specific disease? What is its characteristics? What must you rule out?

A

IBD is a histopathological definition; often misused to describe all-cause chronic enteropathy

Not a single entity

 Characterized by infiltration of immune cells to the lamina propria

 Rule outs- parasites, bacterial enteritis/ dysbiosis, dietary intolerance, neoplasia

147
Q

How can you achieve dissolution of struvites?

A

Medical management
- treat UTI
- treat predispositions
Diet strategies
- dilution
- Precursors
- composition
Monitoring
- culture
- imaging ( you should see rather quick decrease in size of urolith)
- failure (make sure were successful or know if we are not)

148
Q

How should we administer Parenteral nutrition?

A

Dedicated line/lumen
- Aseptic placement Catheter- maintain clean area, cover/bandage
-Do not disconnect line if possible (walk dogs with line connected)
- Cover if B vitamins added
Replace bag every 24-48 hours

149
Q

What are the different complications associated with feeding tubes?

A

Erythema
Cellulitis
Early removal
Tube clogging/coiling/migration
Infection of stoma
Vomiting, coughing, sneezing
Diarrhea

150
Q

What is a cutaneous adverse food response?

A

The most common presentation for a dog or cat with cutaneous adverse food reaction (CAFR) is nonseasonal pruritus, although other syndromes such as otitis externa and gastrointestinal (GI) signs may also be present (indistinguishable from atopy)

151
Q

Should you restrict phosphorus if patient is not hyperphosphatemic?

A

yes. Compensatory mechanism. Negative indications for having high PTH, so though it is not problematic, likely will cause other issues over time.

152
Q

What are important points to remember/ tips for nutritional management of an AKI?

A

• The optimal nutritional management of acute kidney injury patients that
do not have an underlying CKD is not determined
• Emphasis should be given to them receiving adequate caloric intake, and if there are electrolyte shift, these should be corrected
• Long-term management may depend on regeneration of kidney function
• It may not always be needed or advised to start with a renal diet while hospitalized
• This may cause food aversion (stress, noise, nausea) for the food

153
Q

What are potential causes of orthopedic disease?

A

• Puppies until the age of 6 months are unable to regulate calcium absorption. This can result in excess bone mineralization • Excess vitamin D, excess phosphorus or
deficiency or a skewed Ca:P ratio may all
result in orthopedic disease
• Large breed dogs are more sensitive to excess calcium compared with small breed dogs.
• AAFCO maximum Ca for large breed
puppy is 4.5 g/1000 kcal whereas small
breed puppies its 6.25 g/1000 kcal
• Expedited growth and weight gain may also predispose dogs to orthopedic disease

154
Q

How do you diagnose stones?

A

Crystalluria- be careful with over interpreting ( sometimes there is crystals that form when urine sits around, also you may not have an issue with certain small amounts of crystals )
Ultrasound - shadowing, sand, grit, etc.
Radiographs -not all uroliths are radiopaque
- Struvite and calcium oxalate are radiopaque
- Urate, xanthine, cystine are not (often)
Contrast radiographs
Urolith mineral analysis

155
Q

What are the risk factors for dogs for pancreatitis?

A

 Breed

 Diet history

 Obesity

 Drugs

 Toxins

 Pancreatic ischemia, trauma

 Hyperlipidemia

 Hypercalcemia

156
Q

How do you compound Parenteral nutrition?

A

Aseptic/sterile procedure (lipid solution has highest risk for contamination) Order of mixing-
◦ 1. AA
◦ 2. Lipid
◦ 3. Dextrose
Important to maintain pH (dextrose has low pH) Temperature Light affects stability of B vitamins (not really of AA)

157
Q

Why do we prefer enteral feeding?

A

Feeding the enterocytes
◦ The enterocytes depend on food in the lumen of
the gut for nutrition
◦ Glutamine is used as fuel for gut enterocytes and lymphocytes
◦ Glutamine is also used for purine synthesis
Healthy enterocytes are vital to maintain gut barrier and prevent villus atrophy

158
Q

What are the commercial diets with restrictions of copper? What are the other treatments of copper hepatopathy?

