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VETM 465: Applied Nutrition > SA 4 - Tesse > Flashcards

SA 4 - Tesse Flashcards

1
Q

What are the clinical signs of protein energy malnutrition (PEM)

A

Weight loss, muscle wasting, pallor, chronic infections, poor hair coat

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2
Q

T/f: specific nutritional deficiencies are common in north american cats and dogs

A

false

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3
Q

what is the pathognomonic clinical signs of taurine deficiency in cats

A

dilated cardiomyopathy, central retinal degeneration

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4
Q

what is the pathognomonic clinical sign of vit K deficiency

A

coagulopathy

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5
Q

what is the pathognomonic clinical sign of thiamine deficiency in cats

A

brain stem necrosis leading to neurologic signs

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6
Q

Are there hematologic abnormalities that can be found on a nutritional assessment?

A

yes -> anemia and lymphopenia (PEM), regenerative to microcytic nonregenerative (iron deficiency), microcytic hypochromic anemia (copper deficiency), macrocytic hypochromic (folate deficiency), megaloblastic anemia (B12 deficiency)

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7
Q

Match the deficiency with the anemia:
1. copper
2. iron
3. B12
4. Folate

a. regenerative to microcytic nonregenerative
b. megaloblastic
c. macrocytic hypochromic
d. microcytic hypochromic

A

1 - d
2 - a
3 - b
4 - c

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8
Q

T/f biochemical abnormalities in nutritional assessments are often pathognomonic and super specific to the disease

A

FALSE. highly insensitive and nonspecific

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9
Q

what are some biochemical abnormalities that can be seen with obesity

A

hyperglycemia and glucose intolerance
hyperlipidemia

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10
Q

what are some biochemical abnormalities that can be seen with PEM

A

creatinine, albumin, BUN changes

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11
Q

What should you do with a nutritional assessment done on a healthy animal

A

make clear and specific recommendations (complete and balanced, ID food by brand name flavor and form, provide several choices, give exact amlount to be fed and frequency). These should be written and updated in the medical record

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12
Q

what should you do with a nutritional assessment done on a sick animal

A

pretty much the same as the healthy animal, except consider specialized or prescription diets, initiate assisted feeding early, and while complete and balanced rations are preferred, they are not always indicated for certain diseases (ie you want a low protein diet for CKD, even if it isnt balanced)

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13
Q

What are some measures you should monitor for response to a diet during a nutritional assessment

A

palatability
signs of dietary intolerance
assessment of BCS and weight
follow underlying disease of sick patients

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14
Q

What type of animal do nutritional deficiencies most commonlyl occur in

A

sick ones

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15
Q

What is Protein Energy Malnutrition (PEM)

A

a deficiency of protein and calories that is common in hospitalized patients

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16
Q

what are the well documented affects of PEM

A

anemia, hypoproteinemia, delayed wound healing, decreased immune function, GI, resp, cardio compromise, death

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17
Q

T/F healthy canids are well adapted to survive food deprivation

A

true

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18
Q

what are the two primary groups of starvation adaptation in canids

A

acute (maintain blood glucose concentration via hepatic glycogen and amino acids)

chronic (fat derived fuels preserve lean body mass)

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19
Q

lean body mass =

A

FUNCTION

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20
Q

what disease compromises adaptation to starvation

A

PEM

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21
Q

what type of starvation adaptation is blocked in patients with PEM

A

chronic (switch to fat derived fuels is blocked)

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22
Q

PEM lease to a relative _____ in metabolic rate, and an altered _____ milieu

A

increase, hormonal

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23
Q

what change in fuel utilization of preferences occurs in PEM patients

A

glucose&raquo_space;» fats

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24
Q

why are amino acids and glucose so often deficient during illness?

A

there is a high demand for protein and energy in illness for protein synthesis (think of how many acute phase proteins, WBCs, immunoglobulins, clotting factors, etc are required for illness and wound healing). Adipose stores cannot meet the energy or synthetic substrate needs of illness, so lean body mass is rapidly catabolized

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25
Q

which species may be predisposed to protein energy malnutrition

A

cats, because they conserve their lean body mass less efficiently and have a high basal protein requirement

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26
Q

what is the common history for a PEM patient

A

critically ill (surgery, infection, cancer, thermal burns)

decreased food intake

27
Q

what are common PE findings for PEM

A

body weight and BCS may be unchanged

nonspecific symptoms (muscle wasting pallor, poor coat, hepato/splenomegaly, chronic infection, peripheral edema, lymphadenopathy)

28
Q

what are common laboratory testing findings for PEM

A

normocytic/normochromic nonregenerative anemia and lymphpenia

29
Q

what are common serum biochemistry parameters in PEM

A

decreased creatinine (from muscle wasting)
hypoalbuminemia

30
Q

what is common during critical illness

A

PEM

31
Q

what are the steps of initiation of nutritional support in critically ill patients

