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3. HM Companion Module > GI Diseases > Flashcards

GI Diseases Flashcards

1
Q

what are the components of the circle of nutrition?

A

patient, diet, feeding management

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2
Q

if a pet has vomiting or diarrhea, how should we alter feeding methods? how has the theory on this evolved over time?

A

PAST: NPO
- Discontinue food & H2O for 24-48 h
- Small amounts of H2O every few hours
- If well tolerated: small amounts of food - No vomiting/diarrhea: increase gradually

Purported advantage:
- Reduce pancreatic secretions
- Reduce gastric distension
– abdominal pain - Bowel rest

CURRENT: EARLY ENTERAL NUTRITION – PO/tube
-Feed through vomiting/diarrhea

Purported advantages:
- Preservation of gut integrity & function
- Improved immune function
- Reduced bacterial translocation
- Attenuated release of inflammatory mediators
- Reduced rate of infection & infectious complications
- Reduced duration of hospitalization

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3
Q

ideal feeding frequency

A

Small meals frequently: 3-6 meals/day
- Reduce gastric distension
- Decrease gastric secretion
- Reduce nausea, vomiting, GE reflux
- More effective assimilation (digestion + absorption)

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4
Q

digestive problems caused by megaesophagus

A

-Peristalsis fails to occur properly
-Enlarged esophagus
-Does not push the food down to the stomach
-Food stays in esophagus
-Eventually food is regurgitated, enters lungs through breathing, decays in esophagus

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5
Q

goal of a feeding plan designed for a patient with megaesophagus

A
  • Meet nutrient requirements
  • Maintain ideal body weight
  • Minimize regurgitation > prevent aspiration pneumonia
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6
Q

key nutritional factors for patients with swallowing disorders due to obstructive lesions or aberrant motility:

A

-higher in fat > overall volume of food is smaller, helps as less volume required to be pushed down esophagus
-high protein > helps with tissue repair

Energy density: >4.5 kcal/g
Fat: >25%
Protein: >25% for dogd, >35% for cats

> often growth foods are good for this, or cat food for dogs

*note: never feed a dog food to a cat

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7
Q

key nutritional factors for patients with swallowing disorders due to esophagitis/gastroesophageal reflux:

A

less fat, as fat makes food sit in the stomach for a long time
fat < 15%

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8
Q

How to determine food ‘form/consistency’ for patient with megaesophagus? considerations

A

 Try various food consistencies
> best texture for individual patient

 Liquid/gruel: > Not stimulate secondary peristalsis
> Higher risk for aspiration pneumonia

GENERALLY BEST:
 Dry food / Moist food formed into large boluses
> Stimulate swallowing reflex maximally
> secondary peristalsis

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9
Q

best feeding method/ frequency for patients with megaesophagus:

A

 Small volume, multiple small meals
 Upright position

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10
Q

Animal-related risk factors for GD/GDV

A

 Large or giant breed
 Deep chested
 Male gender
 Purebred
 Older age (6-7 y)
 Rapid eating
 Recent car journey (within 24 h)
 Recent time in boarding kennel (within 24 h)
 Personality (fearful, nervous or aggressive)
 Esophagal motility disorders
 Previous GI disease (IBD)
 Excessive belching or flatulence

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11
Q

Dietary risk factors for GD/GDV

A

-infrequent meals / large food volume at once
- only single food form
- only dry food
- no snacks, treats
- small kibble size
- fat in first 4 ingredients
- Citric acid in first 4 ingredients
 Dietary indiscretion
 Elevated food bowl
 Eating too fast
 Gulping water
 Aerophagia
 Thin body condition
- higher body weight
- periprandial exercise

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12
Q

what to advise owner about animal related risks of GD/GDV

A

ADVISE OWNER: No matter what you do, the risk still exist Teach owner what signs to look for

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13
Q

how to deal with a dog with GDV risk: type of food, amount, frequency, other considerations

A

 Food: Highly digestible, 12-15% DM fat
 Amount: Based on idBW 31 kg
Go home: MER: 1.6 x RER
 Divided into 3 to 4 meals daily
 Eliminate rapid eating
 Restricted exercise / avoid car rides in close association with
meals
 Prevent dietary indiscretion
 Warn owner!!