A

 Only commercially available diets restricted in copper are
therapeutic liver diets (Hill’s l/d, Royal Canin Hepatic)
 Home-cooked diet formulation may be option in these cases

 Avoid high copper foods such as internal organs, seafood, mushrooms etc
 Can be with treatment with chelation, and with zinc
 Zinc induces the synthesis of metallothionine, a protein that binds copper in the enterocytes and renders it unabsorbable (and possibly detoxifies the liver too)

159
Q

How can you dissolve urate urolithiasis?

A

Urinary dissolution
dec precursors ( decrease purine consumption, avoid high purine foods (liver, organ meats, ect), use low purine foods ( dairy, egg, some vegetable based)
Make urine more alkaline
- accomplished with reduced protein/ vegetarian diet
Dissolution protocols: only successful with non- liver disease urate
- allopurinol: be careful of inducing xanthine uroliths.

160
Q

How can you treat refeeding syndrome?

A

Treatment:

  1. Slow feeding rate
  2. Correct electrolyte abnormalities
  3. Thiamin supplementation
161
Q

What does the resting energy requirements helping the body achieve? Is it better to feed more to patients ?

A

Accounts for energy needed for homeostasis in a thermoneutral environment Energy needed for basic metabolic processes: protein turnover, ATP requiring pumps, etc.
Not necessarily helpful to feed more

162
Q

What are dietary prevention strategies for calcium oxalates?

A

Moistures
Precursors
- balanced diet ( moderate calcium)
- Low oxalate intake
- investigate supplements and treats ( some can contribute/ be very important sources of oxalate)
Conditions: ideally don’t acidify the urine ( too acidic will promote ca++ oxalates.

163
Q

What is the issue with eliminating/ reducing cystine and methionine? How can you prevent issues?

A

The issue is that these are essential for taurine synthesis. You can supplement taurine if you are concerned there is not enough.

164
Q

What are potential signs of an adverse food response?

A

erythema, pruritis, otitis, redness, ear infections ( even chronically) red papules on skin, (thorax and abdomen)

165
Q

What is the etiology of hypoglycemia, hypothermia, dehydration? What are the clinical signs? treatments?

A

Etiology:
• Decreased food intake
• High requirements, low reserves
• Low environmental temperature
• Disease (diarrhea)
Clinical signs:
• initially- vocalizing, active
• with time- sluggish, cool (below 94 F)
• poor skin turgor
• often rejected by bitch
Treatment:
• increase core temperature slowly to 94-98 F
• correct low BG
• correct dehydration (1 ml/30g BW)

166
Q

What is secondary obesity?

A

While obesity is the result of energy intake vs. energy expenditure, there are
several endocrine diseases that negatively affect metabolism and can increase the
risk for obesity:
• Hypothyroidism (dogs)
• Cushing’s disease (hyperadrenocorticism)

167
Q

What are complications with parenteral nutrition?

A

Metabolic complications are relatively common
◦ Hyperglycemia
◦ Hyperlipidemia
◦ Hyperammonemia
◦ Electrolyte shifts Mechanical complications Septic complications- 0-8%

168
Q

What commercial diets can be given to patients with EPI?

THIS IS NOT NEEDED TO BE MEMORIZED, JUST AN FYI

A

Commercial diets:

  • Hill’s Prescription Diet i/d
  • Purina Veterinary Diet EN
  • Royal Canin Digestive Low Fat (dogs)

Home cooked diets:

  • May be more digestible
  • Need to be complete and balanced
169
Q

What is the organ that is most affected by nutrition? What do the enterocytes rely on within the intestinal lumen for sustenance? What is the importance of protein, and what is produced as a result that is essential?

A

The organ system most affected by nutrition
The enterocytes rely on nutrients in the intestinal lumen
- Protein: source of essential amino acids, dispensable amino acids for oxidation, AA and
energy for microflora
- Key for hormone stimulation (insulin, IGF-1, GLP-2, CCK)
antigenicity

170
Q

What are portosystemic shunts?

