Management of SA oesophageal and gastric SA disease Flashcards
Which gastric and oesophageal diseases need surgery? (5)
- Foreign bodies that can’t be removed endoscopically or where this is not feasible?
- Gdv!
- Hiatal hernia
- Vascular ring anomaly?
- Pyloric outflow tract obstruction?
When would you not investigate gastric and oesophageal disease? (3)
- Acute cases?
- Possibility/likelihood of self limiting disease
- Patient is generally well (albeit with a problem)
What general supportive care can we give to a GI patient?
- Oral fluids – small volumes frequently
- S/c fluids for mild dehydration
- Starve 24h/small volume liquid diets
- Introduce bland, highly digestible diet e.g. fish and rice
- Small, frequent meals
- Low fat, high quality protein à promotes stomach emptying
- Gradual transition back to normal
- Small, frequent meals
- Consider use of anti emetics +/- gastroprotectants (??)
- Remember time is a healer: “tincture of time”
- Always suggest: call or revisit if not VMB in 24 hours (very much better)
Why is nutrition so important to the gut? (3)
- Supports mesenteric perfusion (which includes the pancreas)
- Provides trophic factors to repair and maintain the intestinal mucosa
- Helps normalise intestinal motility
How long does it take for a cat to suffer metabolic consequences from anorexia?
3-4 days
What is cachexia?
- metabolic derangement not “just” severe wt loss
- reduced energy intake
- increased requirements
- pro inflammatory state
Name a formula to calculate nutriotional requirements (there are 2)
- 70 x bodyweight in kg0.75
- RER= (30 x current body weight in kg) + 70
What do we need to consider when choosing an appropriate diet?
- Digestibility?
- Special requirements?
- Low fat diet for pancreatitis dogs?
- Single source or hydrolysed protein diet for suspected food intolerance cases? Or even a specific exclusion diet for an IBD patient down a tube
- Balanced diet for young cats with nutritional hyperparathyroidism?
- Is the diet practical?
What is a oesophageal feeding tube good for? What do we need to use?
- Head trauma
- Need a GA and not good for oesophageal disease
Name 3 nutrional support techniques
- Tempt feeding
- Hand feeding
- Syringe feeding
What are the risks of providing nutritional support?
- Food aversion with the more you try to force feed a cat
- Aspiration
- Further weight loss
- False sense of security
Name a appetite stimulant
Mirtazapine
What dose is used for mirtazepine and why?
Lower dose the better - in case the animal has kidney or liver disease and the drug will be excreted by either of these methods.
Mirtazapine:
A) What role does it have?
B) Is it licensed?
A) Palliative
B) No
What skill is needed for placing feeding tubes?
little
Which feeding tube is a GA not needed?
Naso-oesophageal
Whic tube can be in place for weeks to months?
Gastrotomy
What things do we need to consider when choosing a feeding tube?
- Is it “safe” to GA or sedate?
- How long might we need the tube for?
- What type of diet needs to be fed?
- Will this affect my patient’s lifestyle?
- The animal should not go out
- They can eat with this tube in
Where should you secure naso-oesophageal tube? Why?
Secure at the top of the head as this is less irritating
What is the lomitation of a naso-oesophageal tube?
Size of the tube and there will be some irritation at the external nares
Discuss the issues of a PEG tube
Percutaenous endoscopic gastrotomy (PEG) tubes require some endoscopy skills and carry more risks for the patient than an O tube
Strap them in – prevent them getting caught
Coming from stomach to the flank
Should be in place for 7-10 days. When you pull the oesophageal tube out (likelihood oesophagus wont leak in cervical region) but I this tube comes out there is a stomach with a hole floating around in the abdomen with fluid and acid which will lead to peritonitis. Keep minimum 7-10days heals and creates a stoma so you get a blowhole from stomach out abdomen wall. Heal over gradual. Wont leak into the abdo cavity which is the key thing
More catatrophic if this comes out than a cat pulling at an oesophageal tube
What is there a risk of when positional feeding?
Aspration pneumonia
How should vertical feeding be done?
Want head above stomach
But need head vertical above stomach if we can
Bailey chairs can be helpful but often hand feeding a dog sitting down
Feeding them up a stairway may help
Why the type of food used might be important in our GI cases?
- Hills
- Royal canin (waltham)
- Eukanuba
- Purina
Define adverse food reaction
Any clinically abnormal response attributed to the ingestion of a food or food additive. Adverse food reactions are categorized as either food allergy or food intolerance reactions.
Define food allergy
•immunologically mediated adverse reaction to food unrelated to any physiological effect of the food or food additive.
Define food intolerance
Any abnormal physiologic response to a food that is not believed to be immunologic in nature and may include food poisoning, food idiosyncrasy, pharmacologic reaction, or metabolic reaction.
How reliable are serum IgE tests for GI disease?
unreliable
What is the useful way to assess food allergy/intolerance?
Lol i fooled ya…
there isn’t a useful way
What do we select a GI disease diet based on (2)?
- Previous diet history
- Careful application of trial and error
When would we use an exclusion diet in GI disease? (2)
- Appropriate clinical signs
- Underlying disease ruled out
What protein do we feed in an exclusion diet?
- Single source?
- Novel?
- Hydrolysed
What considerations do we need to have when using an exclusion diet? (5)
- Home cooked or commercial?
- No other feed can be given
- How long do we use the diet for? 2-8 weeks min
- Should we try a different diet if the first one doesn’t work?
- If there is clinical improvement what happens next?
What are we hoping for when using an exclusion diet?
a maintained trend of improvement
reduced frequency and severity of clinical signs
When should we investigate a GI disease (3)
- suspect problem is not self limiting
- patient deteriorating
- demanding owners?
What 3 things do we check when reviewing a case?
- history
- physical examination
- owners hopes and expectations
What 3 things does fluid therapy correct?
- fluid deficits
- electrolyte imbalances
- restores acid-base balance
What do we have to do prior to surgery even if an emergency?
Stabilise the patient
What 3 electrolyte abnormalities may manifest in GI obstruction?
- hypochloraemia
- hypokalaemia
- hyponatraemia
