Exam 4: Week 13-16

Question 1

Given dietary history of a dog or cat, and product labels for prescription diets, select an appropriate elimination diet for your patient.

Answer 1

Strict elimination diet trial
Duration
◦ Dogs: clinical signs in remission in 85% by 6 weeks, 95% by 8 weeks
◦ Cats: clinical signs in remission in 80% by 6 weeks, 90% by 8 weeks
◦ Detailed diet, supplement, and medication history

Question 2

Develop an elimination diet trial plan for a patient, including duration of the diet, and interpretation strategy.

Answer 2

6-8 weeks
Make sure they aren’t doing treats or flavored tablets as well.

Question 3

To review and understand the nutritional needs of growing companion animals

Answer 3

Tube functioning at the highest part of GI tract.
Disadvantages of going too far down: a tube that goes into the jejunum -jejunostomy tube, (stomach has mechanical breakdown, pepsin, kind of like food traffic control, straight into jejunum would cause malabsorption)

Question 4

To review the terminology used to classify hepatic diseases

Answer 4

Hepatic terminology:
* Liver enzymes: ALT (in liver cells), ALP (endothelial cells), ASP (mitochondria and muscles)
* Pseudo liver function tests: blood urea nitrogen (BUN), albumin, glucose, cholesterol
* Pre and post prandial bile acids - easiest and best liver function tests
* Bilirubin concentration: Pre‐hepatic (hemolytic anemias), Hepatic, Post‐hepatic (obstruction outside the liver parenchyma)
* Hepatic dysfunction
* Hepatic failure

Question 5

To recognize clinical and laboratory findings suggesting specific hepatic and urinary tract diseases that could benefit from dietary interventions

Answer 5

In liver disease patients you may see: ascites
Dietary management of liver disease: energy, protein (restrict in hepatic encephalopathy), fiber (lessen ammonia absorption, may lessen hepatic encephalopathy), vitamins and minerals (B & E, moderate sodium, adequate potassium, restrict copper), anti-oxidants (increased zine, E, C, taurine)

**In urinary tract disease patients you may see: **
Azotemia: increased BUN, creatinine, or SDMA.
Pre-renal: dehydration (specific gravity >1.035/1.030
Renal: urine specific gravity < 1.035/1.030 (anuria, oliguria, polyuria)
Post-renal: hyperkalemia, the bladder could be blocked or ruptured

Question 6

To discuss specific nutritional management strategies to treat or slow progression of hepatic and urinary tract diseases

Answer 6

The key to liver is to avoid malnutrition and lessening copper accumulation

Control of phosphorous in a renal failure patient is most important. Give more water, and wet food if possible.

Question 7

Understand the definitions for hepatic enzyme activities and function tests

Question 8

Learn the basic dietary management strategies for liver disease (slide 16)

Answer 8

Energy
High palatability, high energy density, small meals frequently. Fat: 20-50% of dietary calories. Carbs: maximum of 45% of dietary calories, complex carbs
Protein
High quality, highly digestible, low in copper (beef, cheese, eggs), more than 20% of dietary calories, restrict only in hepatic encephalopathy
Fiber
Moderate amounts, preferably soluble (effect on bacterial aftergrowth, lessen NH3+ absorption > may lessen hepatic encephalopathy)
Vitamins and minerals
Increased vitamin B&E (anti-oxidant), moderate sodium restriction (lessens ascites), adequate potassium and restricted copper (lessens accumulation)
Anti-oxidants
Increased zine, vitamin E, vitamin C, and taurine

Question 9

Discuss the management of complications of hepatic encephalopathy and ascites

Question 10

Understand the definitions of azotemic.

Answer 10

Azotemia: increased BUN, creatinine or SDMA

Question 11

Learn the benefits of diets in the management of polyuric renal azotemia (slide 41).

Answer 11

BUN control (highly digestible, low protein), acidosis control (alkalinizing diets), phosphorous control (secondary renal hyperparathyroidism), corrects potassium wasting (extra supplementation sometimes indicated, MAKE SURE THEY EAT.

Question 12

Learn which urinary bladder stones are radiodense and can be dissolved by diets (slide 52).

Answer 12

Dense: ca oxolate, struvite *, silicate
Lucent: urate *, cystine * (need ultrasound)
You only acidify the urine of the STRUVITES
* Can be dissolved medically *

Question 13

Understand the approach to feeding a hospitalized patient

Answer 13

Why wait to feed? Make sure patient is stable before you decide to feed
Why and what should your feed? ¼ - ⅓ RER, thiamine, cobalamin, vitamin B complex

Question 14

Understand the complications associated with feeding a starved animal too fast

Answer 14

Refeeding syndrome, K, MG2+, P : refeeding Kills Malnourished Pets
Correct electrolyte balances and hydrate before feeding

Question 15

Review how to evaluate a product and convert crude protein and crude fat to g/1000 kcal

Answer 15

Grams of nutrient per 100 or 1000 kcal basis Formula: (Nutrient on
GA)/(kcal per kg) x 10000 = grams of nutreint per 1000 kcal

Guaranteed analysis

Question 16

Understand complications associated with NPO

Answer 16

Say no to NPO.
Enteral feeding maintains the gut barrier, reduces the risk of bacterial translocation, shortens the time to recovery, and improves weight gain

Question 17

Be able to list the different assisted feeding tube methods and advantages/disadvantages to each one:

NASOESOPHAGEAL

Answer 17

Nasoesophageal
feeding tubes
Advantages:
require minimal, if any, sedation
require no special equipment
Disadvantages:
patient discomfort
exclusive use of liquid diets because of small tube size
Procedure is largely blind‐ rare but serious complication is perforated lung
IMPORTANT: must verify placement of the tube
* radiograph
* end‐tidal carbon dioxide monitor.
Always take a radiograph before putting food through the tube.

