Midterm 1 Part 4

Question 1

what are the three primary components of a nutritional assessment?

Answer 1

• the food and food related factors
• the animal and animal related factors
• the owner and feeding management

Question 2

the first step in doing a nutritonal assessment is to obtain a history of diet. Describe how you would do this

Answer 2

define the current diet by asking what brand, flavor, form, and quantity consumed (how many cups or how long does a bag last), define what “normal” is for the animal, if the owner feeds the animal something different when sick (like chicken and rice), make sure to ask about treats and supplements or medications

Question 3

why is the signalment of the animal important to consider whe getting a history for a nutritional assessment?

Answer 3

the age, breed, and sex helps determine:
- physiologic status which may alter the nutritional environments
- breed related issues (certain breeds predisposed to certain nutritional diseases or hypersensitivites, etc)

Question 4

the second step in a nutritional assessment is exploring changes in the environment or activity of the animal. What kind of things would you want to ask the owner?

Answer 4

if the animal lives in environmental extremes like very hot or very cold, if they are primarily indoor or outdoor and how much physical activity they get each day, if they have free range over property or if they are all indoors and never are allowed outside, etc

Question 5

the third step in a nutritional assessment is to ask about dietary sensitivites or aversions. Descirbe what you would ask the owner

Answer 5

ask them to be as specific and presice as possible: identify what was eaten, the exact circumstances in which the feed was eaten, what exactly happens, and the frequency and occurrance of the events. owners may assume things! be careful

Question 6

thw owner management is imporant in gathering a nutritional assessment history. What kind of questions would you ask them?

Answer 6

meal vs ad lib feeding, how is food prepared, who feeds, location of feed bowls, other pets in the house, additional feed sources (think outdoor cats or dogs hunting or eating mice, etc)

Question 7

why is it important to use the same scale every time an animal is weighed

Answer 7

scales can differ and if you’re using multiple scales the weights may be scewed and may give you false information about weight gain or weight loss

Question 8

what are important things to consider in a physical exam as a part of your nutritional assessment?

Answer 8

• you need to assess all body systems!
• obesity is the most common form of malnutrition
• protein energy malnutrition will be associated with illness
• specific deficiencies are unusual

Question 9

what are the clinical signs of protein energy malnutrition?

Answer 9

it is usually associated with critical illness and clinical signs will ve vauge and non specific: weight loss, muscle wasting, pallor, chronic infections, poor hair coat

Question 10

specific nutritional deficencies are not common, but what are 3 that are worthy of note?

Answer 10

taurine in cats (DCM and central retinal degernation)
vitamin K (coagulopathy)
thiamine/vitamin B (neurologic signs)

Question 11

what blood changes might you see in a patient with protein energy malnutrition?

Answer 11

anemia and lympohpenia

Question 12

give examples of some specific deficinecies thatcan cause anemia

Answer 12

iron
copper
folate
vitamin B12

Question 13

what are some common biochemical changes in patients with obesity?

Answer 13

hyperglycemia and glucose intolerance
hyperlipidemia

Question 14

what are some biochemical changes seen in patients with protein energy malnutrition?

Answer 14

creatinine (proportional to muscle mass), albumin, blood urea nitrogen (related to protein being consumed)
**if you have a patient with low creatinine is can indicate muscle wasting
**if the creatinine and blood urea nitrogen are normalit doesn’t mean they don’t have PEM; dehydration can cause these values to go back up after they potnetially decrease due to PEM

Question 15

nutritional assessment includes evaluation of the response to diet. what kinds of things would you want to know?

Answer 15

palatability of the diet, signs of dietary intolerance, reassessing body weight and body condition score, if an animal is sick follow up that sickness

Question 16

is malnutrition common in the companion animal world?

Answer 16

in healthy animals usually no, obesity is the most common form
in sick patients there can be nutrient deficinecies

Question 17

what is protein energy malnutrition?

Answer 17

deficinecies of protein and calories, very common in hospitalized patients

Question 18

what are some of the documented detrimental effects of protein energy malnutrition?

Answer 18

anemia and hypoproteinemia
delayed wound healing
Gi, resp, cardio compromise
death

Question 19

true or false: healthy dogs are well adapted to survive food deprivation

Answer 19

true

Question 20

what are the two primary groups of adaptations to starvation?

Answer 20

acute: maintain blood glucose concentrations in a narrow range using hepatic glycogen and amino acids
long term: fat derived fuels used to preserve lean body mass

Question 21

lean body mass =

Answer 21

FUNCTION

Question 22

why does protein energy malnutrition happen in diseased individuals?

Answer 22

disease compromises the normal adaptations to starvation and the switch to dat-derived fuels is blocked, so the body ends up eating away at lean body mass

Question 23

with protein energy malnutrition, there is a relative increase in ______

Answer 23

metabolic rate

Question 24

explain how hormones differ in protein energy malnutrition causing the body to prefer glucose for energy utlization over fats

Answer 24

epinepherine, cortisol, glucagon, insulin all affect the changes in utilization over glucose over fats

Question 25

why is there such a high demand for protein and energy in illness?

Answer 25

you need amino acids (from protein) for synthesizing imporant proteins like acute phase proteins, white blood cells, antibodies, clotting factors, and for wound healing, AND gluconeogenesis

Question 26

who is more predisposed to protein-energy malnutrition, dogs or cats? why?

Answer 26

cats
cats have a high basal protein requirements (continuous gluconeogenesis, continuous hepatic transaminase, urea cycle activity, cats cannot turn these processes off!)

Question 27

true or false: you should maintain a high index of suscpicion for protein energy malnutrition

Answer 27

true!

Question 28

what two things predispose an animal to develping protein energy malnutrition?

Answer 28

if the patient is critically ill (sugery, infection, cancer, thermal burns) and if there is decreased food intake (specifcally inadequate to meet energy and protein needs)

Question 29

true or false: if a patient has protein energy malnutrition, it will be noticable on body weight and body condition scoring

Answer 29

false! the animal may appear completely normal in terms of weight or BCS but malnutrition could still be present

Question 30

true or false: signs of protein energy malnutrition are specific and make it easy to diagnose

Answer 30

false! all the signs are non specific: muscle wasting, pallor, poor coat quality, hepato/splenomegaly, chronic infection, peripheral edema, lymphadenopathy, etc

Question 31

what are the problems with doing bloodwork to detect protein energy malnutrition?

Answer 31

complete blood counts and chemistry panels are VERY insensitive but you might see lymphopenia or anemia

Question 32

in a patient with protein energy malnutrition, what findings might you see specifically on a serum biochemistry panel?

Answer 32

decreased creatinine (muscle wasting), hypoalbuminemia (BUT albumin has a long half life so the albumin could appear normal even if an animal does have hypoproteinemia. you could use a protein with a shorter half life like insulin growth factor IGF-1 or transferrin