Exam 3 - Final exam Material Flashcards
How can you prevent struvites in?
Infection specific strategies
- Address uti’s
- Continue monitoring
- Address predisposition
- Cranberry extract does not work
- Urine dilution
- precursor intake
What is important about sodium in patients with CKD?
- 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…
How can you prevent refeeding syndrome?
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
What are the possible consequences of chronic enteritis?
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
How long can you feed SD?
Deficient in protein, no longer than 3 months.
What do you do if patient refuses appropriate CKD diet?
• 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
What is hepacutaneous syndrome?
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
When would we intervene in regards to nutrition?
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
What is the treatment of Failure of passive transfer?
- Surrogate colostrum
- Plasma may be used for infusion of antibodies
- Prevention of pathogen exposure
What does adiponectin and leptin do? What occurs with obesity?
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)
Which is most safe and effective in unclogging a feeding tube?
Water
What are the adipokines?
- Steroid hormones
- Growth factors
- Cytokines
- Eicosanoids
- Complement proteins
- Binding proteins
- Vasoactive factors
- Regulators of lipid and glucose metabolism
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?
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
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?
- Critical disease -> cytokines (TNFα etc) catabolic state
- Preferential use of amino acid oxidation for energy
- Negative nitrogen and energy balance
What is colostrum banking? What is the issues with that? How is it stored?
- 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
What are supplements that are used for patients with liver disease?
- 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)
What are signs of Klotho deficiency?
Animals with Klotho deficiency show signs of FGF‐23 deficiency with high serum phosphate and calcitriol
concentration.
What is preferred when feeding through different feeding tubes?
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
What are neonates susceptible to at birth? Why?
- 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
What are calcium oxalate predispositions?
Hypercalcemia (Cancer, hyperparathyroidism, ect)
Increased absorption of calcium and oxalate
Increased excretion of calcium and oxalate excretion is ideal.
What conditions may increase energy/ protein requirements?
Seizures
Burns
Sepsis
Besides total amount of protein in HE what else should you be mindful of? Why? What protien should be avoided? Which is ideal?
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
Who is not likely to have stones?
Young animals
How can you prevent urolithiasis?
- urine dilution
- precursor excretion
- urine composition/ environment modification (add inhibitors/ change ph)
What is important about hydration in terms of kidney disease? How can you maintain hydration?
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…
What are veterinary weight loss diets? What are the aspects they utilize to assist with weight loss?
• 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
How are B vitamins utilized / indicated in patients with kidney disease?
• 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
How is maternal immunity transferred via colostrum?
• 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
What other options are available for dogs with liver dysfunction?
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
Based on all the studies in this lecture what is the overall consensus?
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.
How long should a diet trial last? If cause reintroduced, how long would it take for allergic signs to show up?
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
What must be done for patients with hepatic lipidosis? What is the ideal plan for refeeding?
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
What is the role in FIC as components of urethral plugs?
FIC cats you may want to put them on a diet that is preventative
What is the pancreas? What is its endocrine and exocrine function? What cells / enzymes are secreted?
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
What are calcium oxalate?
- Oxalates typically come from plants
- some can be formed by compounds in the body.
- Non soluable cystals in water
How to achieve intentional weight loss?
• 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
Are there genetic tests for urolithiasis?
Yes, and there a may be some benefit to putting them on a diet that prevents urates.
What are the important parts of creating a nutritional support plan?
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)
What would be the best option for a patient with prolonged anorexia and diagnosed idiopathic megaesophagus?
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).
When should a patient be offered parenteral nutrition?
A good option for patients that cannot tolerate enteral feeding
◦ Severe pancreatitis
◦ Not stable for anesthesia
◦ GI obstruction/ dysfunction
◦ Temporary support
What are concurrent diseases associated with diabetes?
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
Based on a survey by the association of pet obesity prevention in 2018, what percentage of dogs are overweight? Cats?
56% of dogs are overweight or obese
59% of cats are overweight or obese
What are the predisposition for struvites?
- 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?
What are cystine urolitiasis?
Cystine is disulfide AA
- Normally reabsorbed in the PCT, therefore genetic defect in the reabsorption mechanism is responsible.
How do you diagnose pancreatitis?
Diagnosis can be challenging
Medical history
Serum pancreatic lipase
immunoreactivity (PLI)
Abdominal US
Histopathology
What is
Hematuria, pollakiuria, stranguria, periuria?
Hematuria- blood in urine
Pollakiuria- often urination (more incidences of urination)
Stranguria - painful or strenuous urination
Periuria- urination in inappropriate location.
How to determine if a pet is obese?
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)
What is the link between obesity and CKD in humans? In dogs?
• 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
What must you monitor with Parenteral nutrition?
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.
What is relative supersaturation?
- 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
What is copper storage disease?
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)
What is the mechanism of allopurinol and how it prevents urate stone formation?
Xanthine oxidase is inhibited by allopurinol -> so it prevents stones, but it can cause xanthine stones ( if given too much)
What are potential diets that can be used for hospitalized patients?