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14
Q

How to deal with a dog with megaesophagus: type of food, amount, frequency, other considerations

A

 Food:
Recovery, working/sporting dog, small breed growth food, cat food
Purina Essential Care Puppy Formula Protein: 31.70 %DM
Fat: 20.10 %DM
 Amount:
Based on ideal body weight 27kg
DER: 1.6 x RER
RER = 70 x kg0.75
 Frequent small meals
 Offered from a bowl placed on the edge of the table

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15
Q

how to eliminate rapid eating in dogs

A

 Decrease competitive eating
 Placing large balls or rocks in food bowl
 Feeding from a muffing tin
 Special made food bowl (Brake-Fast®)
 Mix of dry and wet food

 Greater kibble size (>30 mm for giant-breed dogs)

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16
Q

4 categories of GI diets

A
  1. Highly digestible /. low residue diets
  2. fat restricted diets
  3. elimination diets
  4. fibre-enhanced diets
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17
Q

what is digestion and what components go into it? what are the goals of a highly digestible diet and how do its macronutrients differ from the average commercial diet in terms of digestibility?

A

 DIGESTION = degradation process in GI tract:
 Mechanical (teeth, stomach)
 Chemical (stomach, small intestine)
 Bacteriological (large intestine)
> Breakdown complex dietary substances
> create absorbable units

HIGHLY DIGESTIBLE = better proximal absorption, less overload distal:
-Digestibility:
Protein: >85% (comm. = 80)
Fat: >90% (comm. = 90)
NFE: >90% (comm. = 85)

Note: NFE = nitrogen free extract, proxy for carbs

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18
Q

factors influencing digestibility

A
  • Ash
    > (low = more digestible)
  • Fibre > Crude fibre <5% DM
    > (more fiber = less digestible)
  • Anti-nutritive factors: trypsin inhibitor
    (eg. in soy products)
  • Processing time/temperature > Maillard
    (creates glycoproteins that are less digestible)

 Animal source&raquo_space; Plant sources

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19
Q

apparent vs true digestiility measurements

A

-manufacturers measure apparent > look at what is left in feces

-true would require inserting illial canula to look only at small intetstine, considered an unethical experiment

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20
Q

clinical applications of highly digestible diets

A
  • Acute gastro-enteritis
  • Small bowel disease
  • Exocrine pancreatic insufficiency
  • Pancreatitis

Also notable mention for:
- Colitis
- Constipation

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21
Q

signs of Exocrine pancreatic insufficiency

A

chronic diarrhea, polyphagia (2 X RER),
weight loss

  • MCS: severe muscle loss
  • Coat: dull, brittle
  • Faeces: - Watery to semi-formed
  • Clay-colored
  • Large volumes
  • Passed 2-3 times a day
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22
Q

in cases of Exocrine pancreatic insufficiency, what 3 M’s are occurring?

A

MALDIGESTION = unable to properly digest food due to pancreatic enzyme deficiency

leads to…

MALABSORPTION = unable to absorb undigested nutrients (e.g. intact proteins, fats, and carbohydrates)

MALASSIMILATION

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23
Q

reasons for bloating, flatulence, statorrhea and diarrhea in EPI

A

 Undigested carbohydrates in the GIT
> bloating, flatulence, and diarrhea
 Undigested fats
> steatorrhea and diarrhea

