Nutritional Management Of GI Disease Flashcards
When would you consider nutritional intervention for an animal of:
- adequate nutritional status
- Mildly affected
Inadequate intake
How could you determine whether food intake is adequate or not?
Quantify how much the animal is eating in terms of grams and calories
When would you consider nutritional intervention for an animal:
- malnourished
- seriously ill
- Haemodynamically stable
Adequate intake
-Monitor closely and consider preemptive nutritional measures
Inadequate intake
- Implement nutritional intervention
- choose route of nutrition - enteral or parenteral
What do you need to do before considering nutritional intervention?
Stabilise patient - address hypovolaemia etc
What are the broad categories of nutritional amenable conditions?
GI disorders
Hepatobiliary disorders
Pancreatic disorders
What GI disorders are nutritional amenable?
Acute V+D Chronic diarrhoea GI motility disorders IBD Fibre responsive disorders
What hepatobiliary disorders are nutritional amenable?
Chronic hepatic disease
Feline hepatic lipidosis
Portosystemic shunts
What pancreatic disorders are nutritional amenable?
Acute and chronic pancreatitis
Why is it important to send hospitalised animals home if they are stable?
Animals don’t like to eat in hospitals
May effect nutritional status
What are the goals of nutritional support for hospitalised patients?
Address malnutrition
Prevent malnutrition
How can you categorise patients by nutritional status?
Debilitated
Not debilitated but high risk for malnutrition
Not debilitated and low risk for malnutrition
What are some indicators of very poor body condition?
Thin coat
Bone visible - FEMUR = muscle loss (+scapula and pelvis)
What patients are particularly at risk of hypoglycaemia ?
Neonates - can drop significantly if starved for around 24h
How could you approach finding the ‘optimal’ diet?
DON’T rely on pet food marketing
treat patient as an individual - 2 animals with same disease can be effected differently
Use both clinical and lab information
Offer choices to client if possible
What advice should you give to a client if an animal doesn’t immediately accept a new diet?
Persevere - doesn’t mean it will never be accepted
What should your approach be if an animal is off its food?
What shouldn’t you do?
ADDRESS UNDERLYING CAUSE
Enticing with ‘nice’ food is not a solution
What diet is suggested for chronic vomiting or diarrhoea?
Low fat, easily digestible
Why are low fat diets recommended for patients with chronic vomiting /diarrhoea?
Fat not digested and absorbed properly due to pathology
If fat reaches large intestine — DIARRHOEA
What diet history factors should you ascertain for a patient with V+D?
Was there dietary indiscretion? Does it eat pet food? Table scraps? Treats? Supplements?
Why would you NOT suggest giving baby food to patients with V+D
High Na
Nutritionally unbalanced
Garlic, onion toxic to cats and dogs
Why are onions bad for cats?
Vulnerable to oxidative damage
Onion makes RBCs burst - blood transfusions
What are the risked involved in feeding cooked meat and rice to patients with V+D
Unbalanced - okay for short term
Picky pets may refuse commercial pet foods
-If started young can lead to orthopaedic problems
If vomiting is persistent, what nutritional intervention may be required?
Parenteral nutrition (uncommon in general practice)
May also use antiemetic (e.g. meropitant) and/or pro kinetic (e.g. metaclopramide)
When is diarrhoea considered chronic?
10 days or longer
What diseases with nutritional implications can cause chronic diarrhoea?
IBD
Exocrine pancreatic insufficiency
PLE
Colitis
What are the potential nutrients of concern in a patient with chronic diarrhoea?
Energy
Fat - need to reduce
Increase digestibility
Protein - if food allergy
Other micronutrients
What are the three nutritional approaches to IBD?
Low fibre, easily digestible
High fibre (large bowel) - in/soluble + high/low fermentability
Food allergy - novel ingredient or hypoallergenic
What is the best source of information about fibre content of food?
Dietary fibre - found in product guide
What us the effect if soluble fibre on:
- the stomach
- the SI
- the LI
Stomach - slows emptying
SI - slows transit time, decreases absorption
LI - increases fecal bulk by increasing bacteria
- Fermentation to short chain fatty acids
What us the effect if insoluble fibre on:
- the stomach
- the SI
- the LI
Stomach - no effect
SI - speeds transit time
- decreases nutrient absorption
LI - increases decal bulk (increases water content) - good for constipation
How can fermentable fibre be beneficial to enterocytes?
Fermented to short chain fatty acids
Cells at the tops of villi are dependent on SCFAs for energy
What are the effects of SCFAs in the small intestines?
Slow transit time Decrease nutrient absorption Decrease inflammation Increase energy production Increase GI hormone release Increase sodium and water absorption
What information may make you suspect a dietary hypersensitivity/ allergy?
Thorough diet history
Information gathered via questionnaire BEFORE consult
How could you nutritionally approach a dietary hypersensitivity or allergy?
What results might you anticipate?
8 week trial diet
Novel ingredient or hypoallergenic
GI disease - improvement within 10 days
Dermatological - 6 weeks to start seeing improvement - may need longer than 8 weeks
How could you prove a food allergy?
Rechallenge the animal with the original diet
- if goes back to same clinical signs as before - ALLERGY
What is the logic behind hypoallergenic feed?
Hydrolysed proteins -
Make it less antigenic and supposedly less likely to trigger an immune response
When might nutritional intervention be required after GI surgery?
If large resection - only small amount of intestine left
What simple GI surgeries would not require drastic nutritional intervention?
How would you manage them?
Foreign body
Simple resection/anastomosis
GDV w/o resection
Don’t withhold food post-op if not vomiting
Low fat easily digestible
What dietary factors can contribute to pancreatitis?
High fat diet
How could you manage pancreatitis nutritionally?
Can be managed enterally if vomiting minimal
Severe pancreatitis - feeding tubes
Intractable vomiting - parenteral nutrition
Should aim to transition back onto enteral feeding ASAP
When would you consider using pancreazyme food?
Exocrine pancreatic insufficiency
NOT pancreatitis
What long term dietary management would you recommend for a patient with a lipid disorder?
Long term low fat diet
