Management of SA oesophageal and gastric SA disease

Question 1

Which gastric and oesophageal diseases need surgery? (5)

Answer 1

• Foreign bodies that can’t be removed endoscopically or where this is not feasible?
• Gdv!
• Hiatal hernia
• Vascular ring anomaly?
• Pyloric outflow tract obstruction?

Question 2

When would you not investigate gastric and oesophageal disease? (3)

Answer 2

• Acute cases?
• Possibility/likelihood of self limiting disease
• Patient is generally well (albeit with a problem)

Question 3

What general supportive care can we give to a GI patient?

Answer 3

• 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
• 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)

Question 4

Why is nutrition so important to the gut? (3)

Answer 4

• Supports mesenteric perfusion (which includes the pancreas)
• Provides trophic factors to repair and maintain the intestinal mucosa
• Helps normalise intestinal motility

Question 5

How long does it take for a cat to suffer metabolic consequences from anorexia?

Answer 5

3-4 days

Question 6

What is cachexia?

Answer 6

• metabolic derangement not “just” severe wt loss
• reduced energy intake
• increased requirements
• pro inflammatory state

Question 7

Name a formula to calculate nutriotional requirements (there are 2)

Answer 7

• 70 x bodyweight in kg0.75
• RER= (30 x current body weight in kg) + 70

Question 8

What do we need to consider when choosing an appropriate diet?

Answer 8

• 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?

Question 9

What is a oesophageal feeding tube good for? What do we need to use?

Answer 9

• Head trauma
• Need a GA and not good for oesophageal disease

Question 10

Name 3 nutrional support techniques

Answer 10

• Tempt feeding
• Hand feeding
• Syringe feeding

Question 11

What are the risks of providing nutritional support?

Answer 11

• Food aversion with the more you try to force feed a cat
• Aspiration
• Further weight loss
• False sense of security

Question 12

Name a appetite stimulant

Answer 12

Mirtazapine

Question 13

What dose is used for mirtazepine and why?

Answer 13

Lower dose the better - in case the animal has kidney or liver disease and the drug will be excreted by either of these methods.

Question 14

Mirtazapine:

A) What role does it have?

B) Is it licensed?

Answer 14

A) Palliative

B) No

Question 15

What skill is needed for placing feeding tubes?

Answer 15

little

Question 16

Which feeding tube is a GA not needed?

Answer 16

Naso-oesophageal

Question 17

Whic tube can be in place for weeks to months?

Answer 17

Gastrotomy

Question 18

What things do we need to consider when choosing a feeding tube?

Answer 18

• 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

Question 19

Where should you secure naso-oesophageal tube? Why?

Answer 19

Secure at the top of the head as this is less irritating

Question 20

What is the lomitation of a naso-oesophageal tube?

Answer 20

Size of the tube and there will be some irritation at the external nares

Question 21

Discuss the issues of a PEG tube

Answer 21

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

Question 22

What is there a risk of when positional feeding?

Answer 22

Aspration pneumonia

Question 23

How should vertical feeding be done?

Answer 23

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

Question 24

Why the type of food used might be important in our GI cases?

Answer 24

• Hills
• Royal canin (waltham)
• Eukanuba
• Purina

Question 25

Define adverse food reaction

Answer 25

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.

Question 26

Define food allergy

Answer 26

•immunologically mediated adverse reaction to food unrelated to any physiological effect of the food or food additive.

Question 27

Define food intolerance

Answer 27

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.

Question 28

How reliable are serum IgE tests for GI disease?

Answer 28

unreliable

Question 29

What is the useful way to assess food allergy/intolerance?

Answer 29

Lol i fooled ya…

there isn’t a useful way

Question 30

What do we select a GI disease diet based on (2)?

Answer 30

• Previous diet history
• Careful application of trial and error

Question 31

When would we use an exclusion diet in GI disease? (2)

Answer 31

• Appropriate clinical signs
• Underlying disease ruled out

Question 32

What protein do we feed in an exclusion diet?

Answer 32

• Single source?
• Novel?
• Hydrolysed

Question 33

What considerations do we need to have when using an exclusion diet? (5)

Answer 33

• 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?

Question 34

What are we hoping for when using an exclusion diet?

Answer 34

a maintained trend of improvement

reduced frequency and severity of clinical signs

Question 35

When should we investigate a GI disease (3)

Answer 35

• suspect problem is not self limiting
• patient deteriorating
• demanding owners?

Question 36

What 3 things do we check when reviewing a case?

Answer 36

• history
• physical examination
• owners hopes and expectations

Question 37

What 3 things does fluid therapy correct?

Answer 37

• fluid deficits
• electrolyte imbalances
• restores acid-base balance

Question 38

What do we have to do prior to surgery even if an emergency?

Answer 38

Stabilise the patient

Question 39

What 3 electrolyte abnormalities may manifest in GI obstruction?

Answer 39

• hypochloraemia
• hypokalaemia
• hyponatraemia