Exam 4: Week 13-16 Flashcards
(32 cards)
Given dietary history of a dog or cat, and product labels for prescription diets, select an appropriate elimination diet for your patient.
Strict elimination diet trial
Duration
◦ Dogs: clinical signs in remission in 85% by 6 weeks, 95% by 8 weeks
◦ Cats: clinical signs in remission in 80% by 6 weeks, 90% by 8 weeks
◦ Detailed diet, supplement, and medication history
Develop an elimination diet trial plan for a patient, including duration of the diet, and interpretation strategy.
6-8 weeks
Make sure they aren’t doing treats or flavored tablets as well.
To review and understand the nutritional needs of growing companion animals
Tube functioning at the highest part of GI tract.
Disadvantages of going too far down: a tube that goes into the jejunum -jejunostomy tube, (stomach has mechanical breakdown, pepsin, kind of like food traffic control, straight into jejunum would cause malabsorption)
To review the terminology used to classify hepatic diseases
Hepatic terminology:
* Liver enzymes: ALT (in liver cells), ALP (endothelial cells), ASP (mitochondria and muscles)
* Pseudo liver function tests: blood urea nitrogen (BUN), albumin, glucose, cholesterol
* Pre and post prandial bile acids - easiest and best liver function tests
* Bilirubin concentration: Pre‐hepatic (hemolytic anemias), Hepatic, Post‐hepatic (obstruction outside the liver parenchyma)
* Hepatic dysfunction
* Hepatic failure
To recognize clinical and laboratory findings suggesting specific hepatic and urinary tract diseases that could benefit from dietary interventions
In liver disease patients you may see: ascites
Dietary management of liver disease: energy, protein (restrict in hepatic encephalopathy), fiber (lessen ammonia absorption, may lessen hepatic encephalopathy), vitamins and minerals (B & E, moderate sodium, adequate potassium, restrict copper), anti-oxidants (increased zine, E, C, taurine)
**In urinary tract disease patients you may see: **
Azotemia: increased BUN, creatinine, or SDMA.
Pre-renal: dehydration (specific gravity >1.035/1.030
Renal: urine specific gravity < 1.035/1.030 (anuria, oliguria, polyuria)
Post-renal: hyperkalemia, the bladder could be blocked or ruptured
To discuss specific nutritional management strategies to treat or slow progression of hepatic and urinary tract diseases
The key to liver is to avoid malnutrition and lessening copper accumulation
Control of phosphorous in a renal failure patient is most important. Give more water, and wet food if possible.
Understand the definitions for hepatic enzyme activities and function tests
Learn the basic dietary management strategies for liver disease (slide 16)
Energy
High palatability, high energy density, small meals frequently. Fat: 20-50% of dietary calories. Carbs: maximum of 45% of dietary calories, complex carbs
Protein
High quality, highly digestible, low in copper (beef, cheese, eggs), more than 20% of dietary calories, restrict only in hepatic encephalopathy
Fiber
Moderate amounts, preferably soluble (effect on bacterial aftergrowth, lessen NH3+ absorption > may lessen hepatic encephalopathy)
Vitamins and minerals
Increased vitamin B&E (anti-oxidant), moderate sodium restriction (lessens ascites), adequate potassium and restricted copper (lessens accumulation)
Anti-oxidants
Increased zine, vitamin E, vitamin C, and taurine
Discuss the management of complications of hepatic encephalopathy and ascites
Understand the definitions of azotemic.
Azotemia: increased BUN, creatinine or SDMA
Learn the benefits of diets in the management of polyuric renal azotemia (slide 41).
BUN control (highly digestible, low protein), acidosis control (alkalinizing diets), phosphorous control (secondary renal hyperparathyroidism), corrects potassium wasting (extra supplementation sometimes indicated, MAKE SURE THEY EAT.
Learn which urinary bladder stones are radiodense and can be dissolved by diets (slide 52).
