Nutritional support in companion animals Flashcards
Define enteral
Methods which utilise the GI tract
What are the advantages of enteral methods?
- Easier
- Fewer complications
- More economical
- More physiological
- Enteral nutritional is preferred
What is the importance of enteral nutrition in malnutrition?
- Healthy animal can reduce nutrient utilisation to compensate
- Sick animals cannot compensate with starvation
- Malnutrition develops early in illness
Name some situations where the need to anticipate and provide nutritional support is needed
- Facial trauma
- Polyneuropathy
- Megaoesophagus
- Post surgery
- Prostatic abscess
What are some general rules of nutritional intervention?
- Recent weight loss >10%
- Partial/complete anorexia for ≥ 3days from the start of the illness
- Diseases causing excess catabolism = increased metabolism
- Treat obese patients the same
What are some considerations when encouraging feeding is being used as a form of enteral nutrition?
- Privacy
- Comfortable environment
- Favourite foods in small amounts
- Feed fresh and try warming
- Do not ‘overface’
- Record closely how much the patient has actually eat
Which drugs can be used in enteral nutrition?
• Diazepam • Mirtazapine in cats - Best appetite stimulant - Usually well tolerated - Only for partial / short term anorexia
Name four methods of tube feeding
- Naso-oesophageal tubes
- Oesophagostomy tubes
- Gastrostomy/ PEG tubes
- Enterostomy tubes
What are the main features/ considerations/ contraindications of using naso-oesophageal tubes?
- Short to medium term
- Small diameter tubes
- Contraindications: Vomiting, no gag reflex, disease of nose or pharynx
Where is an oesophagostomy tube placed?
Tube is placed through the left side of the neck, directly into the distal oesophagus
What are the main features/ considerations of using an oesophagostomy tube
- Medium - long term support
- Well tolerated
- GA required: patients may initially not be well enough for this
What are the indications and contraindications of using an oesophagostomy tube
Indications: Oral cavity, nasal, pharyngeal disease
Contraindications: Diseases of oesophagus and below
Where is a gastrostomy/PEG tube placed?
Tube is placed through the left side of the flank, directly into the stomach
What are the main features/ considerations of using a gastrostomy tube
Long term support: minimum of 7 days as it needs time to seal
- Well tolerated
- GA required
- Indications: all but gastric, intestinal and pancreatic
Where are Enterostomy tubes placed?
Into the intestine
What are the main features/ considerations of using an enterostomy tube?
- GA required, typically required surgery
- No gastric reservoir
- Need a constant rate infusion
What are the indications and contraindications of using an enterostomy tube?
Indications: good for pancreatitis
Contraindications: diffuse intestinal disease
What equipment is needed for a naso-oesophageal tube placement?
- A tube
- Adhesive tape
- Topical local anaesthetic solution
- Suture material
- 2 syringes, one filled with tap water
How is the length of a naso-oesophgeal tube measured?
Aiming for the tip of the tube to be in the distal oesophagus
- Either: Nose to 9-10th rib
- Or: ¾ x (Nose to caudal rib
Describe how a naso-oesophageal tube is placed and how you would check its in the oesophagus
- First push the nose dorsally, then flex the head ventrally
- Pass tube in a ventromedial direction
- Once in place, attach the empty syringe to the tube, if it is in the oesophagus there should be no air (creating a vacuum), if its in the trachea there will be air so the plunger will continue to pull back
- Can check by flushing the tube with water, if its in the trachea the animal will cough
- You then want to secure it in place with tape to the head of the patient and suture it in place
- Place a collar onto the patient
What equipment is needed to place an oesophagostomy tube?
- Forceps
- Simple stich kit and suture material
- Tube
- Scalpel
Name the forceps used to measure and place where an oesophagostomy tube will go
Carmalt forceps
Describe how an oesophagostomy tube is placed
- Length of the tube is the same as before
- Once the whole in the neck has been made the tube can be passed through and out of the mouth. Using the forceps it then needs to be redirected down the oesophagus
- Any extra tube can be pulled out through the neck incision, the tube should ‘flip’ which shows its directed down towards the oesophagus
- Can then x-ray the patient to ensure the tube is in the distal oesophagus
- The tube is secured to the skin with a finger trap pattern
Describe PEG/Gastrostomy tube placement
- Placed in the fundus of the stomach
- One person pushes a finger into the side of the flank, whilst another person has an endoscope inside the stomach (it is fully inflated), the endoscope is looking to find the finger indentation on the fundus
- Once in the right place wire is passed through that point using a needle. It is then passed out of the mouth where a tube is attached and is passed back down the oesophagus and through the hole in the fundus
- Once in place cannot use for 24 hours – needs to seal closed
How is resting energy requirement calculated in dogs and cats?
Dogs - RER (Kcal) = 30 x BW + 70
Cats - RER (Kcal) = 40 x BW
How much food should be fed to animal needed enteral nutrition?
Resting energy requirement
- This is not the time for weight loss or weight gain
How can you calculate how much food is needed?
Energy requirement ÷ Caloric density of food
How should food be introduced enterally?
- Nothing for 1st 24 hours
- Start slowly
- 1/3 on day 1
- 2/3 on day 2
- 3/3 on day 3
What are the rules when tube feeding an animal
- Small, frequent meals - 4-6 per day
- Always aspirate first
- Warm the food
- Administer over several minutes
- Flush tube with warm water
What are some complications that can occur when tube feeding?
- Mechanical Blockage: flush the tube
- Metabolic e.g. Gastrointestinal upset
- Tube dislodgement
- Stoma infection
- Tube removal by patient
What is parenteral nutrition?
Intravenous feeling with elemental diets
What is a parenteral diet composed of?
Diet which has the critical components of nutrition
- Amino acids = protein
- Glucose = carbohydrate
- Lipid = fat
How and when is parenteral nutrition used?
- Delivered through a central vein e.g. jugular vein
- Needs to be delivered at a constant rate and protected from light
- Used only if the GI route is not possible
