Nutrition Flashcards
what are the 2 categories of dietary sensitivities?
non-immunologically mediated
immunologically mediated
what are the 2 sub categories of non-immunologically mediated dietary sensitivities?
repeatable
non repeatable
what are repeatable non-immunologically mediated dietary sensitivities?
those that happen on every exposure
what is an example of a non-immunologicaly mediated repeatable dietary sensitivity?
food intolerance e.g. lactose deficiency in adult cats
what are examples of a non-immunologicaly mediated non- repeatable dietary sensitivity?
dietary indiscretion
intoxication
contamination (poisoning)
what is an immunologicaly mediated dietary sensitivity?
food allergy (hypersensitivity)
can immunologicaly mediated dietary sensitivities be repeated?
yes
are immunologicaly mediated dietary sensitivities often proven?
no - owners will often stop investigations once pet improves
what is the definition of a food allergy?
immunologically mediated, adverse food reaction to a dietary component - usually a protein
what dietary component often leads to food allergy in animals?
proteins
why is it remarkable that more adverse food reactions do not occur?
the gut is always exposed to foreign antigens
what is in place within the body to reduce the likelihood of AFR?
defence mechanisms
what are some of the defence mechanisms found within the gut to prevent AFR?
gut is designed not to let large molecules through
large molecules are broken down into unrecognisable components by the time they reach the blood stream
peristalsis leads to constant movement of food
villi enhance food movement
what is oral tolerance?
body learns food is not harmful through complex sequence of signalling and processing events which result in tolerance of foreign antigens
what happens if there is a failure of oral tolerance?
leads to adverse food reaction
what type of hypersensitvity reaction do most AFRs manifest as?
type 4 - delyed hypersensitivity
when are signs of most AFRs seen?
days after the food is eaten
anaphylaxis is rare
where are clinical signs of AFR commonly seen?
dermatological
GI
what are the most common food allergens in dogs?
beef
dairy
wheat
what are the most common food allergens in cats?
beef
dairy
fish
what do the common food allergens of dogs and cats reflect?
common ingredients in commercial diets
what food intolerance is commonly seen in boarder terriers?
canine epileptoid cramping syndrome
in what animals is canine epileptoid cramping syndrome commonly seen?
boarder terriers
what AFR is seen in canine epileptoid cramping syndrome?
allergy to gluten
what are the cutaneous signs of food allergy?
pruitus
erythema
what is the most common food allergic reaction?
cutaneous
if a patient presents with dermatological issues is it likely to be food allergies?
no - much less common than atopy and flea allergy
are cutaneous food allergy signs seen with GI signs?
no - usually seen without
what are the GI signs of food allergy?
V
D
what are the 3 broad signs of food allergy?
cutaneous
GI
systemic
what are the systemic signs of food allergy?
anaphylaxis
what type of diarrhoea is seen with food allergy?
LI
colitis and blood seen within
what is the urge to defecate like with LI diarrhoea?
urgent
if GI signs of food allergy are seen what must be investigated?
all causes as GI signs are non-specific
at what age do pets tend to present with food allergy?
young
likelihood decreases with age but not impossible in an older pet
what must be done before allergy is investigated?
other causes of the clinical signs excluded as/when appropriate
what type of diarrhoea is seen with food allergy?
large intestinal pattern most common but any pattern possible
what are the 4 stages of diagnosis and management of food allergy?
exclusion/limitation
challenge and rescue
provocation and rescue
maintainance
what is involved in the exclusion/limitation stage of food allergy management?
all possible allergens excluded from diet
novel protein used
patient fed water and diet only
lasts several weeks
what will the patient be fed during the exclusion/limitation phase of food allergy diagnosis?
specific diet
may use novel protein
water and diet only
how long does the exclusion/limitation phase of food allergy diagnosis last?
several weeks
what is involved in the challenge and rescue phase of food allergy diagnosis?
patient is put back on their normal diet
if their symptoms reoccur then it proves the diet is an issue
what is involved in the provocation and rescue phase of food allergy diagnosis?
one food added in at a time to see if symptoms are triggered
what is the benefit of the provocation and rescue phase of food allergy diagnosis?
may enable animal to eat a wider range of foods
how long should pets be on an exclusion diet to see skin improvement?
10 weeks to marked improvement
how long should pets be on an exclusion diet to see GI improvement?
6 weeks to full resolution
should blood testing be used for GI manifestations of food allergies?
no- has no clinical utility
what are chronic inflammatory enteropathies?
group of diseases with chronic GI inflammation
what signs suggest chronic inflammatory enteropathies?
