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BVM3 Alimentary > Nutritional Management of GI Disease > Flashcards

Nutritional Management of GI Disease Flashcards

1
Q

List GI disorders which can cause nutritional imbalance?

A

Acute V/D
Chronic Diarrhea
GI motility disorders
Adverse reaction to food
IBD
Fiber responsive disorders

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2
Q

List Hepatobiliary disorders which can cause nutritional imbalance?

A

Chronic hepatic disease
Feline hepatic lipidosis
Portosystemic shunts
Copper hepatopathy

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3
Q

List pancreatic disorders which can cause nutritional imbalance?

A

Acute pancreatitis
Chronic pancreatitis
Exocrine pancreatic insufficiency

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4
Q

What is critical to ask about the history when assessing a patient with acute vomiting and diarrhea? How common is this presentation?

A

Very common presentation, many DDx
Dietary history critical
- Dietary indiscretion, Table foods, garbage digger
- Hunting, Raw food, supplements

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5
Q

Define “minimal luminal nutrition” and why this is an important concept in acute vomiting/diarrhea?

A

Small bowel atrophy begins within days of absence of luminal stimulation
Food in lumen stimulates integrity and function, so it needs minimal input to function normally

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6
Q

Should you increase an animal to full RER if they haven’t been appropriately eating due to vomiting?

A

No - monitor before increasing to full RER
Gradual increase important

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7
Q

What are the 3 ideal dietary characteristics for management of a patient with vomiting/diarrhea

A

Low fat
Dietary fiber
Highly digestible

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8
Q

What does the dietary fiber component of V/D management diet do for the patient? What does it add to the diet?

A
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9
Q

What % digestibility is ideal for V/D therapeutic diets? What does this do for the GIT?

A

> 80-85% digestibility
Less work/bulk in GIT

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10
Q

What does the low fat component of V/D management diet do for the patient? What does it help with?

A
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11
Q

What is the first objective in treating a patient with acute vomiting/diarrhea?

A

Correct dehydration and electrolyte, glucose and acid-base imbalances if present

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12
Q

List some medications used for treatment of patients with acute vomiting/diarrhea

A

Gastroprotectants
Antiemetics
Analgesia
Prokinetics
Anthelmintics
Etc.

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13
Q

What are the dietary goals in treating patients with acute vomiting and diarrhea?

A

Provide a food that meets the patient’s nutrient requirements
Allows normalization of intestinal motility and function

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14
Q

What are the short-term dietary options for patients with acute vomiting/diarrhea?

A

Home prepared
NE Tube feeding (continuous feeding)

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15
Q

In what situation would continuous NE tube feedings be ideal for a patient? (hint - virus that commonly affects puppies)

A

Parvoviral enteritis - need constant nutrition due to damage of intestinal mucosa

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16
Q

Give some options for home cooked bland diets appropriate for veterinary patients?

A

Cottage cheese and cooked white rice
Boiled boneless/skinless chicken breast and cooked white rice
Canned tuna (ONLY TUNA) and cooked white rice

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17
Q

What are the 3 long term dietary options appropriate for acute vomiting/diarrhea?

A
  1. Commercial OTC diet
  2. Commercial therapeutic GI diet (Ex. bland)
  3. Complete and balanced home-cooked diet
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18
Q

What is the prognosis for patients with acute vomiting and diarrhea?

A

Majority do well (very good prognosis)
Some may continue to have chronic bouts of GI signs - further diagnostic work up and dietary management as indicated

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19
Q

Which of these is an ideal characteristic for feeding of acute vomiting and diarrhea?
- Low protein
- Low fat
- High sodium
- Increased caloric density

A

Low Fat

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20
Q

What are the 3 common causes of adverse food reaction?

A

Toxic
Dietary intolerance
Dietary hypersensitivity

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21
Q

What are the differentials for a patient with non-toxic cause of adverse food reaction?

A

Immune mediated
- Innate immune response
- Adaptive immune response (IgE, Non-IgE, or mixed)
Non-immune mediated
- Enzymatic (Ex. lactose intolerance)
Pharmacologic (Ex. vasoactive amines)

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22
Q

What is a top differentials for a patient with toxic adverse reaction to food?

A

Aflatoxin

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23
Q

Is allergy testing for allergen-specific serum IgE of any diagnostic value for patients with adverse reaction to food? What is the current gold standard for diagnosis of food allergy/hypersensitivity?

A
24
Q

What are the 3 diet options for food trial?

A
25
Q
A

B

26
Q

What tests can you use to rue out secondary causes of chronic GI signs?

A

CBC/Chem/UA
Baseline cortisol/ACTH stim test/T4
Fecal analysis
Pancreatic tsting (TLI/PLI)
Abdominal imaging

27
Q

What are the dietary options available for treating chronic inflammatory enteropathy?

A
28
Q

Define chronic inflammatory enteropathy

A

Chronic enteropathy (CE) is a term used for gastro-intestinal diseases present for a duration of 3 weeks or longer, when extra-intestinal diseases or intestinal disease such as parasitic disease or neoplastic disease are ruled out.