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24
Q

causes of small intestinal bacterial overgrowth

A

 Loss of motility
 Mechanic obstruction
 Malassimilation > EPI
 Local immunity

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25
markers for SIBO
high folate, low cobalamine
26
consequences of SIBO
 Toxins, hydroxy fatty acids, unconjugated bile acids > secretory diarrhea  Unconjugated bile acid: - Less efficient micell formation - Fat malassimilation
27
general approach for feeding a dog with EPI
highly digestible diet + enzymes moderate fat restriction low fiber generally, - dietary fiber impairs pancreatic enzyme activity in vitro ?soluble vs insoluble?
28
why do we want to restict fat for a dog with EPI? how much restriction is needed? what important consideration needs to be made?
 Reduces bile secretion  Fewer unconjugated bile acids/hydroxy-fatty acids  Secretory diarrhea ↓ Dietary fat levels: - Moderate fat: 12-15% DM > Usually appropriate - Severe restriction: <10% DM > Rarely necessary WITH ENZYME SUPPLEMENTATION when we decrease dietary fat, we decrease caloric density substantially. EPI patients are in need of weight gain, so we must increase volume.
29
appropriate protein levels in food for EPI patient? what other considerations?
 Moderate: 20 - 25% DM if good BCS/MCS > IF Patients require weight gain (including lean body mass) then >30% DM  Highly digestible proteins > Reduce protein available for bacterial growth (SIBO) -eg.  Hydrolyzed Proteins > Proteins that are already broken down (i.e. hydrolyzed) into smaller fragments, making them highly digestible.
30
should we supplement fat soluble vitamins ADEK for animals with EPI?
Vit ADE - depend on fat absorption - supplement only if low levels, ongoing fat malabsorption, emaciated patient - over-supplementation can cause problems! * Vit K1 - If coagulopathies >must inject!  Dietary supplementation: - when disease responds to treatment - when fat absorption is re-established
31
problems with vit B12 in EPI cases
Pancreas is not properly producing intrinsic factor. B12 must bind to intrinsic factor for absorption.  Development of VitB12 deficiency: - Lack of intrinsic factor  Reduced VitB12 absorption in ileum - Absence pancreatic HCO3  Decreased luminal pH  Reduced affinity for intrinsic factor - SIBO: VitB12 consumed by microflora in GIT
32
functions of vitamin B12
- Protein synthesis - Red blood cell production - Enzyme function in biochemical pathways
33
where is vit B12 stored?
- Liver *UNUSUAL FOR WATER SOLUBLE VITAMINS*
34
vit B12 deficiency leads to what conditions?
- Macrocytic anemia - Poor growth - Neuropathies
35
function of Vit B9
Enzyme function in biochemical pathways
36
how does SIBO affect folate (B9) levels? how to supplement?
Folate Excess: Due to SIBO (antibiotics required) -can also sometimes see deficiency if concurrent enteropathies supplement per os
37
should we supplement dogs with EPI with raw pancreas? why?
no, risk of bacterial contamination - used dried extracts instead
38
treatment and diet plan for dog with EPI
-high protein (37%) diet with fat 12-15% DM  Amount: 2 x RER based on idBW 34kg (to start) -Adjust based on stool quality/quantity, BW, BCS, MCS  Frequent small meals  Pancreatic enzymes: - 1 tsp, 3x/d, just before feeding - Mixed with slightly moistened food  Parenteral fat-soluble & B-complex vitamins over time, once ideal BW is reached, can reduce amount of food and pancreatic enzymes in absence of clinical signs
39
 IMPORTANCE OF FAT in diets
- Energy source - Source of essential fatty acids - Vehicle of fat soluble vitamins - Palatability
40
what signs do we often see if there is a disruption of fat digestion and absorption?
- Malassimilation: steatorrhea, weight loss - Fatty acid, vitamin & mineral deficiency - Secretory diarrhea
41
what is considered a moderate vs severe fat reduction in a diet? what is an important consideration when decided how much to restrict?
 MODERATE REDUCTION DOG: 12-15% DM CAT: tolerate higher amounts (<23%DM)  SEVERE REDUCTION could be necessary DOG: <10% DM Tolerate large food volumes? e.g. pancreatitis + obesity / hyperlipidemia e.g. lymfangiectasia consider DIET HISTORY
42
lymphagniectasia clinical signs
 History: Watery diarrhea, flatulence Good appetite, yet weight loss  Diet history: A lot of different diets, no succes
43
what is lymphangiectasia?
 Obstruction of lymphactic system (primary, secondary)  Impaired lymphacticovenous flow  Lacteals distended with chyle - Fat malabsorption - Disruption of mucosal barrier - Reflux of protein-rich lymph in lumen - Hypoproteinemia
44
goals of feeding plan for lymphangiectasia
- Meet nutrient requirements - Gain/maintain body weight - Correct/prevent nutritional deficiencies - Promote nutrient absorption - Reduce enteric protein loss
45
key nutritional factors for foods for patients with lymphangiectasia/protein-losing enteropathy, and reasoning
Fat: Severe restriction (<10% DM) > Minimise lymph flow > Reduce lacteal & lymphatic distension > Minimise protein loss * Supplement Medium Chain Triglycerides oil (10-25% MER) if emaciated
46
theory behind feeding medium chain triglycerides to dogs with lymphangiectasia? contraindications?
