GI - clinical nutrition

Question 1

What is the resting energy requirement?

Answer 1

Energy used in thermoneutral conditions at rest

Question 2

What is the equation for RER?

Answer 2

70(BW in kg)^0.75
For animals between 2-30kg - 30(BW in kg) + 70

Question 3

What are the units for RER?

Answer 3

Kcal/day
to get grams you will be given kcal/kg so divide by this number divided by 1000

Question 4

What is the maintenance energy requirement?

Answer 4

Energy used in thermoneutral conditions by a moderately active animal including the energy require to obtain and use the food

Question 5

What are some secondary problems of obesity?

Answer 5

Osteoarthritis
Respiratory compromise/disease
Urinary disease
Diabetes mellitus
Hepatic lipidosis
Pancreatitis

Question 6

What is a risk in cats if they lose too much fat too quickly?

Answer 6

Hepatic lipidosis

Question 7

What disease does low calcium containing diet eg. raw diet cause?

Answer 7

Nutritional secondary hyperparathyroidism - takes calcium out of bones causing thin bones

Question 8

What causes taurine deficiency?

Answer 8

Cats fed vegan/vegetarian diets - is an essential amino acid from meat
Can be from manufacturing fault

Question 9

What does taurine deficiency cause?

Answer 9

Blindness - retinal degeneration
Dilated cardiomyopathy
Reproductive failures

Question 10

What causes thiamine (vitamin B1) deficiency?

Answer 10

Manufacturing fault
Excessive dietary thiaminase - raw fish diet

Question 11

What are the clinical signs of thiamine (vit B1) deficiency?

Answer 11

Anorexia
Neck ventroflexion
Neuro signs

Question 12

What is the main differential or thiamine deficiency?

Answer 12

Hypokalaemia

Question 13

What is pansteatitis?

Answer 13

Yellow fat disease - caused by high polyunsaturated fatty acid diet which increases oxidation and depletes vitamin E leading to deficiency

Question 14

What diet usually causes pansteatitis?

Answer 14

Oily fish diets

Question 15

What are the clinical signs of pansteatitis?

Answer 15

Hot painful inflamed fat in abdominal/inguinal areas
+/- Fat necrosis, drainage tracts
Pyrexia

Question 16

What is the treatment and prognosis of pansteatitis?

Answer 16

Appropriate diet
Vit E supplementation
Analgesia - steroids
Good prognosis

Question 17

What are ways to encourage oral intake?

Answer 17

Address underlying disease
Correct fluid deficits, electrolyte imbalances
Antiemetics
NEVER syringe feed - creates aversions
Highly palatable, highly digestible food

Question 18

What electrolyte imbalances will anorexic cats tend to have which will stop them wanting to eat?

Answer 18

Vitamin B12 deficient
Potassium deficient

Question 19

What is the main food of the enterocytes?

Answer 19

Glutamine - get nutrition directly from the lumen of the intestine

Question 20

When should you use naso-oesophageal feeding?

Answer 20

Suitable for short term (<7day) nutritional assistance - liquid diet

Question 21

When is a naso-oesophageal tube unsuitable?

Answer 21

If regurgitating/vomiting
If have nasal/oral/pharyngeal/oesophageal disease

Question 22

How can you test if a naso-oesophageal tube is in the oesophagus?

Answer 22

Negative pressure in syringe
Water push in quickly - cough

Question 23

When should you use an oesophagostomy tube?

Answer 23

If need longer term placement
If needs managing at home

Question 24

Where should you measure the oesophagostomy tube to?

Answer 24

7th/9th rib from neck

Question 25

When should you use a gastrostomy tube?

Answer 25

Where bypass of the proximal GI tract is needed eg. oesophageal disease
Longer term management
At home use

Question 26

What are the complications of tube feeding?

Answer 26

Stoma infections
Tube dislodgement
Tube obstruction (try coke)
Re-feeding syndrome

Question 27

What is re-feeding syndrome?

Answer 27

Insulin release following prolonged fasting can cause hypophosphatemia, goes into cells and causes haemolysis
So gradually increase food over 3-4 days

Question 28

How do you remove a oesophageal/gastrostomy tube?

Answer 28

Remove sutures
Keep end of tube capped to prevent aspiration
Clean stoma site
Apply primapore - hole will heal itself, dont need to suture