29
Q

What are the pros/cons of commercial therapeutic GI diet?

A
30
Q

What are the pros/cons of commercial therapeutic limited-ingredient novel protein diet?

A
31
Q

What are the pros and cons of commercial therapeutic hydrolyzed diet?

A
32
Q

What are the pros and cons of limited ingredient novel protein/complete and balanced home cooked diet?

A
33
Q

What is food responsive enteropathy?

A

Chronic enteropathy that responds to a change in diet

34
Q

What proportion of dogs and cats with CE are food-responsive?

A

2/3

35
Q

How quickly do the majority of patients with food responsive CE respond to new diet change?

A

Majority respond within 2 weeks of change to new diet

36
Q

The presence of which one of the following would make you consider collection of GI biopsies over an empirical diet trial for a dog with 4 weeks of intermittent mixed bowel diarrhea:
- Concurrent pruritis
- Low vitamin B12 (folate)
- BCS 4/9
- Increased serum albumin

A

BCS 4/9

37
Q

Define “acute pancreatitis”?

A

Sudden onset inflammation of the pancreas caused by activation of digestive enzymes within the pancreas - auto-digestion

38
Q

What are the nutritional risk factors which can lead to acute pancreatitis?

A

Obesity
Ingestion of table scraps or food from the bin
High fat meal
High fat, low protein diet

39
Q

What are the clinical signs associated with acute pancreatitis?

A

Sudden onset lethargy
Depression
Anorexia
Vomiting and/or diarrhea
Dehydration
Severe abdominal discomfort

40
Q

What is the most common age/presentation of a patient with acute pancreatitis?

A

Middle-aged, neutered
Overweight/obese - higher prevalence

41
Q

What is the most common cause for cats with pancreatitis?

A

Idiopathic
>90% cats with pancreatitis, cause not identified

42
Q

Are there any common dietary risk factors for cats which can induce pancreatitis?

A

Not really - dietary risk factors not well described in cats
Some clinicians have reported pancreatitis occurring in some cats fed high fat diets

43
Q

What is the main dietary change recommended for treatment of dogs with acute pancreatitis?

A

Recommend 50% less fat than currently eating if suspect dietary induced

44
Q

How should you adjust RER for a canine patient with acute pancreatitis? How gradually should you increase the diet to full RER?

A

Start with 10-25% RER and gradually increase to 100% over 4-5 days

45
Q

What should you do for an overweight/obese patient who is experiencing acute pancreatitis?

A

Start weight loss plan

46
Q

How should you adjust frequency of feeding for a patient with acute pancreatitis?

A

Small amounts, more frequently

47
Q

How does treatment of cats with acute pancreatitis compare with treatment of dogs?

A

Dietary management for cats with acute pancreatitis not well described
Many clinicians find that cats tolerate higher fat diet than dogs with pancreatitis, but general rule is to avoid higher fat foods

48
Q

What should you try to do early on for anorectic cats experiencing acute pancreatitis? Why?

A

Early placement of nasogastric or esophageal feeding tube is important in anorectic cats due to their high risk of hepatic lipidosis (liberating fats too quickly to make up for lack of dietary intake, too much pressure on liver)

49
Q

What is triaditis in cats and how does this occur?

A

Cholangitis + Pancreatitis + IBD

50
Q

What are the clinical signs associated with triaditis?

A

The main symptom of triaditis in cats is vomiting. Other clinical symptoms of triaditis in cats may include weight loss, dehydration, anorexia, lethargy, diarrhea, abdominal pain and distention, jaundice, and fever.

51
Q

What vitamin are many cats with pancreatitis deficient in? What should you do to correct this?

A

B12 - add supplement

52
Q

What is the nutritional recommendation for cats with triaditis?

A

Hydrolyzed diet - Purina HA

53
Q

How do the protein requirements of a dog with liver disease differ from a normal dog? What should you assess to determine adequate protein intake?

A

Protein requirements may be higher than adult maintenance
Assess BCS/MCS

54
Q

What condition do patients with liver disease run the risk of developing? How can this be minimized through diet?

A

Hepatic Encephalopathy
Feed lower protein content diet (indicated for patients with liver disease and HE) - commercial therapeutic liver diets available

55
Q

What is a portosystemic shunt and how can this lead to hepatic encephalopathy?

A

Abnormal vessel bw portal vasculature and systemic circulation
Blood from intestines delivered straight into circulation without liver detoxification
Toxins in bloodstream = HE

56
Q

What are the types of portosystemic shunts?

A

Congenial vs. acquired
Intrahepatic vs. extrahepatic

57
Q

How do the following therapies for portosystemic shunts work to prevent HE?

A

Feed commercial therapeutic liver diet (Purina HA, home-cooked diet, etc.) - lower protein reduces ammonia in system
Lactulose - Lactulose acts by acidifying intestinal content thus reduces absorption of ammonia, decreases transit time, and reduces colonic bacterial population
Antibiotics - bacterial toxin reduction

BVM3 Alimentary (24 decks)

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