Veterinary Medicine - November 2008 - (Page DM12)

perform surgical exploration on a patient, we always put in a jejunostomy feeding tube. Williams: Does it make a lot of difference where you deliver the nutrition? Twedt: No. But if a patient is vomiting, a jejunostomy tube allows the food to go farther down in the gastrointestinal tract and beyond where nutrients stimulate pancreatic secretion. The limitation of the tubes is that the nutrition must be a liquid diet. Forman: I prefer to place gastronomy tubes and feed right into the stomach in these cats. Steiner: You can also provide nutrition to these cats parenterally. You can use partial parenteral nutrition (PPN) or total parenteral nutrition. PPN is more userfriendly, and I think it’s adequate for a while. Robertson: Parental nutrition supports the patient’s caloric needs, but it doesn’t nourish the enterocytes. Some internists and criticalists recommend providing microenteral nutrition by trickle feeding through a feeding tube to provide nourishment to the gastrointestinal tract. Do you do that? Forman: Yes, even a small amount of enteral nutrition has been shown to prevent the complications of NPO. Robertson: I put a jejunostomy tube in my cat when he developed pancreatitis and was anorectic, but this became a problem when my cat came home because you can’t meal feed through a jejunostomy tube. Only small amounts of food are tolerated at one time. With a gastrostomy tube, you can still give food through the tube as a CRI while the cat is hospitalized, but then when the cat goes home, the owner can bolus or meal feed the cat if some nutritional support is still necessary. Nasogastric tubes are convenient especially for short-term nutritional support, either because you think the cat is getting better or it is too unstable to anesthetize for a more permanent tube. However, nasogastric tubes limit what you can feed because they require a very liquid diet. What do you recommend feeding the cats through tubes? Williams: Low-fat diets can be formulated that are easily injected down feeding tubes, but I don’t worry too much about fat content unless the cat has hyperlipidemia, which is rare. Anecdotally, veterinary nutritionists have told me they don’t see any bene t from administration of special low-fat liquid diets. Twedt: I use CliniCare Canine/Feline Liquid Diet (Abbott Animal Health) if I’m using a nasogastric or jejunostomy feeding tubes. Forman: I avoid high fat levels and choose diets that are better balanced for the intestinal tract. A low12 residue diet is my rst choice for feeding through a gastrostomy tube. Steiner: I would use the diet with the lowest fat content that I can nd. Twedt: Practitioners must be careful about using human preparations because of the protein content being too low for cats because of their high protein requirements. Robertson: We discussed diet for hospitalized patients. What about the feeding of cats with chronic pancreatitis? The challenge I’ve had with these cats is that they often have concurrent disease, such as IBD, and I wanted to put them on a low-fat, novel protein source diet but no such diet is commercially available. So I focused on the intestinal disease. What are your recommendations? Forman: If I think that the cat only has pancreatitis, then I put it on a low-residue diet. If I think that the cat has pancreatitis and intestinal disease, I usually put it on a novel protein diet. The caveat for owners is that the cat must eat. So if their cat won’t eat one of these special diets, they need to go back to whatever they were previously feeding. Steiner: If the cat just has IBD, I would use a novel protein diet. No studies show whether a novel protein diet, a hydrolyzed protein diet, an easily digestible diet, or a low-carbohydrate diet works better than any of the others in patients with IBD. So I don’t think it makes a difference. If the cat I am treating has IBD and pancreatitis, I use an easily digestible diet because it is lower in fat than the others. Also, if the cat has pancreatitis and diabetes, then I use a high- ber diet. No diet is perfect for any one of these situations, so I choose the one that is best for the patient as a whole. Williams: My dietary recommendations are driven by the clinical signs. If chronic diarrhea is the major clinical problem, no matter what the laboratory results are, I recommend a low-carbohydrate diet or highly digestible diet in the rst instance. If the major problem is chronic vomiting, I try a novel antigen diet. If these choices do not work then try an alternative diet before abandoning the dietary management route. Twedt: We have no studies to support these diet choices; all of these recommendations are opinions. It’s trial and error to nd a diet that works and that the cat will eat. Robertson: This is another area where we may be able to use the Spec fPL test. We can start a diet and then retest. We can change the diet and look at the response. Maybe monitoring these cats with the Spec fPL will help us sort out these dietary recommendations.

Table of Contents Feed for the Digital Edition of Veterinary Medicine - November 2008

Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

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