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1/10/12
Case 1
5yr old, mixed breed Poor appetite for 5 days previous Vomiting for a few times per day BCS - 4/9, lost quite a bit of weight Sent home with antiemetic which decreased vomiting but dog still had no appetite Discovered it had very thickened segment of small intestine Plan is to go to surgery to remove abnormal segment Risk of malnutrition is higher as dog is already showing signs of malnutrition The thickened bowel is likely indicative of an infiltrative disease (which is often not determined until histopathology) which if responsive to therapy will take some time to resolve. Therefore appetite is unlikely to be immediately resolved Better plan is to think how to give good nutritional support to the dog in the face of poor food intake following surgery Had the intervention been definitely curative for example the removal of a chronic foreign body that was only partially obstructing the bowel, the risk for developing malnutrition would have been lower
Dan Chan
1/10/12
Case 2
8 month cross breed dog Loss of appetite Diarrhoea this morning, abdominal discomfort Owners found vomit in the house but did not witness or hear the event, they also have no other pets Shows some signs of dehydration BCS - 5/9, dog is quiet and alert With further questioning, the owners revealed the dog was scavenging in rubbish the previous night Abdominal radiographs taken, no obstruction seen just fluid distension Low risk of developing malnutrition dietary indiscretion whereby a dog consumes a variety of things usually leads to a short term, self-resolving bout of GI upset Dogs often respond to a day of starvation as long as treated for dehydration Fluid therapy usually sufficient enough Food is offered once dog has stopped vomiting offered gradually Use food which is easily digestible with low fat so boiled rice and chicken or mince
Case 3
14 yr old cat 4 week weight loss despite good appetite (more than usual) Some vomiting after eating which the client attributed to eating too fast Doesnt know if it is has diarrhoea because the cat is free to go outside Cat has lost 0.9kg since last check 6 months ago now weighs 4.2kg with a BCS of 4/9 Coat quality has also decreased Otherwise the cat is bright, alert, even anxious and vocal Has tachycardia with gallop rhythm Thyroid nodule is easily palpable Some muscle loss is noted over its back Hyperthyroidism is the most likely diagnosis This is not likely to produce malnutrition if treated correctly
Vomiting and nausea are common to many conditions and is a leading cause of poor food intake usually treated with antiemetic medications Hypersalivating is a classic sign of nausea If animals are inappetant, an enteral feeding tube can be used o When this is not possible eg the gut is intolerant of food or animal continues to vomit, parenteral nutrition is the only possible intervention
Dan Chan
1/10/12
Naso-oesophageal tube
Most common tube used in practice, however may not be the most efficient Easily placed with local anaesthetic within the nasal cavity Lubricated small feeding tube (3.5-5 Fr sized) is placed within the most medial and ventral nasal meatus and fed down to the caudal oesophagus After placement, a radiograph should be taken to confirm proper location Only allows liquid diets which are limited in choice and fairly expensive
Oesophagostomy tube
One of the most efficient tubes Tubes are well tolerated and allow more significant amounts of food to be fed because they are at least 14Fr in diameter Easy to place, only brief anaesthesia needed but it is general anaesthetic
If they do not tolerate tube feeding, parenteral nutrition is used Parenteral nutrition is amino acids, glucose and lipids directly into the bloodstream via IV It is expensive, requires specialist equipment and facilities to make There is a risk of complications hyperglycaemia, hyperlipidaemia and infection For these reasons, it is carried out at referral centres usually