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BVetMed3 Alimentary > Nutritional Management Of GI Disease > Flashcards

Nutritional Management Of GI Disease Flashcards

1
Q

When would you consider nutritional intervention for an animal of:

  • adequate nutritional status
  • Mildly affected
A

Inadequate intake

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2
Q

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

A

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

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3
Q

When would you consider nutritional intervention for an animal:

  • malnourished
  • seriously ill
  • Haemodynamically stable
A

Adequate intake
-Monitor closely and consider preemptive nutritional measures

Inadequate intake

  • Implement nutritional intervention
  • choose route of nutrition - enteral or parenteral
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4
Q

What do you need to do before considering nutritional intervention?

A

Stabilise patient - address hypovolaemia etc

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5
Q

What are the broad categories of nutritional amenable conditions?

A

GI disorders

Hepatobiliary disorders

Pancreatic disorders

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6
Q

What GI disorders are nutritional amenable?

A 
Acute V+D
Chronic diarrhoea 
GI motility disorders
IBD
Fibre responsive disorders
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7
Q

What hepatobiliary disorders are nutritional amenable?

A

Chronic hepatic disease

Feline hepatic lipidosis

Portosystemic shunts

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8
Q

What pancreatic disorders are nutritional amenable?

A

Acute and chronic pancreatitis

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9
Q

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

A

Animals don’t like to eat in hospitals

May effect nutritional status

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10
Q

What are the goals of nutritional support for hospitalised patients?

A

Address malnutrition

Prevent malnutrition

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11
Q

How can you categorise patients by nutritional status?

A

Debilitated

Not debilitated but high risk for malnutrition

Not debilitated and low risk for malnutrition

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12
Q

What are some indicators of very poor body condition?

A

Thin coat

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

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13
Q

What patients are particularly at risk of hypoglycaemia ?

A

Neonates - can drop significantly if starved for around 24h

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14
Q

How could you approach finding the ‘optimal’ diet?

A

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

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15
Q

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

A

Persevere - doesn’t mean it will never be accepted

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16
Q

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

What shouldn’t you do?

A

ADDRESS UNDERLYING CAUSE

Enticing with ‘nice’ food is not a solution

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17
Q

What diet is suggested for chronic vomiting or diarrhoea?

A

Low fat, easily digestible

18
Q

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

A

Fat not digested and absorbed properly due to pathology

If fat reaches large intestine — DIARRHOEA

19
Q

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

A 
Was there dietary indiscretion?
Does it eat pet food?
Table scraps?
Treats?
Supplements?
20
Q

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

A

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

21
Q

Why are onions bad for cats?

A

Vulnerable to oxidative damage

Onion makes RBCs burst - blood transfusions

22
Q

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

A

Unbalanced - okay for short term

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

23
Q

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

A

Parenteral nutrition (uncommon in general practice)

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

24
Q

When is diarrhoea considered chronic?

A

10 days or longer

25
Q

What diseases with nutritional implications can cause chronic diarrhoea?

A

IBD
Exocrine pancreatic insufficiency
PLE
Colitis

26
Q

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

A

Energy

Fat - need to reduce

Increase digestibility

Protein - if food allergy

Other micronutrients

27
Q

What are the three nutritional approaches to IBD?

A

Low fibre, easily digestible

High fibre (large bowel) - in/soluble + high/low fermentability

Food allergy - novel ingredient or hypoallergenic

28
Q

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

A

Dietary fibre - found in product guide

29
Q

What us the effect if soluble fibre on:

  • the stomach
  • the SI
  • the LI
A

Stomach - slows emptying

SI - slows transit time, decreases absorption

LI - increases fecal bulk by increasing bacteria
- Fermentation to short chain fatty acids

30
Q

What us the effect if insoluble fibre on:

  • the stomach
  • the SI
  • the LI
A

Stomach - no effect

SI - speeds transit time
- decreases nutrient absorption

LI - increases decal bulk (increases water content) - good for constipation

31
Q

How can fermentable fibre be beneficial to enterocytes?

A

Fermented to short chain fatty acids

Cells at the tops of villi are dependent on SCFAs for energy

32
Q

What are the effects of SCFAs in the small intestines?

A 
Slow transit time
Decrease nutrient absorption 
Decrease inflammation
Increase energy production
Increase GI hormone release
Increase sodium and water absorption
33
Q

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

A

Thorough diet history

Information gathered via questionnaire BEFORE consult

34
Q

How could you nutritionally approach a dietary hypersensitivity or allergy?

What results might you anticipate?

A

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

35
Q

How could you prove a food allergy?

A

Rechallenge the animal with the original diet

  • if goes back to same clinical signs as before - ALLERGY
36
Q

What is the logic behind hypoallergenic feed?

A

Hydrolysed proteins -

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

37
Q

When might nutritional intervention be required after GI surgery?

A

If large resection - only small amount of intestine left

38
Q

What simple GI surgeries would not require drastic nutritional intervention?

How would you manage them?

A

Foreign body
Simple resection/anastomosis
GDV w/o resection

Don’t withhold food post-op if not vomiting
Low fat easily digestible

39
Q

What dietary factors can contribute to pancreatitis?

A

High fat diet

40
Q

How could you manage pancreatitis nutritionally?

A

Can be managed enterally if vomiting minimal
Severe pancreatitis - feeding tubes

Intractable vomiting - parenteral nutrition

Should aim to transition back onto enteral feeding ASAP

41
Q

When would you consider using pancreazyme food?

A

Exocrine pancreatic insufficiency

NOT pancreatitis

42
Q

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

A

Long term low fat diet

BVetMed3 Alimentary (16 decks)

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