Nutritional Diseases

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Nutritional Diseases
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Nutritional Diseases

• Obesity
• Starvation
• Vomiting/Diarrhoea
• Skin Problems
• Colitis

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Obesity

• Energy intake exceeding requirement at some stage
  in the animals life.
• In a few cases obesity may be secondary to
  endocrine disorders and drug-induced polyphagia
• Excess energy is deposited as fat

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Problems associated with obesity

• Joint and Circulatory Disease
• Liver disease
• Reduced heat tolerance
• Reduced resistance to disease
• Increased skin problems
• Decreased life span
• Complicates surgical and medical treatment

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Managing Obesity

• Should be able to feel the back bone and palpate
  the ribs with 4-10mm of fat over the ribs
• Estimate ideal weight
• Weight loss should be gradual -5 per week
  maximum
• Commercial calorie controlled diets are easiest
  to use
• Encourage increased exercise

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Weight Reduction

• Programme based on a combination of decreased
  energy intake, increased physical exercise (where
  possible) and behavioural management is
  considered the most effective approach to
  reducing body

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More exercise as well
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Starvation

• After 48hrs of starvation the livers reserves of
  glycogen are depleted
• Instead, fat sources are utilized extensively
  until they are exhausted.
• The pancreas reduces insulin secretion.
• The animal reduces its metabolic rate and many
  organs begin to shrink.
• The villi in the gut also shrink and the gut has
  less capacity to absorb nutrition.
• Eventually the body will utilise protein for
  energy resulting in loss of body mass
• Levels of potassium, magnesium, and phosphate in
  the body diminish even though serum levels are
  maintained.
• 1-3 of body weight is lost daily

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Appropriate precautions in re-feeding

• Feedings should be divided into 6-8 small
  feedings/day
• Initially only be enough to supply an estimated
  50 of caloric needs, gradually increasing the
  amount fed at each feeding and decreasing the
  frequency. Go very slowly!
• Feed performance high quality foods with high
  biological value protein
• Fluids should be administered very carefully to
  prevent volume overloading complications, with
  the reduced cardiac functioning.
• Provide vitamin and mineral supplementation.
• Go very slowly!

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Vomiting

• a symptom of many different diseases.
• Dont confuse with regurgitation
• Passive back flow of food from the stomach
• May be recently eaten food, partly digested food,
  water froth or bile
• Will cause profuse salivation
• Occasional vomiting is normal because the dog is
  a garbage eater

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• In order to determine how sick the dog has become
  as a consequence of the vomiting some of the
  following may be noted   1. diarrhoea   2.
  dehydration   3. loss of appetite   4.
  abdominal pain   5. high fever   6.
  lethargy   7. bloody vomit

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Vomiting

• Gastritis/ Enteritis
• Food allergies/IBD
• Pancreatitis
• