Treatment options for weight loss Flashcards
Focus on GI and liver
Tx of dental problems
- rasp teeth
- extraction
- diastemas
- etc
Tx of intestinal parasitism
- broad-spec
- little resistance
Tx of malnutrition
- increase caloric intake
- RER= (21kcal X BW (kg)+975) + 5% extra
- Protein=1.5g/kg
Tx of PPID
- pergolide
Tx of chronic pain
- NSAIDs
- Gabapentin
Intestinal weight loss - IBD tx - core therapy
ØProlonged corticosteroid therapy
– Dexamethasone 0.05 mg/kg IM daily for 2 weeks, then Prednisolone 0.5-1mg/kg for 3 weeks oral
Or
– Dexamethasone 0.03mg/kg for 3 weeks oral
– Followed by tapering dose another 6 weeks (half the dose and every other day dosing)
- Response to steroid therapy is achieved in ~50% of IBD cases with long term survival of ~65%.
- Generally survival improves if we see an early response to therapy.
Ø Chemotherapeutic agents (Azathioprine, vincristine..)
– Recommended in refractory cases of IBD and confirmed cases of lymphosarcoma
Ø Resection and anastomosis:
– localized idiopathic eosinophilic enteritis
-> good results of full resolution in some cases of localised idiopathic eosinophilic enteritis, and a good outcome for all IBD conditions
Why is initial parental administration of steroids needed for the tx of IBD?
- to bypass the intestinal malabsorption
Intestinal weight loss - IBD tx - dietary recommendations
Minimize SI function:
-Fibre»_space;>VFA digestion
- Highly digestible, well balanced food split into small feeds throughout the day should optimise the limited absorptive capacity of the SI
Add vegetable oils to diet:
- corn/sunflower/flaxseed
Prioritise monodiet with fibre:
- decrease inciting antigens??
- Avoiding or limiting commercial feeds is thought to help decrease the antigenic exposure of the SI mucosa (through the different additives added to the feeds)
Diet high in fibre and veg oils:
- Maximises the amount of VFAs produced in the LI and reduces the SI workload
Intestinal weight loss - IBD tx - frequent deworming
- avoid parasite triggered inflammation
- reduce inflammatory triggers in the intestinal mucosa
- Small/low parasite burden that wouldn’t cause issues for a normal horse can be triggering for these animals.
Intestinal weight loss - proliferative enteropathy tx
Ø Antibiotics: Tetracyclines
– Intravenous oxytetracycline (6.6 mg/kg every 12 hours) for 1 week followed by
doxycycline (10 mg/kg every 12 hours PO)
OR
– Macrolide and rifampin (5–10 mg/kg every 24 hours PO)
– Antibiotic therapy 2-3 weeks»but rapid response to treatment clinically: 82-93% resolved
Ø No steroids»_space;>NSAIDs if pyrexic
Ø IV fluids and plasma/ colloids if profuse diarrhoea & severe hypoalbuminemia
Intestinal weight loss - large intestine - broad tx
Treat diarrhoea if present: supportive fluids, plasma/colloids, +/- NSAIDs
Intestinal weight loss - right dorsal colitis tx
- Withdrawal of NSAIDs
- Prostaglandin analoges: Misoprostol (2-5μg/kg BID orally)
Intestinal weight loss - chronic sand enteropathy
- Psyllium and MgSO4 (both 1 g/kg by nasogastric tube ): daily for 5-7 days
- NSAIDs (flunixin 1.1mg/kg BID)
- Surgical emptying if refractory to medical therapy (14-31%)
- Enough roughage: hay/haylage or alfalfa mix
- Do not feed on the ground: rubber mats, feeders, hay nets
General liver disease tx
- Removing the instigating cause: plant, bacteria, virus?
- Supportive care
– Vitamin E: 20IU/kg
– Milk Thistle extracts (Silymarin): 11mg/kg PO q 24h
– S-adenosylmethionine: 24mg/kg PO q 24h
– N-acetylcysteine: (70-80mg/kg IV q8h) - Diet changes
- Vitamin B complex
– Injectable particularly in acute dz
Milk thistle use
- inhibits hepatic fibrosis
- encourages hepatocyte regeneration
- anti-oxidant
S-adenosylmethionine use
- increases glutathione synthase in hepatocytes
- stabilises
N-acetylcysteine use
- Cytoprotective (through cysteine pathway increase microcirculation and O2 delivery)
Diet for liver disease
Ø High carbohydrate (be careful in obese/laminitic horses)
Ø Low protein (high branch aa/aromatic aa ratio)
– Beet-pulp
– Cracked corn
– Milo/Sorgum/bran
-> be careful with hyperphosphataemia
-> nutritional secondary hyperparathyroidism = osteodystrophia fibrosa
Ø Small frequent feedings: reduce glucogenic load
Ø Avoid alfalfa and legume type grasses (high protein)
Ø Control fats (poor metabolic capacity of liver)
Limiting fat and protein in the diet reduces the metabolic workload of the liver.
Liver disease - pyrrolizidine alkaloids
- Irreversible damage: liver biopsy will aid to establish long term prognosis
- Antifibrotic agents (alongside antioxidants and diet changes)
– Steroids: dexamethasone (0.05-0.1mg/kg q 24h IM/oral) or prednisolone (1mg/kg PO q24h) several weeks, followed by tapering dose
– Colchicine: (0.01-0.03mg/kg PO q 12h)
– These 2 products should help slow fibrosis in chronic cases - can be used together or separately
Liver disease - cholangiohepatitis
- Antibiotics: broad-spectrum (+++Gram Neg +/- anaerobes)
– Potentiated sulphonamides (enterohepatic circulation -> increases [] significantly in liver tissue)
-> 25mg/kg PO q 12h
– Fluoroquinolones: Enrofloxacin 7.5mg/kg PO q 24h
– Cephalosporins: 2-5mg/kg q IV/IM12h
– +/- Metronidazole: 15-20mg/kg PO q8h (for anaerobic cover) - Ideally based on liver biopsy culture sensitivity
- Therapy should be continued until 2-4 weeks with normal liver enzymes and
no fever
Liver disease - cholelithiasis
Ø Broad spectrum antibiotics
– Potentiated sulphonamides (enterohepatic circulation -> increases [] significantly in liver tissue)
-> 25mg/kg PO q 12h
– Fluoroquinolones: Enrofloxacin 7.5mg/kg PO q 24h
– Cephalosporins: 2-5mg/kg q IV/IM12h
– +/- Metronidazole: 15-20mg/kg PO q8h (for anaerobic cover)
– Implication of bacteria is controversial
Ø DMSO 0.5-1g/kg IV in a 10% solution q 24h for 3-5 days daily
– aid dissolving intrabiliary sludge and bilirubinate stones?
Ø Cholodecholithotripsy/ Cholodecholithomy»possible but limited success
Ø Tx difficult if stones are large
Ø Laser therapy for bigger stones and biliary obstruction can be attempted
What are the 2 most commonly used anti-oxidants in horses?
- vitamin e
- milk thistle
Vitamin e use
- participates in glutathione cysteine pathways of detoxification int he liver