Question 18

Be able to list the different assisted feeding tube methods and advantages/disadvantages to each one:

ESOPHAGEAL TUBE

Answer 18

Advantages:
easy to place
require only brief anesthesia
can accommodate more calorically‐dense diets (ie, >1
kcal/mL), making them ideal for patients that have
feeding‐volume limitations.
Tube size range from 12 to 19 Fr
Potential problems:
tube obstruction
cellulitis at the stoma site

Question 19

Be able to list the different assisted feeding tube methods and advantages/disadvantages to each one:

PERCUTANEOUS GUIDED GASTRONOMY

Answer 19

tubes (PEG)
* Good options for patients undergoing laparotomy and endoscopy.
* Used for long‐term nutritional support (ie, months)
* Largest feeding tube (16–32 Fr) options and can deliver most diets
after mixing in a blender.
* Requires special equipment and experience Complications:
* mild cellulitis around the stoma site
* Peritonitis‐ can be life threatening
* Premature tube dislodgement (before 14 days) should
be immediately evaluated for the need for possible
surgery.

Question 20

Ideal diet for ferrets

Answer 20

Short intestinal tract, short GI transit time (3-4 hours adults, 1 hour kits), Carnivores, but do not gorge = small meals, frequent intervals,hide snacks, Unsophisticated gut flora = scant anaerobic bacteria = decreased, GI upset and diarrhea from long term antibiotic therapy, Don’t digest fiber…you put broccoli in, you get broccoli out, Need high protein (30-40%), high fat (15-30%) diet, In addition to being high protein, it needs to be of high quality

Question 21

ideal diet for rabbits (guinea pigs and chinchillas)

Answer 21

are all hindgut fermenters with a long GI transit time. High fiber, low nutrient, poorly digestible diet = intake of diet is high, compliments GI tract design, useful for constant chewing for wear of dentition. Unique calcium metabolism = calcium carbonate crystals. Inappropriate diet can lead to dental malocclusion, obesity, dysbiosis, enteritis, decreased GI motility. IDEAL DIET 90% hay, grass for adults, alfalafa for young and pregnant and thin geriatric - pellets feed in small portions, size of eyes - leafy green vegetables, size of skull - fruits/grains/seed/treats

(Guinea pig difference: VITAMIN C, water supplementation not reliable.
Chinchilla difference: higher nutrient need, also limit suits seeds and carbs)

Question 22

ideal diet for rats and mice

Answer 22

highly studied, not hindgut fermenters= higer protein requirements, rodent block=mahority of diet, small amounts of produce as treats

Question 23

ideal diet for hamsters and gerbils

Answer 23

(similar to cows, foregut fermentation) less reliant on protein than rats, large cecum and colon, more omnivores than herbivores, desert animals but still need water, produce items as rewards

Question 24

ideal diet for hedghogs (insectivores)

Answer 24

chitinase, hedgehog specific diet, higher fiber requirement than carnivores, small amount of insects, small food items (can get lodged in mouth)

Question 25

ideal diet for sugar gliders

Answer 25

enlarged cecum, Spring/summer: primarily insectivorous. Winter: gum, sap, sugar from trees, or sap sucking insects. Captive diets: insectivore diet, small amount of nectar (Limited fruits and vegetables, Avoid large amount of sugar and fat – obesity common, Can use insects as treats). Offer food in evening to ensure freshness

Question 26

ideal diet for parrots

Answer 26

Pelleted diets – grind and mix all components together to make a balanced diet. Pellets: 60-70% (or at least 50%), Vegetables: 20% (focus on those high in calcium and vitamin A), Fruits: 5-10% (focus on tropical fruits), Nuts: 5% (almonds, walnuts, Brazil nuts)

Question 27

ideal diet for reptiles

Answer 27

carnivores: pre-killed prey, feed in separate encolsement, feed every 1-2 weeks
Insectivore: live insects, dust insects
Herbivores: dark leafy greens
Omnivores: mix of veggies with protein

Question 28

The pancreas as an organ, has two different functions:

Answer 28

endocrine and exocrine

Question 29

endocrine funciton of pancreas

Answer 29

Most common endocrine: diabetes mellitus, high glucose, clinical sign: PU/PD, polyphagia, weight loss
(Treatment, give insulin)

Diabetes is a metabolic disease. number one causes of blindness, stroke, heart attacks, dialysis, and limb amputations (apart from car accidents). Diabetes is second to cancer.
Control of metabolism: insulin (anabolic) and glucagon (catabolic)
Diabetes is a catabolic state, missing anabolic hormone. Not enough insulin.
Somatostain helps control both.

Question 30

exocrine function of pancreas

Answer 30

Digestive enzymes: trypsin, chymotrypsin, carboxypeptidase, elastase, amylase,

Functional unit of exocrine pancreas is acinar cells
Pancreas also secretes bicarbonate so enzymes can do their job.
Digestive enzyme is produced inside acinar cells. If enzymes dugest the cell (pamncreatitis), that would be bad. So they are produced in inactive forms and packaged in a certain way.

Question 31

Appreciate that although Diabetes Mellitus (DM) is a “sweet” disease, it is really a disorder of lipid metabolism, or dyslipidemia

Question 32

Anticipate how changes in your DM patient might impact subsequently changes in their insulin requirement