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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
Q

markers for SIBO

A

high folate, low cobalamine

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26
Q

consequences of SIBO

A

 Toxins, hydroxy fatty acids, unconjugated bile acids > secretory diarrhea

 Unconjugated bile acid:
- Less efficient micell formation
- Fat malassimilation

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27
Q

general approach for feeding a dog with EPI

A

highly digestible diet + enzymes

moderate fat restriction

low fiber generally,
- dietary fiber impairs pancreatic enzyme activity in vitro
?soluble vs insoluble?

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28
Q

why do we want to restict fat for a dog with EPI? how much restriction is needed? what important consideration needs to be made?

A

 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
Q

appropriate protein levels in food for EPI patient? what other considerations?

A

 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
Q

should we supplement fat soluble vitamins ADEK for animals with EPI?

A

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
Q

problems with vit B12 in EPI cases

A

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
Q

functions of vitamin B12

A
  • Protein synthesis
  • Red blood cell production
  • Enzyme function in biochemical pathways
33
Q

where is vit B12 stored?

A
  • Liver UNUSUAL FOR WATER SOLUBLE VITAMINS
34
Q

vit B12 deficiency leads to what conditions?

A
  • Macrocytic anemia
  • Poor growth
  • Neuropathies
35
Q

function of Vit B9

A

Enzyme function in biochemical pathways

36
Q

how does SIBO affect folate (B9) levels? how to supplement?

A

Folate Excess:
Due to SIBO (antibiotics required)

-can also sometimes see deficiency if concurrent enteropathies

supplement per os

37
Q

should we supplement dogs with EPI with raw pancreas? why?

A

no, risk of bacterial contamination
- used dried extracts instead

38
Q

treatment and diet plan for dog with EPI

A

-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
Q

 IMPORTANCE OF FAT in diets

A
  • Energy source
  • Source of essential fatty acids
  • Vehicle of fat soluble vitamins
  • Palatability
40
Q

what signs do we often see if there is a disruption of fat digestion and absorption?

A
  • Malassimilation: steatorrhea, weight loss
  • Fatty acid, vitamin & mineral deficiency
  • Secretory diarrhea
41
Q

what is considered a moderate vs severe fat reduction in a diet? what is an important consideration when decided how much to restrict?

A

 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
Q

lymphagniectasia clinical signs

A

 History: Watery diarrhea, flatulence
Good appetite, yet weight loss

 Diet history: A lot of different diets, no succes

43
Q

what is lymphangiectasia?

A

 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
Q

goals of feeding plan for lymphangiectasia

A
  • Meet nutrient requirements
  • Gain/maintain body weight
  • Correct/prevent nutritional deficiencies
  • Promote nutrient absorption
  • Reduce enteric protein loss
45
Q

key nutritional factors for foods for patients with lymphangiectasia/protein-losing enteropathy, and reasoning

A

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
Q

theory behind feeding medium chain triglycerides to dogs with lymphangiectasia? contraindications?

A
  • 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
Q

diet choice for dog with lymphangiectasia

A

<10% DM fat
high protein for weight gain

small frequent meals

can supplement protein, MCT

48
Q

how do we diagnose and treat food allergies in dogs

A
  1. Novel protein diets
  2. Hydrolyzed protein diets
49
Q

typical signs of food allergy

A

Chronic intermittend diarrhea: 3-5 times a week
Fluid to semi-formed Occasional black
No tenesmus, no blood, no mucus Weight loss
Anorexia

50
Q

feeding plan goals for dog with food allergies

A
  • Meet nutrient requirements
  • Maintain healthy body weight
  • Correct/prevent nutritional deficiencies
  • Promote nutrient absorption
  • Reduce exposure to food allergens
51
Q

key nutritional factors for hypoallergenic diet

A

 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
Q

what are novel proteins

A

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
Q

common food allergens in dogs and cats

A

beef
dairy

Particular attention: ingredients containing PROTEIN.
 Molecular weight 10 – 70 kD
 Stable to treatment with heat, acid, proteases

54
Q

common novel proteins

A

venison
duck
rabbit
peas
lentils
……….
getting harder as more availability

55
Q

what are hydrolyzed proteins? use in allergy treatmnet?

A

 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
Q

influence of allergen size on reaction

A

 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
Q

elimination challenge steps

A

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
Q

purpose of fibre-enhanced diets

A

soluble fiber - prebiotics

PREBIOTICS
- Non-digestible food ingredients
- Selectively stimulate limited # bacteria
- Improve host health

59
Q

possible positive effects of fibre enhanced diet

A
  • Modifying gastric emptying
  • Normalizing intestinal motility -
    Buffering toxins
  • Binding excess water
  • Maintaining normal GI flora
  • Buffering gastric acid
  • Altering viscosity – gel-like
60
Q

possible negative effects of fibre enhanced diet

A
  • Decrease DM digestibility
  • Affect mineral availability
  • Too high levels rapidly fermentable fibre: loose stool
  • Too high levels of insoluble fibre: constipation
61
Q

what happens to insoluble fibre after ingestion? what does it do for stool/food? application?

A

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
Q

what happens to soluble fibre upon digestion?

A

Small intestine: Escape enzymatic digestion
Large intestine: anaerobic bacteria > fermentation

63
Q

effects of soluble fibre in the diet, and application

A
  • 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
Q

why does cude fibre for a food not tell the whole story? better measure?

A

only looks at cellulose, hemicellulose, lignin
>there are more fibre sources

Total dietary fiber is better - also includes soluble fibres

65
Q

constipation diet reccomendation

A

-high water >75%
-crude fibre >7%
highly digestible

66
Q

can high fibre help with megacolon? what should we do?

A

 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
Q

Three different approaches for large bowel disease:

A
  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
Q

use for probiotics?

A

-in trial, reduced time to resolution of diarrhea

-but not really regulated….

3. HM Companion Module (11 decks)

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