Clinical Nutrition Flashcards
(189 cards)
1
Q
what are the 6 basic classes of nutrients?
A
protein fat carbohydrate minerals vitamins water
2
Q
why may dry food be prefurrable?
A
aids dental health
3
Q
what is the most important nutrient?
A
water
4
Q
how much water intake is required per day?
A
20-70 ml/kg/day
5
Q
what is the correct urine output for animals?
A
1-2 ml/kg/hr
6
Q
what must be available at all times?
A
water
7
Q
what are vitamins?
A
organic compounds
8
Q
what are the lipid soluble vitamins?
A
A, D, E, K
9
Q
what are the non-lipid soluble vitamins?
A
B and C
10
Q
what are vitamins used for?
A
energy metabolism
biochemical reactions
11
Q
what can happen if an animal is receiving an inadequate number of vitamins?
A
deficiency syndromes
12
Q
what are the macrominerals?
A
calcium phosphorus magnesium sodium potassium chloride sulpher
13
Q
what are the most important microminerals?
A
iron copper zinc manganese iodine selenium
14
Q
what is protein formed from?
A
chains of amino acids
15
Q
how many amino acids to animals need?
A
all 23
16
Q
what is formed from amino acids?
A
hair skin muscle hormones antibodies (etc)
17
Q
where can many amino acids be synthesised?
A
in the body
18
Q
what are the essential amino acids?
A
those that cannot be synthesised within the body and so must be gained through the diet
19
Q
why are cats obligate carnivores?
A
require taurine in their diet as they are unable to synthesise it
20
Q
what are the functions of protein?
A
regulation of metabolism
tissue growth and repair
cell and muscle fibre structure
energy source
21
Q
what are the essential amino acids?
A
phenylalanine valine tryptophan threonine isoleucine methionine arginine leucine lysine taurine (cats only)
22
Q
what will deficiency in taurine cause?
A
blindness and heart problems
23
Q
what is the biological value of protein?
A
a measure of the proportion of absorbed protein from a food which becomes incorporated into the proteins of the organism’s body - higher value is easier for the body to utilise
24
Q
what are the issues caused by excess dietary protein?
A
liver and kidney problems
25
why must care be taken to to ensure dietary protein is at the right level at different life stages?
care that there is not excess in ageing animals as their kidney function is likely reduced
ensure high protein diet in growing young
26
what is caused by protein deficiency?
```
poor growth, muscle and weight loss
dull hair
reduced immunity
oedema (due to hypoalbuminemia)
death
```
27
what are fats made up of?
triglycerides (glycerol and fatty acids)
28
what is the role of fats in the body?
```
provide energy
aid absorption of fat soluble vitamins
enhance palatability
source of essential fatty acids
neural development (DHA)
```
29
what are the essential fatty acids?
linoleic
linolenic
arachidonic
30
what is DHA essential for?
neural development
31
what is the effect of inadequate intake of fats?
energy deficiency
| EFA deficiency
32
what are the effects of EFA deficiency?
```
impaired reproduction
impaired wound healing
dry coat
flaky skin
eczema
hot spots
```
33
what are the 3 main groups of carbohydrates?
monosaccharides
disaccharides
polysaccharides
34
what group do complex carbohydrates fall into?
polysaccharides
35
what are carbohydrates used for?
energy
| metabolic requirement for glucose
36
what will happen to excess carbohydrates?
converted to fat
37
what is fibre?
indigestible polysaccharide
38
what are the main sources of fibre?
cellulose
lignin
pectin
39
where is fibre most commonly found?
plant cell walls
40
is fibre digestible in the intestine of dogs and cats?
no
41
what is the function of fibre?
bulk out faeces
prevent constipation and diarrhoea
role in correction of obesity (satiety)
role in regulating blood glucose levels in diabetes
42
when should animals be body condition scored?
at all clinical exams
43
describe a BCS of 4 in a dog
Ribs easily palpable, with minimal fat covering. Waist easily noted, viewed from above. Abdominal tuck evident
44
describe BCS of 5 in a dog
Ribs palpable without excess fat covering. Waist observed behind ribs when viewed from above. Abdomen tucked up when viewed from side
45
describe BCS of 5 in a cat
Well-proportioned body. Ribs are not visible but easily felt. Waist obvious/ slight abdominal tuck. Small amount of abdominal fat.
46
describe BCS of 4 in a cat
Ribs not visible but are easily felt. Waist is obvious/ slight abdominal tuck. Minimal amount of abdominal fat.
47
what is metabolisable energy (ME)?
kcal per 100g of a diet - most accurate way to see what calories the animal will take in
48
why is gross energy a less reliable measure of energy intake?
not all available to the animal so less reliable
49
what is basal energy requirement (BER)?
amount of energy expended during sleep, 12-18 hours after food in a thermoneutral enviroment
50
what is resting energy requirement (RER)?