Dense: ca oxolate, struvite *, silicate
Lucent: urate *, cystine * (need ultrasound)
You only acidify the urine of the STRUVITES
* Can be dissolved medically *
Understand the approach to feeding a hospitalized patient
Why wait to feed? Make sure patient is stable before you decide to feed
Why and what should your feed? ¼ - ⅓ RER, thiamine, cobalamin, vitamin B complex
Understand the complications associated with feeding a starved animal too fast
Refeeding syndrome, K, MG2+, P : refeeding Kills Malnourished Pets
Correct electrolyte balances and hydrate before feeding
Review how to evaluate a product and convert crude protein and crude fat to g/1000 kcal
Grams of nutrient per 100 or 1000 kcal basis Formula: (Nutrient on
GA)/(kcal per kg) x 10000 = grams of nutreint per 1000 kcal
Guaranteed analysis
Understand complications associated with NPO
Say no to NPO.
Enteral feeding maintains the gut barrier, reduces the risk of bacterial translocation, shortens the time to recovery, and improves weight gain
Be able to list the different assisted feeding tube methods and advantages/disadvantages to each one:
NASOESOPHAGEAL
Nasoesophageal
feeding tubes
Advantages:
require minimal, if any, sedation
require no special equipment
Disadvantages:
patient discomfort
exclusive use of liquid diets because of small tube size
Procedure is largely blind‐ rare but serious complication is perforated lung
IMPORTANT: must verify placement of the tube
* radiograph
* end‐tidal carbon dioxide monitor.
Always take a radiograph before putting food through the tube.
Be able to list the different assisted feeding tube methods and advantages/disadvantages to each one:
ESOPHAGEAL TUBE
Advantages:
easy to place
require only brief anesthesia
can accommodate more calorically‐dense diets (ie, >1
kcal/mL), making them ideal for patients that have
feeding‐volume limitations.
Tube size range from 12 to 19 Fr
Potential problems:
tube obstruction
cellulitis at the stoma site
Be able to list the different assisted feeding tube methods and advantages/disadvantages to each one:
PERCUTANEOUS GUIDED GASTRONOMY
tubes (PEG)
* Good options for patients undergoing laparotomy and endoscopy.
* Used for long‐term nutritional support (ie, months)
* Largest feeding tube (16–32 Fr) options and can deliver most diets
after mixing in a blender.
* Requires special equipment and experience Complications:
* mild cellulitis around the stoma site
* Peritonitis‐ can be life threatening
* Premature tube dislodgement (before 14 days) should
be immediately evaluated for the need for possible
surgery.
Ideal diet for ferrets
Short intestinal tract, short GI transit time (3-4 hours adults, 1 hour kits), Carnivores, but do not gorge = small meals, frequent intervals,hide snacks, Unsophisticated gut flora = scant anaerobic bacteria = decreased, GI upset and diarrhea from long term antibiotic therapy, Don’t digest fiber…you put broccoli in, you get broccoli out, Need high protein (30-40%), high fat (15-30%) diet, In addition to being high protein, it needs to be of high quality
ideal diet for rabbits (guinea pigs and chinchillas)
are all hindgut fermenters with a long GI transit time. High fiber, low nutrient, poorly digestible diet = intake of diet is high, compliments GI tract design, useful for constant chewing for wear of dentition. Unique calcium metabolism = calcium carbonate crystals. Inappropriate diet can lead to dental malocclusion, obesity, dysbiosis, enteritis, decreased GI motility. IDEAL DIET 90% hay, grass for adults, alfalafa for young and pregnant and thin geriatric - pellets feed in small portions, size of eyes - leafy green vegetables, size of skull - fruits/grains/seed/treats
(Guinea pig difference: VITAMIN C, water supplementation not reliable.
Chinchilla difference: higher nutrient need, also limit suits seeds and carbs)
ideal diet for rats and mice
highly studied, not hindgut fermenters= higer protein requirements, rodent block=mahority of diet, small amounts of produce as treats
ideal diet for hamsters and gerbils
(similar to cows, foregut fermentation) less reliant on protein than rats, large cecum and colon, more omnivores than herbivores, desert animals but still need water, produce items as rewards
ideal diet for hedghogs (insectivores)
chitinase, hedgehog specific diet, higher fiber requirement than carnivores, small amount of insects, small food items (can get lodged in mouth)