A

1: determine fluid requirement
2: determine energy requirement
3. select calorie sources
4. micronutrient requirements
5. select route of administration

32
Q

what is the daily fluid requirement in an average animal

A

~60 mL/kg

33
Q

how can you supply fluids to an animal

A

voluntary intake, tube, or parenteral solution

34
Q

what energy requirement parameter should be used during initiation of nutritional support of critically ill patients

A

resting energy requirement (RER)

35
Q

what does RER do

A

maintains basal metabolic rate, maintains body temperature in thermoneutral environment, allows recovery from activity, no increment for food consumption

36
Q

What are the two equations for RER

A

RER = 30(BW in kg) + 70 for animals over 2 kg and under 45 kg

RER = 70(BW in kg) ^3/4 for all animals

37
Q

what are some factors that effect optimal distribution of calories

A

species, palatability, digestibility, cost and availability, ease of use, specific disease process

38
Q

what is the optimal protein intake variable in dogs

A

25 -45% of calories

39
Q

what is the optimal protein intake variable in cats

A

30 -50 % of calories

40
Q

T/F critical care diets are often high in fats

A

true

41
Q

optimal fat intake of fat in dgs

A

20-60 % of calories

42
Q

optimal fat intake in cats

A

35-50% of calories

43
Q

T/f carbohydrates are not required by dogs or cats

A

true

44
Q

why does optimal intake of carbs vary in critically ill patients

A

they may not be used efficiently during illness, but can be an alternative calorie source for some patients with protein or fat restrictions

45
Q

what should you consider first when selecting a ration for a critically ill patient

A

optimal caloric distribution

46
Q

how can you best meet the micronutrient requirements for patients with critical illness

A

via commercial diets, with supplementation only if specifically indicated

47
Q

what nutrients are important for immune response

A

protein, zinc, iron, vit A, arginine

48
Q

what are the three possible routes for nutritional support

A

voluntary intake

enteral (tube) feeding

parenteral (intravenous) feeding

49
Q

which route of administration is best if nutrient requirements are met

A

voluntary intake

50
Q

what are some steps to maximize voluntary food intake

A

hand feed small frequent meals

offer highly palatable and aromatic foods

warm food prior to serving

use calorie/nutrient dense commercial rations

pharmacologic appetite stimulation

51
Q

what are some examples of pharmacologic appetite stimulation that can be used to maximize voluntary intake

A

antidepressants (mirtazapine, diazepam)

cyproheptadine (periactin)

52
Q

what are advantages of enteral feeding

A

more physiologic
prevents villous atrophy
prvents bacterial translocation
less complex
fewer complications
cheaper

53
Q

what are disadvantages of enteral feeding

A

long periods of transition
contraindicated if GI tract non-functional

54
Q

what are the various types of feeding tubes

A

nasoesophageal
pharyngostomy
esophagostomy
gastrostomy
jejunostomy

55
Q

How do you choose which type of feeding tube to use?

A
  • anatomic site of GI dysfunction
  • expected duration of nutritional support
  • patient conformation and concurrent diseases
  • type of ration intended to be fed
  • clinical status of the patient
56
Q

okay… so what do we put in the feeding tubes?

A

-blenderized commercial pet food
- commerical paste-type formulations specifically designed for tube feeding
- commercial veterinary liquid formulations (for nasoesophageal and jejunostomy tubes only)

57
Q

what are the general differences between critical care/tube feeding rations and normal diets?

A

CC/feeding tube rations will have much higher % protein kcals and %fat kcals, much lower %carb kcals, and slightly higher caloric density

58
Q

which type of tube feeding requires CRI

A

jejunostomy

59
Q

what is the ultimate goal of enteral feeding delivery

A

initial bolus feeding every 2 hours, to delivery of requirements in 4 to 6 daily feedings

60
Q

what are the pros of parenteral feeding

A

bypasses GI tract

allows complete bowel rest

decreased risk of aspiration

may not require anaesthesia

decreased risk of bleeding

61
Q

what are the cons of parenteral feeding

A

villous atrophy

bacterial translocation

increased complications (sepsis. hyperglycemia, hyperlipidemia)

requires specialized equipment and products

increased level of care

more expensive

62
Q

T/F you should discontinue nutritional support after removing your feeding tube/catheter

A

FALSE. you should do it before removing the route of admin, and compare the patient’s food intake and make sure they still meet the requirements on their own

63
Q

what type of diet should you transition to after discontinuing nutritional support in critical care patients

A

highly digestible, low residue rations via small and frequent feedings for days to 1-2 weeks

VETM 465: Applied Nutrition (20 decks)

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