- Hydrolyzed more rapidly in GI lumen - Rely on small amount of intestinal lipase - Absorbed in absence of bile acids - Not re-esterified in enterocytes - Primarily transported via portal vein?  APPLICATION: Extra energy in emaciated patients 10-25% MER Contraindication: liver pathology
47
diet choice for dog with lymphangiectasia
<10% DM fat high protein for weight gain small frequent meals can supplement protein, MCT
48
how do we diagnose and treat food allergies in dogs
1. Novel protein diets 2. Hydrolyzed protein diets
49
typical signs of food allergy
Chronic intermittend diarrhea: 3-5 times a week Fluid to semi-formed Occasional black No tenesmus, no blood, no mucus Weight loss Anorexia
50
feeding plan goals for dog with food allergies
- Meet nutrient requirements - Maintain healthy body weight - Correct/prevent nutritional deficiencies - Promote nutrient absorption - Reduce exposure to food allergens
51
key nutritional factors for hypoallergenic diet
 FAT Moderate: 12-15% DM -MCT oil (10-25% MER) if emaciated -N-3 fatty acid: reduce allergic & inflammatory reaction Ratio: N-6:n-3 > 5:1 to 1:1 Dose: 50-100 mg EPA+DHA/kg BW  FIBRE Low: Crude fibre < 5% DM > Insoluble vs. soluble fibre: benefit from a little bit of soluble fiber  PROTEIN Highly digestible Source: - hydrolysed - novel Moderate: 20 - 25% DM go >30% if weight gain required can use short term supplement
52
what are novel proteins
Animal or vegetable ingredients containing proteins that are: - Not commonly used in pet food and/or - Not commonly associated with adverse food reactions PRACTICALLY:  Avoid most common allergens  Max. 2 protein sources (animal + vegetable) to which animal has not been exposed before  DIET HISTORY!!
53
common food allergens in dogs and cats
beef dairy Particular attention: ingredients containing PROTEIN.  Molecular weight 10 – 70 kD  Stable to treatment with heat, acid, proteases
54
common novel proteins
venison duck rabbit peas lentils .......... getting harder as more availability
55
what are hydrolyzed proteins? use in allergy treatmnet?
 Enzymatic hydrolysis + ultrafiltration: - Proteases: cleave protein into smaller peptides - Ultrafiltration: removal of larger fragments  Smaller peptides / amino acids > Lower molecular weight > Reduced allergenicity ! PREVENT: - Clinical signs if sensitised to intact protein - Sensitisation of naïve individual
56
influence of allergen size on reaction
 Recommended < 10 kD, larger can bridge between 2 mast cells and cause degranulation (there are other mechanisms though)  BUT Average – very limited info Infants <1kD > still allergic
57
elimination challenge steps
STEP 1: Elimination of the responsible food > Resolution of clinical signs >GI disease 2-4 weeks!! STEP 2: Challenge with the original food > Return of clinical signs within 3 - 7 days > Elimination food > Again alleviate clinical signs STEP 3: Provocation with single ingredients > Return clinical signs?
58
purpose of fibre-enhanced diets
soluble fiber - prebiotics PREBIOTICS - Non-digestible food ingredients - Selectively stimulate limited # bacteria - Improve host health
59
possible positive effects of fibre enhanced diet
- Modifying gastric emptying - Normalizing intestinal motility - Buffering toxins - Binding excess water - Maintaining normal GI flora - Buffering gastric acid - Altering viscosity – gel-like
60
possible negative effects of fibre enhanced diet
- Decrease DM digestibility - Affect mineral availability - Too high levels rapidly fermentable fibre: loose stool - Too high levels of insoluble fibre: constipation
61
what happens to insoluble fibre after ingestion? what does it do for stool/food? application?
Small intestine: Escape enzymatic digestion Large intestine: Fermentation: extremely slowly  Adds non-digestible BULK > Decreased energy density ↓ > DM digestibility ↓ Colonic distension Stimulus for motility  APPLICATION: - Colitis - Constipation
62
what happens to soluble fibre upon digestion?
Small intestine: Escape enzymatic digestion Large intestine: anaerobic bacteria > fermentation
63
effects of soluble fibre in the diet, and application
- Affect composition of GI flora - Short chain fatty acids - Intraluminal pH - Water holding capacity and gel formation: > Better consistency of ingesta Application: - Small / large bowel diseases
64
why does cude fibre for a food not tell the whole story? better measure?
only looks at cellulose, hemicellulose, lignin >there are more fibre sources Total dietary fiber is better - also includes soluble fibres
65
constipation diet reccomendation
-high water >75% -crude fibre >7% highly digestible
66
can high fibre help with megacolon? what should we do?
 If motility patterns are completely abolished: Fibre-enhanced diets / Fibre supplements - No longer be effective stimulants of colonic motility - Worse, can contribute to obstipation Diet choice: Highly digestible/low residue
67
Three different approaches for large bowel disease:
1. Highly digestible, low residue GI diet > Minimise amount of digesta entering colon 2. ‘Hypoallergenic’ diet > Decrease potential antigens absorbed in the colon 3. High fibre diet > Alter colonic motility > Increase production of SCFA > Maintain colonic pH > Control pathogen growth > Water & electrolyte absorption 4. Or a combination
68
use for probiotics?
-in trial, reduced time to resolution of diarrhea -but not really regulated....

3. HM Companion Module (11 decks)

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