A

 Congenital or acquired vascular abnormalities in the portal vascular system
 Congenital shunts are common in certain breeds including Yorkshire Terriers
 Decreased portal perfusion and decreased liver mass permits encephalogenic material to bypass the
liver

 Protein is typically metabolized to ammonia and then detoxified to urea in the liver, however its possible that heme, RNA and other nitrogenous products also
contribute to clinical signs of hepatic encephalopathy

171
Q

What is considered low level nutritional intervention?

A

Low level intervention:
◦ Offer food for voluntary intake
◦ Switch foods as possible (dry/wet/flavor)
◦ Offer food in a quiet environment/away from cage/change
bowl/food temperature/mix with palatants ◦ Address health factors that could contribute to dysrexia
◦ Dehydration
◦ Pain
◦ Reduced mentation

172
Q

What is the treatment of exocrine pancreatic insufficiency?

A

 Treatment: Enzyme supplementation
1 Enzyme preparations
2 Raw fresh pancreas

173
Q

What is refeeding syndrome? When does it occur? What can be seen occurring metabolically and why?

A
  • Animals with prolonged anorexia (longer than 4 days) are at risk of refeeding syndrome
  • For example, a young healthy dog with foreign body GI obstruction that resolves
  • Can be severe enough to be life threatening
  • During prolonged fasting, hormonal and metabolic changes are aimed at preventing protein and muscle breakdown
  • Muscle and other tissues decrease their use of ketone bodies and use fatty acids as the main energy source
  • This results in an increase in blood levels of ketone bodies, stimulating the brain to switch from glucose to ketone bodies as its main energy source
  • The liver decreases its rate of gluconeogenesis, thus preserving muscle protein
  • During the period of prolonged starvation, several intracellular minerals become severely depleted
  • However serum concentrations of these minerals (including phosphate) may remain normal
  • This is because these minerals are mainly in the intracellular compartment, which contracts during starvation
  • In addition, there is a reduction in renal excretion
174
Q

What are the clinical signs of pets with GI disease?

A

 Loss of appetite - or ravenous appetite
 Weight loss
 Abdominal pain/discomfort (can have gas pain/ discomfort, gi distention)
 Small bowel diarrhea
- Voluminous
- Low urgency
- No mucus
- No tenesmus
 Large bowel diarrhea
- Low volume
- Mucus
- High urgency
- Tenesmus

175
Q

What are the Metabolic implications of obesity?

A

Adipose tissue is active and secretes
hormones called adopokines.

176
Q

What should you tell owners in terms of GI diets?

A

Be prepared, the first one we try may not be the fix all one.

177
Q

What are some dangers of an unbalanced diet in neonates that cause cataracts?

A

Deficiencies: Vitamin A, Vitamin E, Riboflavin, Calcium, Tryptophane, Methionine, Arginine, Cystine
Excess: Glucose, lactose, galactose, xylose

178
Q

What is important about giving feeding instructions to owners?

A
  • Include a goal for main meal,
    supplements (ie fish oil), treats
  • Provide a gram amount- much more
    accurate than cups
179
Q

How should you feed a pregnant dog?

A

Gravid uterus may impair gastric filling
• Feed several smaller meals
• Feed high energy food (4.0 kcal/g)
• Feed high protein food (7g protein/kg BW or about 25% crude protein dry matter)
• Requirements for fatty acids, calcium, phosphorous and certain amino acids increased after day 40
• Typically- feed an ‘all-life stages’ or puppy food

180
Q

What is liver disease? What is a common cause for liver disease?

A

 Liver disease causes altered protein, carbohydrate and fat metabolism

 Vitamin deficiency is common with liver disease
 B vitamin supplementation may assist with energy metabolism

 Vitamin C is produced by the liver and is an important anti-oxidant

 Vitamin E is an antioxidant and can be helpful when there is oxidative damage (for example, copper storage disease)

 Vitamin K is stored in the liver and can rapidly deplete
 Synthesis by bacteria may be reduced due to dysbiosis

181
Q

What is B12 and Folate?

