Nutritional Management Of GI Disease

Question 1

When would you consider nutritional intervention for an animal of:

• adequate nutritional status
• Mildly affected

Answer 1

Inadequate intake

Question 2

How could you determine whether food intake is adequate or not?

Answer 2

Quantify how much the animal is eating in terms of grams and calories

Question 3

When would you consider nutritional intervention for an animal:

• malnourished
• seriously ill
• Haemodynamically stable

Answer 3

Adequate intake
-Monitor closely and consider preemptive nutritional measures

Inadequate intake

• Implement nutritional intervention
• choose route of nutrition - enteral or parenteral

Question 4

What do you need to do before considering nutritional intervention?

Answer 4

Stabilise patient - address hypovolaemia etc

Question 5

What are the broad categories of nutritional amenable conditions?

Answer 5

GI disorders

Hepatobiliary disorders

Pancreatic disorders

Question 6

What GI disorders are nutritional amenable?

Answer 6

Acute V+D
Chronic diarrhoea 
GI motility disorders
IBD
Fibre responsive disorders

Question 7

What hepatobiliary disorders are nutritional amenable?

Answer 7

Chronic hepatic disease

Feline hepatic lipidosis

Portosystemic shunts

Question 8

What pancreatic disorders are nutritional amenable?

Answer 8

Acute and chronic pancreatitis

Question 9

Why is it important to send hospitalised animals home if they are stable?

Answer 9

Animals don’t like to eat in hospitals

May effect nutritional status

Question 10

What are the goals of nutritional support for hospitalised patients?

Answer 10

Address malnutrition

Prevent malnutrition

Question 11

How can you categorise patients by nutritional status?

Answer 11

Debilitated

Not debilitated but high risk for malnutrition

Not debilitated and low risk for malnutrition

Question 12

What are some indicators of very poor body condition?

Answer 12

Thin coat

Bone visible - FEMUR = muscle loss (+scapula and pelvis)

Question 13

What patients are particularly at risk of hypoglycaemia ?

Answer 13

Neonates - can drop significantly if starved for around 24h

Question 14

How could you approach finding the ‘optimal’ diet?

Answer 14

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

Question 15

What advice should you give to a client if an animal doesn’t immediately accept a new diet?

Answer 15

Persevere - doesn’t mean it will never be accepted

Question 16

What should your approach be if an animal is off its food?

What shouldn’t you do?

Answer 16

ADDRESS UNDERLYING CAUSE

Enticing with ‘nice’ food is not a solution

Question 17

What diet is suggested for chronic vomiting or diarrhoea?

Answer 17

Low fat, easily digestible

Question 18

Why are low fat diets recommended for patients with chronic vomiting /diarrhoea?

Answer 18

Fat not digested and absorbed properly due to pathology

If fat reaches large intestine — DIARRHOEA

Question 19

What diet history factors should you ascertain for a patient with V+D?

Answer 19

Was there dietary indiscretion?
Does it eat pet food?
Table scraps?
Treats?
Supplements?

Question 20

Why would you NOT suggest giving baby food to patients with V+D

Answer 20

High Na
Nutritionally unbalanced
Garlic, onion toxic to cats and dogs

Question 21

Why are onions bad for cats?

Answer 21

Vulnerable to oxidative damage

Onion makes RBCs burst - blood transfusions

Question 22

What are the risked involved in feeding cooked meat and rice to patients with V+D

Answer 22

Unbalanced - okay for short term

Picky pets may refuse commercial pet foods
-If started young can lead to orthopaedic problems

Question 23

If vomiting is persistent, what nutritional intervention may be required?

Answer 23

Parenteral nutrition (uncommon in general practice)

May also use antiemetic (e.g. meropitant) and/or pro kinetic (e.g. metaclopramide)

Question 24

When is diarrhoea considered chronic?

Answer 24

10 days or longer

Question 25

What diseases with nutritional implications can cause chronic diarrhoea?

Answer 25

IBD Exocrine pancreatic insufficiency PLE Colitis

Question 26

What are the potential nutrients of concern in a patient with chronic diarrhoea?

Answer 26

Energy Fat - need to reduce Increase digestibility Protein - if food allergy Other micronutrients

Question 27

What are the three nutritional approaches to IBD?

Answer 27

Low fibre, easily digestible High fibre (large bowel) - in/soluble + high/low fermentability Food allergy - novel ingredient or hypoallergenic

Question 28

What is the best source of information about fibre content of food?

Answer 28

Dietary fibre - found in product guide

Question 29

What us the effect if soluble fibre on: - the stomach - the SI - the LI

Answer 29

Stomach - slows emptying SI - slows transit time, decreases absorption LI - increases fecal bulk by increasing bacteria - Fermentation to short chain fatty acids

Question 30

What us the effect if insoluble fibre on: - the stomach - the SI - the LI

Answer 30

Stomach - no effect SI - speeds transit time - decreases nutrient absorption LI - increases decal bulk (increases water content) - good for constipation

Question 31

How can fermentable fibre be beneficial to enterocytes?

Answer 31

Fermented to short chain fatty acids Cells at the tops of villi are dependent on SCFAs for energy

Question 32

What are the effects of SCFAs in the small intestines?

Answer 32

``` Slow transit time Decrease nutrient absorption Decrease inflammation Increase energy production Increase GI hormone release Increase sodium and water absorption ```

Question 33

What information may make you suspect a dietary hypersensitivity/ allergy?

Answer 33

Thorough diet history Information gathered via questionnaire BEFORE consult

Question 34

How could you nutritionally approach a dietary hypersensitivity or allergy? What results might you anticipate?

Answer 34

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

Question 35

How could you prove a food allergy?

Answer 35

Rechallenge the animal with the original diet - if goes back to same clinical signs as before - ALLERGY

Question 36

What is the logic behind hypoallergenic feed?

Answer 36

Hydrolysed proteins - Make it less antigenic and supposedly less likely to trigger an immune response

Question 37

When might nutritional intervention be required after GI surgery?

Answer 37

If large resection - only small amount of intestine left

Question 38

What simple GI surgeries would not require drastic nutritional intervention? How would you manage them?

Answer 38

Foreign body Simple resection/anastomosis GDV w/o resection Don’t withhold food post-op if not vomiting Low fat easily digestible

Question 39

What dietary factors can contribute to pancreatitis?

Answer 39

High fat diet

Question 40

How could you manage pancreatitis nutritionally?

Answer 40

Can be managed enterally if vomiting minimal Severe pancreatitis - feeding tubes Intractable vomiting - parenteral nutrition Should aim to transition back onto enteral feeding ASAP

Question 41

When would you consider using pancreazyme food?

Answer 41

Exocrine pancreatic insufficiency | NOT pancreatitis

Question 42

What long term dietary management would you recommend for a patient with a lipid disorder?

Answer 42

Long term low fat diet