BER with energy expended for recovery from physical activity and feeding
51
what energy requirement is used to calculate food needs in hospitalised patients?
RER
52
what is maintenance energy requirement (MER)?
energy required by a moderately active animal
53
what is not included within MER?
energy for growth, lactation and work
54
what factors must be considered when calculating MER?
lifestage
55
what is the calculation for RER for animals under 2kg and above 45kg?
RER= 70 x (BWT/kg)0.75
56
what is the calculation for animals between 2 and 45kg?
RER = 30x BWT/kg + 70
57
how can calorie intake be calculated?
calculate RER
choose most beneficial diet
divide energy content of diet by RER to achieve daily food required
divide total for the day by total number of feeding times /max volume of each meal
58
what should be used to calculate calorie needs in the clinical environment?
RER
59
what should be used to calculate calorie needs in the healthy patient?
MER
60
what makes up the MER calculation?
RER x lifestage factor
61
what factors are now no longer considered appropriate to factor into calorie needs?
illness factors
62
what is obesity?
excess accumulation of body fat
63
what can cause obesity?
modern lifestyle
neutering
overfeeding
poor owner understanding
64
what can be used to give an indication of obesity?
BCS
65
what are the possible consequences of obesity in dogs and cats?
```
hepatic lipidosis
joint disease
exercise intolerance
DM
skin disease
cardiorespiratory disease
impacts on surgery
FLUTD
```
66
what is a safe amount of weight loss per week?
1-2%
67
what is required in order to achieve safe weight loss?
diet changes
exercise plan
behavioural changes
68
what should the MER of an obese dog be calculated based on?
ideal weight not current weight
69
what should weight loss programmes be tailored to?
individual animal and owner
70
what are the key issues with starvation for weight loss?
ethically questionable
excessive loss of lean body mass (LBM)
body function problems
risks hepatic lipidosis in cats
71
what are the main features of obesity diets?
nutritionally balanced
high protein
joint health often supported
L- carnitine included
72
what is the benefit of a nutritionally balanced obesity diet?
pet receives correct levels of vitamins and minerals
73
what is the benefit of a high protein obesity diet?
preserves lean body mass
reduced net energy
satiety
palatability
74
why are joint health supplements often included in obesity diets?
obesity and joint issues linked
75
what is the benefit of joint supplements within an obesity diet?
helps maintain joint health in overweight pets
| reduces the need to supplement
76
what are the main components of joint supplements?
glucosamine and chondroitin
77
what is L-carnitine?
non essential amino acid
78
what does L- carnitine do?
transports long chain fatty acids into the mitochondria for use in beta oxidation
79
what are the benefits of including L- carnitine into obesity diets?
helps encourage use of fat for energy and reduce fat storage
| reduces risk of hepatic lipidosis in cats
80
what is one of the key areas where owners can make a significant difference to their pet's health?
diet
81
what are the key GI issues that may be managed through nutrition?
acute and chronic GI issues
| EPI and uncderweight
82
what acute and chronic GI issues may be managed with diet?
```
diarrhoea
gastritis/enteritis
IBD
maldigestion/malabsorption
bacterial overgrowth
cholangiohepatitis (cats)
```
83
what is cholangiohepatitis?
inflammation of liver and bile duct
84
what are the ingredients found in diets for GI disease?
```
highly digestible proteins and starch
mannon oligosaccharrides
FOs
EPA/DHA
Psyllium
high or low fat
supplementation for EPI or absorption syndromes
```
85
what do highly digestible proteins have?
high bioavailablity (easy to break down)
86
what does MOS stand for?
mannan oligasaccharide
87
what does FOS stand for?
fructose oligasaccharides
88
where do MOS come from?
cell wall of yeast
89
where does FOS come from?
beet pulp, grains, barley and wheat
90
what is the role of MOS and FOS?
enhances good gut bacteria
91
what does EPA stand for?
eicosapentaenoic acid
92
what does DHA stand for?
docosahexeanoic acid
93
what are EPA and DHA?
omega 3 essential fatty acids (unsaturated)
94
what is the role of EPA and DHA?
increase digestion
95
what is the role of psyllium in GI diets?
aids toxin and waste removal
bulks faeces and absorbs water
relieves constipation
aids peristalsis
96
where does psyllium come from?
plant husk
97
what will the decision to feed high or low fat diets depend on?
individual patient
98
what my be included in GI diets to support EPI or malabsorption syndromes?
supplementation e.g. Lypex
99
how does Lypex deliver pancreatic enzymes to the small intestine?