A

 Cobalamin (B12):
- Absorbed in the distal small intestine (specifically in the ileum)
- Values below the control range:
- EPI & bacterial overgrowth in the small intestine  diseases affecting the distal small intestine (such as IBD)
 Folate (B9) :
- Absorbed in the proximal small intestine
- Values above the control range:
- bacterial overgrowth in the small intestine  Values below the control range:
- disease affecting the proximal small intestine

182
Q

When do energy requirements increase in dogs? What BCS should you feed a bitch to? What RER should a whelping bitch receive?

A

• 15- 20% gain in BW prior to whelping
• 5% fetal mass developed by 40 days
• Therefore, energy requirements do not
increase until day 40
• begin to increase food intake @40d so at
whelping bitch receives 1.25 X MER
• Feed to BCS 5

183
Q

What occurs between glucose, electrolytes, and other important vitamins during refeeding syndrome?

A
  • Rapid increase in glucose -> insulin increase - Na-K pump is coupled to sodium glucose transporter -> high insulin->hypokalemia
  • Phosphorous is shifted intracellularly for ATP
  • Magnesium is shifted intracellularly as it is a cofactor for enzymes that participate in glycolysis
    ◦ Hypomagnesemia may cause GI, muscle and cardiac
    abnormalities
    ◦ Magnesium is important to prevent passive potassium membrane leakage
  • Thiamin is important for CHO metabolism
184
Q

What should you feed through a G tube?

A
  1. Complete and balanced diet for growth
  2. Highly digestible
  3. Calorically dense (lower volume)
  4. Short GI transit time
  5. Low fiber
  6. low fat
  7. Affordable
  8. Easy to prepare
    Ideal is not canine recovery diet. Its a homemade diet which is in the image
185
Q

What is copper associated hepatopathy?

A

May be hereditary in certain breeds (Bedlington Terriers,
Labrador)
 Defect in biliary copper excretion

 May also be due to excessive dietary intake of highly bioavailable copper
 Copper form in petfood was previously cupric oxide which has low bioavailability, it was since changed to copper sulfate and copper chelate forms that are more bioavailable

186
Q

What is failure of passive transfer?

A
  • Failure of passive transfer (FPT) is not a disease, but a condition that predisposes the neonate to the development of disease
  • In domestic large animals, the placenta prevents transmission of immunoglobulins from the dam to the fetus in utero
  • Neonates that do not nurse on colostrum in time, develop susceptibility to disease
187
Q

What is the difference between acute and chronic colitis?

A

Acute

 Caused by ingestion of foreign material, specific pathogens

 Changes in intestinal peristalsis

 Lack of evidence-based approach for management

 Highly digestible diet/fiber responsive?

 Prebiotics?

Chronic

Same reasons/management as acute
+ Food antigenicity

 Novel protein

 Omega-3

188
Q

How can you dilute urine to prevent stones?

A

Increase water intake: Add water fountains, higher sodium diets, wet food, protein content decrease.
Protein is metabolized to urea, which is concentrated in renal medulla. Low protein = medullary washout. Urine doesnt get as concentrated.

189
Q

Why are newborn puppies highly dependent on their mothers? What percentage of IgG is obtained by placental transfer? How is the remainder obtained?

A

• Newborn puppies are highly dependent on their mothers
• Unable to walk
• Unable to hear/see
• unable to regulate body temperature
• Unable to spontaneously urinate and defecate
• Ineffective immune system
• Only 1-7% of the IgG obtained by passive transfer are by
placental transfer • The rest are through colostrum

190
Q

Is high dietary phosphorus safe in adult animals?

A

While calcium is tightly regulated, phosphorus regulation is not as
tight
• Meaning, calcium is usually kept in a tight range in the
blood/plasma, whereas
phosphorus has a wider range
• Phosphorous in foods can be
organic (from fruit, vegetables,
grains, meat) or inorganic
(phosphoric salts)
• Highly bioavailable phosphorous have been found to damage the kidneys in rats
• In current guidelines, there is no maximum P in cats

191
Q

What are some of the adverse food responses?