V
D
dysorexia
weight loss
any lasting more than 3 weeks
what must be done before chronic inflammatory enteropathies suspected?
all other causes of GI clinical signs of inflammation must be excluded first
what extra GI diseases can cause GI clinical signs?
exocrine pancreatic insufficiency
local abdominal inflammation (hepatic/renal)
metabolic diseases - PSS, hypoadrenocorticism, hyperthyroidism
how can other causes of GI signs be excluded before chronic inflammatory enteropathies suspected?
lab testing (faecal analysis, bloods)
abdominal US
how is CIE diagnosed?
if al other diagnostic tests are normal
what are the causes of chronic inflammatory enteropathies?
food responsive disease
antibiotic responsive disease
idiopathic disease
how can food responsive chronic inflammatory enteropathies be managed?
diet trial
how can antibiotic responsive chronic inflammatory enteropathies be managed?
metronidazole or other antibiotic used to manage patient
what patients is antibiotic responsive chronic inflammatory enteropathies considered in?
GSD
how is idiopathic chronic inflammatory enteropathies diagnosed?
endoscopy to diagnose / confirm and exclude other microscopic or structural disease
how is idiopathic chronic inflammatory enteropathy thought to occur?
patient identifies own gut as harmful causing inflammation and damage to villi which worsens inflammation
what were idiopathic chronic inflammatory enteropathies previously known as?
IBD
what causes idiopathic chronic inflammatory enteropathy?
loss of immune tolerance of mucosal flora
GI inflammation
shift in flora
leads to further inflammation
how is chronic inflammatory enteropathy diagnosed?
exclusion of other causes
biopsies indicative of inflammation and architectural changes
what architectural changes may be seen which indicate chronic inflammatory enteropathy?
villi atrophy
what are the 2 methods of obtaining intestinal biopsy?
laparotomy
endoscopy
what is the benefit of laparotomy for intestinal biopsy?
enables multiple full thickness biopsies
enables full exploration of other organs
what is the risk of laparotomy for intestinal biopsy?
risk of dehiscence ~10%
surgical risks e.g. peritonitis
what are the benefits of endoscopic intestinal biopsies?
minimally invasive
small biopsies
what are the disadvantages of endoscopic intestinal biopsies?
small biopsies
cannot reach jejunum so will not reflect disease here
what are the main complications and consequences of chronic inflammatory enteropathies?
dehydration
protein malabsorption
hypocobalaminaemia
GI haemorrhage
GI perforation (rare)
why can chronic inflammatory enteropathies lead to protein malabsorption?
gut inflammation prevents protein absorption
what is the result of protein malabsorption?
PLE
hypoalbuminaemia
what is the effect of hypoalbuminaemia?
reduction in oncotic pressure
fluid begins to leak from vessels
what signs can be seen with protein malabsorption?
effusions (pleural and peritoneal)
oedema
thromboembolic events
why are patients with protein malabsorption more at risk of thromboembolic events?
blood more viscose due to reduced fluid
what can be an effect of GI haemorrhage?
anaemia
what is hypocobalaminaemia?
low B12
what can be an effect of GI perforation?
septic peritonitis
what are the standard therapies for chronic inflammatory enteropathies?
maintain fluid balance
nutrition
anti-emetics
appetite stimulants
what must be stabilised in chronic inflammatory enteropathy patients before nutrition starts?
haemodynamically stable (hydration and volaemia)
what are the main supportive therapies for nutrition of patients with chronic inflammatory enteropathies?
exclusion diet
dietary modification
tube feeds if necesary
what may affect appetite in chronic inflammatory enteropathy patients?
low B12
when should a new diet be introduced?
once home to prevent aversion
what are the standard therapies for idiopathic chronic inflammatory enteropathies?
immunosuppression
what additional drugs may be given for idiopathic chronic inflammatory enteropathies?
fenbendazole
metronidazole
B12
anti-platelet drugs
what drugs can be used for immunosuppression of idiopathic chronic inflammatory enteropathies?
preds
what is the benefit of immunosuppression for treatment of chronic inflammatory enteropathies?
allows gut time to recover normal flora
what should animals be fed if on a dietary trial?
diet exclusively and water
will improvement be seen with dietary trials if the patient does not have food allergy?
possibly as if patient is being fed high quality, highly digestible diet they may improve
what are the main diet options for food intolerance or sensitivity trials?
novel protein / carbohydrate
hydrolysed protein
what are the main novel protein / carbohydrate diet options?
home cooked
commercial
what should you do if a client wishes to feed home cooked diet to their pet?
advise they seek a referral to a specialist nutritionist
what are the main novel protein / carbohydrate diets?
hills d/d
eukanuba Dermatosis FP
Dechra specific food allergen management (non HY)
what are the main hydrolysed protein diets?
purina HA
Hill’s z/d
Royal canin hypo/allergenic
dechra specific food allergen management (-HY)
what are the main nursing considerations for chronic inflammatory enteropathy patients?
hydration status
inappectance
nausea
nutrition or malnutrition status
abdominal discomfort
hypoproteinaemia
diarrhoea or faecal scauld