coated so that they are unaffected by the gastric environment
100
what does Lypex provide?
artificial pancreatic enzymes for patients with EPI
101
why may a patient need a hypoallergenic diet?
allergic to a component or ingredient of normal diets
102
what can food allergy lead to?
skin and GI diseases
103
what is the role of hypoallergenic diets?
nutritional management of dogs and cats with food allergy/hypersensitivity/intolerance
104
what may be involved in diagnosis food allergy/hypersensitivity?
food elimination
105
what other conditions aside from allergy are hypoallergenic diets useful for?
inflammatory bowel disease
EPI
as it increases the digestibility of food
106
what are some common protein allergies?
chicken
| beef
107
what can be done to prevent food allergy but still be able to feed protein?
hydrolysed proteins
108
how does hydrolysation of proteins prevent allergic reaction?
change the protein surface so that immunoglobulins in the body no longer recognise and bind to the protein. This means mast cells no longer degranulate and histamine is not released (no symptoms)
109
how are proteins hydrolysed to prevent allergic reaction?
using enzymatic hydrolysis by hydrolysates
110
what immunoglobulin is involved in hypersensitivity reactions?
IgE
111
what happens during a hypersensitivity reaction that causes symptoms?
IgE binds, mast cells are stimulated to degranulate
| histamine released
112
how long can a hypersensitivity diet take to have effect?
several weeks - up to 6
113
what are hypoallergenic diets made from?
hydrolysed proteins
| novel source of protein (e.g. duck)
114
what is included within hypoallergenic diets to improve the skin barrier?
B vitamins
amino acids
zinc
linolenic acid
115
what fatty acids are found in hypoallergenic diets?
EPA and DHA
116
why are the essential fatty acids EPA and DHA needed in hypoallergenic diets?
support skin and GI mucosal integrity so the animal is less prone to upset
117
what is included in hypoallergenic diets to improve digestive security?
beet pulp
FOS and MOS
zeolite
118
what is the role of beet pulp in a hypoallergenic diet?
promote motility
119
what is the role of FOS, MOS and zeolite in hypoallergenic diets?
support a healthy intestinal environment
120
what is zeolite?
mineral that removes toxic elements
121
who are convalescent required for?
hospitalised patients / those with anorexia
122
how much of total energy provision in convalescent diets is from protein sources?
30-50%
123
why must care be taken when feeding high protein convalescent diets?
if patient is in renal failure or has hepatic encephalopathy as these animals are less able to manage protein safely in the body
124
what should happen before feeding a convalescent diet to patients?
check with vet
125
what are the most widely available forms of convalescent diets?
liquid diets
powdered diets
solid wet diets
126
can all convalescent diets be given via feeding tube?
yes but care must be taken to ensure correct calories if diluting and that they will not get stuck in the tube
127
what are critically ill patients at risk of?
malnutrition
128
why are critically ill patients at risk of malnutrition?
energy is not conserved as normal due to catabolism and rapid breakdown of energy stores that occurs in the stress state of metabolism
129
what is one of the most marked features of critically ill patients?
catabolic depletion
130
what will be improved by proper nutrition of the critically ill patient?
tissue repair
wound healing
immune function
131
what should be encouraged in all sick patients as soon as is safe?
oral nutrition considering possible complications (e.g. aspiration)
132
what should not be introduced in a hospital setting?
new diet (if long term use planned) as there is risk of food aversion
133
what is the first option when feeding animals?
voluntary eating
134
how can an animal be encouraged to eat?
```
calm environment
warm food
strong smelling
palatable
remove any physical barriers
ensure fresh
offer one food type at a time
leave patients without food
```
135
what are the physical barriers that may prevent a patient from eating?
buster collars
injury to face
too small bowl (esp. cats)
136
what can be used if voluntary feeding is not achieving adequate calorie intake?
enteral feeding tubes
137
what type of diet is judged to be better for dental health in dogs and cats?
hard kibble
138
what 3 things can be included in the diet to improve dental health?
phosphate salts - anti calculus properties
Igy-GP - blocks bacterial formation
omega 3 - controls inflammation caused by periodontal disease
139
what is the exocrine function of the pancreas?
synthesis and excrete digestive enzymes
140
what causes pancreatitis?
premature activation of digestive enzymes within acinar cells - leads to pancreas autodigestion
141
what does the inflammatory cycle of pancreatitis begin with?
addition of neutrophils
142
what are the clinical signs of pancreatitis?
vomiting
abdominal pain
anorexia
lethargy
143
what can severe pancreatitis lead to?
```
renal failure
acute lung injury
DIC
chronic pancreatitis
EPI
```
144
how is pancreatitis treated?
