Nutritional support in companion animals Flashcards
What is nutritional support?
*Method to support metabolic status of hospitalised patients
What is the difference between enteral + parenteral?
*Enteral - enteric - use of intestines + GI tract
*Parenteral - bypassing intestines + GI tract
Why is enteral nutrition preferred?
*Easier
*Fewer complications
*More economical
*More physiological
Why is enteral nutrition important?
*Malnutrition
-sick animals have magnified nutritional deficiencies
Give examples of when injuries / conditions can lead to malnutrition if not given nutritional care?
*Facial trauma - can’t eat
*Megaoesophagus - can’t deliver food
*Post surgery - painful can’t eat
*Prostatic abscess - painful can’t eat
*Polyneuropathy - can’t move - paralysis
What are general rules of nutrition + when to intervene?
*If they’ve lost 10% of their weight recently
*If they’re not eating at all / not eating most of their food for over 3 days
*Diseases causing excess catabolism (increased energy requirements)
What are the different types of enteral nutrition techniques?
*Encourage feeding
*Force feeding
*Drugs
*Tube feeding
How can you encourage feeding?
*Privacy
*Comfortable environment
*Favourite foods in small amounts
*Feed fresh + try warming
*Do not ‘overface’
What type of food should be used?
*Highly digestible - cooked meat /fish
What drugs can be used?
*Diazepam
*Mirtazapine
*Cyprohepatadine
What are the different types of food tubing?
*Naso-pharyngeal tubes
*Pharyngostomy tubes
*Oesophagostomy tubes
*Gastrostomy / PEG tubes
*Enterostomy tubes
When would you use and What are contraindications of using naso-pharyngeal tubes?
*Use for short - medium term problems
Contraindications
*Vomiting
*No gag reflex
*Disease of nose / pharynx
When would you use oesophagostomy tubes? What are the contraindications?
*Medium - long term support - GA required
*Use in diseases of the oral cavity, nasal cavity + pharynx
Contraindications:
*Disease of oesophagus + below
When would you use a gastrostomy tube?
*Long term support - minimum 7 days - GA required
When are enterostomy tubes useful?
*Pancreatitis
Why is enterostomy different?
*Need constant rate of food as there is no stomach to control rate of feed into intestines
What should always be done prior to naso-pharyngeal intubation?
*Local anaesthetic
Why should you mark the tube?
*So that you know how far in it should go
How do you know if tube is in oesophagus or trachea?
*attach syringe + withdraw
- if negative pressure = oesophagus
-if it fills with air = trachea
Why does the tube have to go between the eyes and not round the side of a face in a cat?
*Will interfere with whiskers if it goes round the side of the face
Which side is better for an oesophagostomy?
Left side - as oesophagus will run on the left
What needs to be done with oesophageal tube before connecting food?
*Radiograph / endoscope to make sure its in the right place
-should be proximal to oesophageal sphincter
How is a percutaneous endoscopically placed gastrostomy tube (PEG) done?
*GA - right lateral recumbency
*Avoid spleen on left - check on endoscope that area is fine + put needle through then place wire through needle
*Catch wire with endoscope and pull out of mouth
*Tie to tube and pull back through mouth from the flank
What are the resting energy requirements of dogs + cats?
*Dogs = 30 x BW + 70
*Cats = 40 x BW
*More needed for burn cases + head trauma due to protein loss in burns
How do you calculate quantity of food needed for patinent?
*Caloric density =
*3.Kcal / g x %protein
* + 8.5x %fat
* +3.5 %carbohydarates
How would you introduce an animal to nutritional support?
*Give nothing for first 24hrs - gastrostomy / enterostomy
*Start slowly - 1/3 on day 1
*2/3 on day 2
*3/3 on day 3
Describe good tube etiquette?
*Small, frequent meals - 4-6 per day
*Always aspirate first - ensure food from previous meal has passed
*Warm food
*Administer over several mins
*Flush food with warm water - no food left
How long should tube feeding continue for?
Until near normal intake - >85%
What nutrients are given by tubing?
*Fluid + electrolytes
*Energy requirements
*Protein
*micronutrients
What are complications of tube feeding?
*Mechanical = blockage
*Metabolic = GI upset + Hypophophataemia
*Tube dislodgement
*Stoma infection
*Tube removal by patients