Commercial veterinary diets: canned or liquid
Commercial human diets: liquid (may not be balanced for dogs and cats!)
Home-prepared die
What tends to be found in lower quantities in liver diets for both cats and dogs?
Dog hepatic diets: relatively low protein, low copper, low
purine
Cat hepatic diets: not available, use renal diets
What is important about protein reduction in patients with CKD?
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
How can you change dietary precursors?
Struvite- combination of ammonia and phosphate-> diet with less of these Precursors would be ideal
- in struvite acidify urine
What is glutamine? Arginine? Where is fat absorbed and what does it stimulate/ cause?
- 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
What are the common uroliths?Less common?
Struvite and calcium oxalate (cats calcium oxalate) dogs (struvite)
Urate, cystine, silicate, ect
When is it ideal to fast a patient? What is the new recommendations in regards to pancreatitis and severe enteritis?
- 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)
What are the risk factors for CKD?
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??
What is important about potassium in dogs with renal disease?
• 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
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?
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
What are diet options for patients with CKD? What resource should not be recommended?
Commercial
• Custom formulated home-cooked diet
• Consult veterinary nutritionist
• Do NOT used recipes on-line or in books…
What is needed for maternal antibody transfer? When does it begin? What is the trend of fetal to maternal abs?
- transport requires a healthy placenta
- Begins at 17 weeks (humans) increases with gestation
- By week 40 (humans): IgG(fetal)> igG (maternal)
What must you do with PPN to meet energy requirements?
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.
What is the correlation between excess weight and musculoskeletal disease?
• 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
What are the kinds of feeding tubes and how are they placed?
Feeding tubes types include:
- Nasoenterel: small lumen, temporary, no anesthesia or incision required
- Esophagostomy tube: larger lumen, can be long-term, requires anesthesia and incision
- Gastrostomy tube: Larger lumen, long-term, requires anesthesia and incision
- Jejunostomy tube: long-term, requires anesthesia, diet- liquid and highly digestible
What are comorbidities that have growing evidence in regards to CKD?
• Evidence accumulates for proteinuria and hyperlipidemia
being comorbidities
• Unknown whether treating one disorders impacts the other
What percent of dogs meet 95% of the resting energy requirements while hospitalized
under 30%
- 0.95XRER met only 27% of the time
What are some different histories prior to gi incidence and what it will indicate?
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.
What is the role of protein in liver disease?
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
How frequent are complications with feeding tubes?
Overall complications are common (up to 77%), but most of them are minor
Can food cause CKD?
- 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)
What can be the results of adverse reactions to food?
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)
What is important about protein quality of patients with CKD?
Highly digestible
• Protein quality (AA profile)
• Less oxidation of AA -> less
uremic toxins
• Less undigested protein
reaching the lower GI tract
What level of IgG in a puppy is considered deficient? What puppies are more sensitive to deficiency? What is the issue with milk replacers?
- 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
What are potential causes of Dysorexia Anorexia relating to CKD?
- 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.
What is canine plasma transfusion? Can it be used for IgG transfer?
- 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
What are the other hunger hormones?
Other hunger hormones include
cortisol and orexin
What is important to know about formulas?
• Use a reputable product/brand
• Even the best products are not equal to natural bitch/queen milk, so a foster is always
preferred
Why is obesity considered an inflammatory condition?
• Other adipokines such as TNF-α and IL-
6 promote inflammation • Therefore chronic obesity is an inflammatory condition
What is the cause of lymphangiectasia? What is the potential consequences of it? What is the treatment?
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
What hormones suppress hunger?
Multiple hormones suppress hunger
including leptin, insulin, CCK, GLP-1
and more
What is feline hepatic lipidosis? What cats does it commonly occur in? What is the pathophysiology of the condition?
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
What are some exocrine pancreatic diseases?
EPI- Exocrine pancreatic insufficiency
- pancreatitis
What possible factors are involved in urolith formation?
PH, mineral concentration of urine, inhibitors and promoters of urolith formation.
How can you provide nutritional management of pancreatitis?
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.
Important image
How can you confirm tube placement in patients?
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)
What are the benefits of CPN feeding? Where is the catheter placed in the animal?
- 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
Why is the ingestion of maternal milk important in the first 24 hours after birth?
- 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
What should you avoid in term of components of treats to prevent Calcium oxalates?
Increased vitamin C
Increased Calcium
Includes glycine
When should you consider a feeding tube? How do you select the right kind of tube?
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
What is the length of embryonic development in humans? Dogs? Cats? Chickens, Horses? Elephants?
Humans: 280 days
Dogs: 63 days
Cats: 62-72 days
Chickens: 21 days
Horses: 330-345 days
Elephants: 22 months
Is there a benefit to Omega -3 PUFAs in CKD? How can it help?
• 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
Where does each tube terminate/ bypass?
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
How common is CKD in cats?
1/3 of cats above the age of 15 suffer from chronic renal
disease