```
IVFT
antiemetics
analgesia
gastro-protectants
nutrition
```
145
what is involved in nutritional support of pancreatitis patients?
no fasting
| eat as early as possible once nausea and vomiting are under control
146
what are the benefits of early nutrition for pancreatitis patients?
reduced villi damage and so less bacterial translocation
reduced villus atrophy
reduced pancreatic inflammation
147
is enteral or parenteral nutrition more beneficial for pancreatitis patients?
enteral
148
what type of diet should be avoided in pancreatitis patients?
high fat
149
why should a high fat diet be avoided in pancreatitis patients?
concurrent hyperlipidaemia which is a risk factor for pancreatitis
150
what enteral feeding methods can be used in pancreatitis patients?
oral
| pre-pyloric (NG, NO)
151
when feeding an anorexic patient what must be considered?
introducing food slowly over a number of days to prevent refeeding syndrome
152
what elements of the diet need to be carefully managed to ensure normal skeletal development/maintenance?
calcium
phosporus
vitamin D
153
what is the benefit of regulating calcium, phosphorus and vitamin D in growing animals?
reduction in orthopoedic issues in later life
154
when is diet management of orthopedic issues particularity important?
large breeds while they're growing
155
what is osteoarthritis?
articular cartilage degradation
156
what animals is osteoarthritis seen in?
ageing cats and dogs
| some rabbits
157
in what breeds is joint dysplasia most commonly seen?
medium to large
158
what makes joint dysplasia more likely?
genetic predisposition
159
what are the main orthopedic issues that can be supported by diet?
osteoarthritis
joint dysplasia
cranial cruciate ligament rupture/luxating patella
160
what must be managed in young dogs (especially large and medium)?
growth rate through diet
| exercise
161
what is the key area of nutrition for dogs with arthritis?
weight management
162
how can reducing weight lead to improved arthritis?
reduces pain as weight and so force through joints is reduced
163
what are the key ingredients in arthritis diets?
omega 3 fatty acids (EPA/DHA)
green lipped mussel
glucosamine and chondroitin sulphate
164
what is the role of omega 3 fatty acids in arthritis management?
reduces inflammation
165
what is the required amount of omega 3 needed to have an effect on arthritis?
230-370 mg/kg
166
what is the role of glucosamine and chondroitin sulphate?
cartilage formation and repair
reduce inflammation
slow cartilage degeneration
167
what are the aims of diabetic diets?
support in achieving normal glucose levels
decrease postprandial glucose peaks
achieve normal metabolism of carbs, fats and proteins
normalise body weight
168
what is the effect of high fibre on DM?
regulation of glucose spikes
169
what % DMB of a diabetic diet should be made up of protein in dogs?
15-25%
170
what % DMB of a diabetic diet should be made up of protein in cats?
28-50%
171
why should fat be controlled in diabetic diets?
high fat will increase insulin resistance
172
what % DMB of a diabetic diet should be made up of fat?
<20%
173
what is an important dietary factor in DM management?
insoluble carbohydrate (fibre)
174
what blood parameter is moderated by diabetic diets?
fructosamine
175
what must be avoided when feeding diets in cats while hospitalised?
food aversion - do not feed new diet while in hospital
176
what is often seen alongside hyperthyroidism?
chronic renal failure
177
why may kidney disease only become apparent after treatment of hyperthyroidism?
renal perfusion is increased in hyperthyroidism
| as thyroid resolves this will drop and so CKD will become obvious
178
what is required in the diet for the production of thyroid hormones?
iodine
179
what level of iodine should be seen in a diet for hyperthyroid cats?
0.2ppm DMB
180
what is the issue with hyperthyroid diets (e.g. Hills y/d)?
must be exclusively fed
| poisonous to euthyroid cats
181
is there a single diet appropriate for all cardia cases?
no - holistic approach and discussion with vets
182
what are the main considerations for nutrition of the cardiac patient?
mild sodium restriction to maintian BP
maintain optimal BCS
monitor muscle mass in severe cases (cardiac cachexia)
183
what are the main things that can be added to the diet to support cardiac health?
amino acids
184
what amino acids can support cardiac function?
taurine
lysine and methionine to synthesise L-carnitine
arginine
185
what is taurine deficiency linked to?
dilated cardiomyopathy
| cats especially needed as they cannot synthesise
186
what is the role of L-carnitine in cardiac health?
myocardial energy production
187
what is the role of arginine in cardiac health?
normal vasular tone
188
what is the role of omega 3 fatty acids in cardiac health?
reduces muscle loss - cardia cachexia
| anti-arrhythmatic effects
189
what should never be restricted in pet diets unless specifically required by condition?
protein - especially in older animals