A

Food allergens: glycoproteins 10,000-60,000 Da (10-60 kDa)

 Type I hypersensitivity suspected Immediate IgE, mast cell degranulation Types III and IV also possible

 Pathogenesis not well known
 Gut-T cells homing to skin?

 Cutaneous sensitization to food

 Genetic predisposition: IgE production

 Breed: Beagle, boxer, cocker spaniel, WHWT

192
Q

What urine concentration should we be shooting for in dogs and cats when diluting their urine? How much is our initial moisture intake goal.

A
  • Dog < 1.020
  • Cat < 1.025
    Goal: 85%

Monitor serial USG at home ( with strips/ refractometer)
Can mix can food 1:1 with H2O or 1:5 H2O with dry food.

193
Q

How can you dissolve stones?

A

Struvite, urate, cystine
- Via nutritional/ medical therapy

194
Q

What is Klotho?

A

Klotho is a transmembrane protein that acts as a coreceptor for FGF-23 in the
kidney

195
Q

What is the risk factors for cats for pancreatitis?

A

 Idiopathic ++

 Toxins

 Pancreatic trauma

 Hyperlipidemia

 FIP

 Inflammatory GI and liver disorders (« triad disease »)

196
Q

What is the discharge rate for an animal with voluntary food intake? Low BCS? Ideal body weight/ overweight? What is associated with more severe disease?

A

93% of animals with voluntary food intake were discharged
73% low BCS 84.7% for those at an ideal BCS or overweight
[However- low BCS may also be associated with a more severe disease]

197
Q

What are different nutrient strategies utilized for patients with chronic enteropathies?

A

 Fiber supplementation (soluble fiber as prebiotics, insoluble helps motilityconsistency)/probiotics (adding fiber can decrease digestibility, so it can worsen maldigestive disorders)

 Provision of antioxidants

 Correction of hypomagnesemia, supplementation of vitamin K

 Moderate fat/ fat restriction- may improve clinical signs in several ways

 Omega-3 PUFA  High digestibility

 Reducing antigenicity
 Novel protein: diet Hx!

 Hydrolyzed protein

198
Q

What should you be looking for when completing a nutritional assessment?

A
  1. Screening- is there a nutrition related risk factor?
    ◦ A. disease with nutrition related management
    ◦ B. prolonged dysrexia
    ◦ C. patient unable to consume food/ unlikely to be able to feed
    ◦ D. poor body condition
    ◦ E. poor muscling
  2. Extended nutritional assessment
199
Q

What happens if you do not feeding orally? What are the potential complications?

A

Intestinal mucosal hypoplasia or atrophy may occur
This may lead to several complications:
- GI dysbiosis
- Bacterial translocation
- Decreased digestive function

200
Q

What are nutritional management strategies for EPI?

A
  • Controversial
  • Need for high digestibility?
  • Fat content?
  • Fiber restriction?
  • Monitor B12 as needed
201
Q

What factors should be considered when selecting a diet?

A

Select the right diet for the specific patient! Macronutrient composition
Electrolytes
Caloric density
Tube clogging
Ease of feeding

202
Q

What are the types of parenteral nutrition?

A
  • CPN= Central parenteral nutrition (i.e jugular)
  • PPN= Peripheral parenteral nutrition (i.e cephalic)
203
Q

What are the nutritional requirements of neonates?

A

• Milk contains all the energy and
other nutrients necessary for growth
during the first 3 weeks of life
• Low concentrations of some
minerals (Fe,Cu, Zn etc) are
compensated for by body stores
and the addition of solid food
during weaning

204
Q

What causes struvites?

A

UTI (dogs)
Urease producers
- Staphylococcus , proteus, klebsiella
Can be sterile ( cats)
Ammonia pushes pH up, which pushes urine towards supersaturated range.
Ammonium is also a component of struvite, so this can increase cause

205
Q

What else can treat leishmaniasis?

