General - sickness Flashcards
How is parenteral nutrition provided?
via a central vein (ie, jugular catheter) or via a large peripheral vein (eg, lateral saphenous
vein in dogs or femoral vein in cats). The limiting factor
in using PN peripherally is the osmolarity of the
parenteral solution, as solutions with very high osmolarities may induce thrombophlebitis
What are TPN and PPN?
Total parenteral nutrition (TPN), which is usually administered via a centra vein, refers to the provision of the entire caloric requirement of the animal by PN, whereas partial parenteral nutrition (PPN) typically only provides 40 to 70 per cent of the animal’s calculated energy requirements
What is normally in a PN solution?
PN solutions are usually a combination of glucose, amino acids and lipid solutions mixed in appropriate proportions based on the needs of the individual patient
What should be considered when deciding on a feeding tube type
■ Anticipated duration of nutritional support
■ Technical difficulty involved in placing the tube and the clinician’s experience
■ Diets available that can be used with the tube
■ Cost
■ Need to circumvent parts of the gastrointestinal tract
■ Need and suitability of the animal for general anaesthesia
■ Ability to meet nutritional goals
■ Invasiveness of the technique
■ Possible complications
■ Tolerance to enteral feeding
What would be considered the gold standard feeding tube for pancreatitis?
postpyloric feeding via a J tube
When are gastrotomy tubes good/ bad?
G tubes are indicated if there is oral, pharyngeal or oesophageal dysfunction but are contraindicated if the patient is vomiting or has severe
gastric pathology
G tubes usually have a large diameter, which allows a larger selection of diets for feeding. In addition to liquid convalescence diets, commercial diets can also be fed after being liquidised with water in a blender. This is particularly useful in situations in which a single novel protein diet is required (eg, inflammatory bowel disease) or a protein-restricted diet is required (eg, hepatic or renal dysfunction)
When are J tubes used?
severe gastric or pancreatic disease. Unfortunately, the dietary options for J tubes are limited. Due to the tube’s narrow diameter, only liquid diets can be used. Ideally, monomeric (ie, semidigested) diets should be fed through J tubes but these are expensive and are not readily available.
Should be given as CRI
Should be monitored in ICU due to the risks of septic periotonitis
What is stress starvation?
When sick
Increased BMR which can vary a lot between similar patients
Increased protein metabolism due to stress hormone release (catecholamines and cortisol)
These hormones also lead to insulin resistance and inefficient carbohydrate use
What is uncomplicated starvation?
When no food available only
Decreased BMR
fat broken down to make ketone bodies
Ketones used for gluconeogenesis and as a cellular substrate
When should you intervene with inappetance?
After 3-5d
Outline assisted oral feeding
(TTE)
only do for 24-48 hours
use with mirtazapine
often limitted nutritional value
What are the pros and cons of NO tubes?
Pros:
doesn’t pass cardiac sphincter, so reduced risk of oesophagitis (so better than NG)
Easy, no GA
Mostly well tolerated
Cons:
3-5d max
Only v narrow
How do you place an NO tube
Measure nose to mid thorax
1-2ml lidocaine up nostril
Insert 1-2inch smooth and fast then let go
aim medially and ventrally
then slowly insert the rest, can watch for swallowing action
let go after each push so that if the animal moves back they don’t pull the tube out
3 sutures: 1. immediately lateral to the nares 2. between eyes 3. top of head X-ray to show just caudal to the heart base
What are the pros and cons of O tubes?
Pros Good range of diets due to size of tube Well tolerate 3-4 weeks minially invasive
Cons
Needs GA
more complications than NO
What are the pros and cons of PEG/ gastrotomy tubes?
Pros
More secure
can use blended pet food
left in for weeks to months
Cons
PEG needs endoscopy, gastrotomy needs for abdominal surgery, both need GA
