Nutritional support in companion animals

Question 1

What is nutritional support?

Answer 1

*Method to support metabolic status of hospitalised patients

Question 2

What is the difference between enteral + parenteral?

Answer 2

*Enteral - enteric - use of intestines + GI tract
*Parenteral - bypassing intestines + GI tract

Question 3

Why is enteral nutrition preferred?

Answer 3

*Easier
*Fewer complications
*More economical
*More physiological

Question 4

Why is enteral nutrition important?

Answer 4

*Malnutrition
-sick animals have magnified nutritional deficiencies

Question 5

Give examples of when injuries / conditions can lead to malnutrition if not given nutritional care?

Answer 5

*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

Question 6

What are general rules of nutrition + when to intervene?

Answer 6

*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)

Question 7

What are the different types of enteral nutrition techniques?

Answer 7

*Encourage feeding
*Force feeding
*Drugs
*Tube feeding

Question 8

How can you encourage feeding?

Answer 8

*Privacy
*Comfortable environment
*Favourite foods in small amounts
*Feed fresh + try warming
*Do not ‘overface’

Question 9

What type of food should be used?

Answer 9

*Highly digestible - cooked meat /fish

Question 10

What drugs can be used?

Answer 10

*Diazepam
*Mirtazapine
*Cyprohepatadine

Question 11

What are the different types of food tubing?

Answer 11

*Naso-pharyngeal tubes
*Pharyngostomy tubes
*Oesophagostomy tubes
*Gastrostomy / PEG tubes
*Enterostomy tubes

Question 12

When would you use and What are contraindications of using naso-pharyngeal tubes?

Answer 12

*Use for short - medium term problems

Contraindications
*Vomiting
*No gag reflex
*Disease of nose / pharynx

Question 13

When would you use oesophagostomy tubes? What are the contraindications?

Answer 13

*Medium - long term support - GA required
*Use in diseases of the oral cavity, nasal cavity + pharynx

Contraindications:
*Disease of oesophagus + below

Question 14

When would you use a gastrostomy tube?

Answer 14

*Long term support - minimum 7 days - GA required

Question 15

When are enterostomy tubes useful?

Answer 15

*Pancreatitis

Question 16

Why is enterostomy different?

Answer 16

*Need constant rate of food as there is no stomach to control rate of feed into intestines

Question 17

What should always be done prior to naso-pharyngeal intubation?

Answer 17

*Local anaesthetic

Question 18

Why should you mark the tube?

Answer 18

*So that you know how far in it should go

Question 19

How do you know if tube is in oesophagus or trachea?

Answer 19

*attach syringe + withdraw
- if negative pressure = oesophagus
-if it fills with air = trachea

Question 20

Why does the tube have to go between the eyes and not round the side of a face in a cat?

Answer 20

*Will interfere with whiskers if it goes round the side of the face

Question 21

Which side is better for an oesophagostomy?

Answer 21

Left side - as oesophagus will run on the left

Question 22

What needs to be done with oesophageal tube before connecting food?

Answer 22

*Radiograph / endoscope to make sure its in the right place
-should be proximal to oesophageal sphincter

Question 23

How is a percutaneous endoscopically placed gastrostomy tube (PEG) done?

Answer 23

*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

Question 24

What are the resting energy requirements of dogs + cats?

Answer 24

*Dogs = 30 x BW + 70
*Cats = 40 x BW
*More needed for burn cases + head trauma due to protein loss in burns

Question 25

How do you calculate quantity of food needed for patinent?

Answer 25

*Caloric density =
*3.Kcal / g x %protein
* + 8.5x %fat
* +3.5 %carbohydarates

Question 26

How would you introduce an animal to nutritional support?

Answer 26

*Give nothing for first 24hrs - gastrostomy / enterostomy
*Start slowly - 1/3 on day 1
*2/3 on day 2
*3/3 on day 3

Question 27

Describe good tube etiquette?

Answer 27

*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

Question 28

How long should tube feeding continue for?

Answer 28

Until near normal intake - >85%

Question 29

What nutrients are given by tubing?

Answer 29

*Fluid + electrolytes
*Energy requirements
*Protein
*micronutrients

Question 30

What are complications of tube feeding?

Answer 30

*Mechanical = blockage
*Metabolic = GI upset + Hypophophataemia
*Tube dislodgement
*Stoma infection
*Tube removal by patients