A

Allopurinol

206
Q

What are the outcomes of CKD?

A

Dehydration (secondary to polyuria)
• Renal Secondary Hyperparathyroidism
• Hyperphosphatemia
• Azotemia/uremia
• Electrolyte & acid/base imbalances
• Hypertension
• Renal hypoxia and/or renal oxidative injury
• Loss of body condition and muscle…

207
Q

What are essential nutritional factors for CKD?

A

• Maintain hydration & body
condition
• Phosphorus
reduction/restriction
• Protein –reduction?
• Address electrolyte
abnormalities
• Address acid/base
disturbances
• Sodium content
• Antioxidants
• Omega-3 PUFAs (marine
sourced)!

208
Q

What IRIS stage has seen improvement with diet?

A

Benefits for kidney diets have been shown from IRIS CKD 2 and above; therefore, many would not change the diet in stage 1

209
Q

What acid base issue can occur with CKD? Why? What is the potential treatments for this condition?

A

Metabolic acidosis can result from CKD
• Increases muscle catabolism • Disrupts intracellular metabolism
• Bone mineral dissolution?
Treatment :
• Provide alkalinizing agents in diet OR supplement
• Bicarbonate, carbonate, citrate
• Beware potassium…

210
Q

Can you use food allergy testing to determine what your animal is allergic to? What can be used? what is a food trial?

A

 While some companies offer “food allergy testing” using serum, saliva, or even hair clippings, the only valid diagnostic test is an elimination diet trial

 Single protein single carbohydrate

 Novel ingredients (diet history!)

 There are a number of veterinary therapeutic diets that can be used for diet trials and long-term management. Home-cooked diets using novel foods are another
option

211
Q

When are puppies weaned? How should moms diet change? How should you wean puppies? Following the correct weaning procedure will prevent what in bitches?

A
  • 6 to 8 weeks of age
  • Decrease Mom’s food intake 50%

• Remove pups during the day for 1-3 days before removing them
completely

  • DON’T limit water intake
  • This procedure allows monitoring of pups for adequate food intake
  • Helps prevent mastitis in the bitch
212
Q

Why is malnutrition such a common issue in hospitalized patients?

A
  1. Poorly written orders (22%)
  2. NPO per doctor (34%)
  3. Patient not eating (44%)
213
Q

What breeds have predispositions (dogs) that have calcium oxalates?

A
  • miniture schnauzer, lasapzo ,……***
214
Q

What is colostrum? How do young animals receive and use colostrum?

A

• Colostrum is the antibody-rich fluid produced from the mother’s mammary glands during the first day or two after
birth
• Young animals can absorb antibodies intact for the first couple of days following birth
• Colostrum production is influenced by maternal hormones which support the development of the mammary gland
at late gestation

215
Q

What are strategies to work on dissolution of cystine urolithiasis?

A
  • Urine alkalization
  • 2- MPG (used)
  • Urine dilution
  • Potassium Citrate
  • takes about 1-2 months
  • prevention is very important
  • Diet must be low in cysteine and methionine intake ( methionine converts to cystine)
216
Q

What are the risks of overfeeding?

A

Risks of overfeeding:
◦ Hyperglycemia- negative prognostic indicator
◦ Increased CO2 production

217
Q

How much should we feed patients with prolonged dysrexia?

A

Starting feeding with 25% of RER in patients with prolonged dysrexia may help decrease the risk for metabolic complications

218
Q

What is hepatic encephalopathy?

A

 Hepatic encephalopathy is the term used to describe neurological signs that result from liver dysfunction

 These are typically vague cortical signs: confusion, staring into space, seizures

 Often these occur after a meal

219
Q

What are the diagnostic signs of protein losing nephropathy? How is it treated?

