Treatment options for weight loss Flashcards
1
Q
What can we start by treating with weight loss?
A
- Dental problems: rasp teeth, extraction, diastemas…
- Intestinal parasitism: broad-spectrum, little resistance
- Malnutrition: Increase caloric intake
◦ RER= (21kcal X BW (kg)+975) + 5% extra
◦ Protein=1.5g/kg - PPID: pergolide
- Address chronic pain: NSAIDs, Gabapentin…
2
Q
What is the core therapy in inflammatory bowel disease?
A
- Prolonged 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) - Chemotherapeutic agents (Azathioprine, vincristine..) Lymphosarcoma
- Resection and anastomosis: localized idiopathic eosinophilic enteritis
3
Q
What supportive treatment can we do in inflammatory bowel disease?
A
Dietary recommendations
* Minimize SI function : Fibre»_space;>VFA digestion
* Add vegetable oils to diet: corn/sunflower/flaxseed
* Prioritize monodiet with fibre: decrease inciting antigens??
Frequent deworming: avoid parasite triggered inflammation
4
Q
How would we treat proliferative enteropathy?
A
- 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 - No steroids»_space;>NSAIDs if pyrexia
- IV fluids and plasma/ colloids if profuse diarrhoea & severe hypoalbuminemia
5
Q
How would we treat right dorsal colitis?
A
- Withdrawal of NSAIDs
- Prostaglandin analogues: Misoprostol (2-5µg/kg BID orally)
6
Q
How can we treat chronic sand enteropathy?
A
- Psyllium and MgSO4 (both 1g/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…
7
Q
What supportive care can we provide in hepatic causes of weight loss?
A
- Vitamin E: 20IU/kg
- Milk Thistle extracts (Silymarin): 11mg/kg PO q 24h
◦ inhibits hepatic fibrosis
◦ encourages hepatocyte regeneration
◦ anti-oxidant - S-adenosylmethionine: 24mg/kg PO q 24h
◦ increases glutathione synthase in hepatocytes
◦ stabilises - N-acetylcysteine: (70-80mg/kg IV q8h)
◦ Cytoprotective (through cysteine pathway
◦ increase microcirculation and O2 delivery
8
Q
What other treatments are available for liver disease?
A
- DIET
◦ High carbohydrate (be careful in obese horses)
◦ Low protein (high branch aa/aromatic aa ratio)
‣ Beet-pulp
‣ Cracked corn
‣ Milo/Sorgum/bran (be careful with hyperphosphataemia)
◦ Small frequent feedings: reduce glucogenic load
◦ Avoid alfalfa and legume type grasses (high protein)
◦ Control fats (poor metabolic capacity of liver) - Vitamin B complex: injectable particularly in acute disease
9
Q
How can we treat pyrrolizidine alkaloids?
A
- Irreversible damage: liver biopsy will aid to establish long term prognosis
- Antifibrotic agents
◦ 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)
10
Q
How can we treat cholangiohepatitis?
A
- Antibiotics: broad-spectrum (+++Gram Neg +/- anaerobs)
◦ Potentiated sulphonamides»_space;»enterohepatic circulation
‣ 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 - Ideally based on liver biopsy culture sensitivity
- Therapy should be continued until 2-4 weeks with normal liver enzymes and no fever
11
Q
How can we treat cholelithiasis?
A
- Broad spectrum antibiotics as before
- DMSO 0.5-1g/kg IV in a 10% solution q 24h for 3-5 days daily
◦ aid dissolving intrabiliary sludge and bilirubinate stones? - Cholodecholithotripsy/ Cholodecholithomy»possible but limited success