A

Diagnostic signs:
• Elevated UPC
• Rule out non renal causes
• May lead to hypoalbuminemia, loss of ATIII (prevents hypercoagulation, so these patients may be hypercoaguable) • A negative prognostic indicator; regardless of azotemia
• Treatment:
• Dietary protein restriction = decrease renal blood pressure, GFR
• Omega-3 supplementation

220
Q

What was the outcome of the study of experimentally induced obesity in dogs

A

Experimentally induced obesity in dogs
• increased mean arterial pressure, increased plasma renin -> altered
function & architecture
• Bowman capsule expansion, glomerular cell proliferation,
thickening of glomerular & tubular basement membranes,
increased mesangial matrix
• Changes in Bowman’s capsule -> pathologic
proteinuria?

221
Q

What mechanisms are there to help reduce phosphorus in the blood?

A

When phosphorous is high, there are several mechanisms including PTH to help reduce it
• Hyperphosphatemia upregulates a factor called fibroblast-growth factor-23 (FGF-23) from the bone
• This factor reduces activation of vitamin D to calcitriol in the kidney
• Reduces P absorption form the GI tract
• Primary action- joins with a factor called Klotho to increase P excretion in the kidney

222
Q

When does total food intake plateau in puppies? What are the rules of thumb for estimating energy intake during growth? When do puppies have a higher risk of weight gain?

A
  • Rules of thumb for estimating energy intake during growth:
  • 2 X MER for weaning to 1/2 adult BW
  • 1.5 X MER for 1/2 - 3/4 adult BW
  • 1.2-1.0 MER for 3/4 to 1.0 adult BW
  • Often total food intake plateaus between 4 and 5 months

• Once neutered, higher risk of weight gain

223
Q

Who is most likely to get Exocrine pancreatic insufficiency?

A

Dogs > Cats

  • Breed disposition (German Shepherd, Chow, Collie
224
Q

What are other diet related dermatological diseases?

A

 Zn responsive dermatosis

 Vitamin A deficiency

 Protein malnutrition

 Copper deficiency

 Tyrosine deficiency

225
Q

What is associated with fast growth post weaning in puppies? How can you prevent it? What dogs are more at risk?

A

Fast growth is associated with increased risk of skeletal disease in large breeds

  • Maintain at BCS of 4/9
  • Especially in large breeds
  • Use growth curves to monitor puppies development and monitor for weight gain/ obesity
226
Q

What are the pro’s and cons of a kidney friendly commercial therapeutic diet?

A

• Many options
- Look at product guides
• Differences between diets may make some better fit
than others
• Different stages, differences in electrolytes, fat content, etc.
• Multiple options for palatability/variety
Be aware that many are high(er) in fat
• May be contraindicated for pancreatitis, hyperlipidemia, etc
- Some multi-function diets now available
• Hydrolyzed/renal diet (adverse food reactions/renal
disease)

227
Q

What are the implications of liver disease?

A

 The liver gets much of its nutrient supply from the portal vein (rather than from an artery)

 The specific nutrient requirements of dogs and cats with liver disease are currently unknown

228
Q

What are some of the mechanisms that contribute to a reduction of insulin response and eventually to diabetes mellitus?
What do they cause?

A

• Reduced expression of insulin signaling molecules in skeletal muscle
• Downregulation of a major insulin-responsive glucose transporter (GLUT4) in
adipocytes

They cause:
- These decrease insulin-stimulated glucose transport and metabolism in
adipocytes and skeletal muscle
- Impaired suppression of hepatic glucose output
- The increased demand for insulin secretion can result in amyloid deposition in the pancreas and decrease in the functional secreting tissue

229
Q

Is there a benefit to using nutrition to help with dermatological disease?

A

 The right diets, nutrients, and sometimes nutritional
supplements can have a significant benefit in
improving or resolving certain skin disorders

 Some supplements may include fatty acids and zinc

 High quality/digestibility protein

230
Q

What is fibroblast growth factor 23?

A

FGF‐23 is a factor synthesized and secreted by bone cells (fibroblasts)

231
Q

Is there a correlation between PTH and Creatinine?

A

yes there is.
Much higher PTH at high creatinine levels.

232
Q

What are the top 3 causes of pruritis?

A

Flea allergic response

Food allergy

Atopy

233
Q

How do you discontinue parenteral nutrition in patients? What is the concern with stopping cold turkey?

A

Discontinuing PN
Usually discontinue in parallel to patient consuming food or fed through tube Wean gradually Abrupt d/c is may lead to serious complications!
◦ While PN is provided, insulin is increased
◦ Abrupt stop = glucose is not provided= insulin still high = hypoglycemia

234
Q

Why must we calculate protein requirements ?

A

Calculating protein requirements:
• Avoid protein malnutrition due to
energy restriction

Dont need to remember:
• The protein requirement for an adult
dog is 3.28 g BW(kg)0.75
• The protein requirement for an adult
cat is 4.96 g BW(kg)0.75

235
Q

What are hydrolyzed protein diets?

A

 Protein size reduction discourages IgE
crosslinking -> mast cell activation

 Theoretically, protein source irrelevant:
chicken, soy with starch

 Helpful when novel foods fail or have been
already tried

 Why can it fail? Theories
 Hydrolysis not small enough

 Bell distribution of protein sizes

 IgG may be more relevant
 Size of glycoprotein can matter
 Purina HA 11.7 kDa or lower
 Ultamino has 99% of peptides below 6 kDa

236
Q

What causes EPI? What are the signs, diagnostic values, ect?

A

 May be a result of pancreatitis

 Loss of pancreatic tissue mass

 deficiency in digestive enzymes (lipases, amylase, chymotrypsin, trypsin, etc…)

 Signs: diarrhea, steatorrhea, weight loss, ravenous appetite, coprophagia

 Diagnosis: Low serum TLI

 Many times accompanied by dysbiosis
 Bacteria may use cobalamin and produce folate
 Cobalamin also requires pancreatic intrinsic factor for absorption
 The result- high folate, low cobalamin

237
Q

What are potential contributing factors to adverse reactions to food?

A

 Potential contributing factors:
 Bacterial enterotoxins
 Parastism
 Malnutrition

238
Q

What are some causes that induce catabolic cytokines? What is the result?

A

Causes:
- Actions of cytokines catabolic hormones
- Severe injury, trauma, sepsis, burns, cancer, critical illness.
- Decreased calorie and nutrient intake
Results:
- Malnutrition
- Negative nitrogen balance and muscle catabolism.
- Decreased healing, depressed immune function, increased intestinal permeability, increased morbidity and mortality.
- Alterations in carbohydrate, lipid, and protein metabolism.

239
Q

What are the signs of uroliths?

A

Some are asymptomatic
Lower urinary signs including, urinary incontinence, hematuria, dysuria, pollakiuria, periuria, stranguria.
Can cause urinary obstruction.

240
Q

What are the desired characteristics for diets when it comes to calcium oxalate predisposition

A

Calcium -> moderate
Phosphorus -> moderate ( to bind some of the calcium/ good Ca++/Phos balance)
Vitamin D: moderate (not enough for Toxicity / not too low)
Oxalate: lower/ reduced
Vitamin C -> should not be high, can be metabolized to oxalate
Vit B6 should also be limited because they can form oxalates as well

241
Q

What is the diagnosis of copper hepatopathy?

A

 Diagnosis: Clinical signs indicative of liver disease (jaundice, ascites, HE etc), elevated liver enzymes
 Definitive diagnosis is done with a liver biopsy and
quantification of copper

 Important to differentiate between primary copper
accumulation and secondary copper increase due to chronic
inflammation

242
Q

What is important when feeding any patient?

A

Monitoring ( Monitor patient response)

243
Q

What is the cause of urate urolithiasis?

A

Breed dispositions -> genetic abnormalities
Problems with purine metabolism ( Nucleic acid)
- Dalmatians, English bull dogs, Yorkies, others
- Siamese, Egyptian may
Liver disease
- decreased conversion of urine acid to Allintoin

animal nutrition (27 decks)

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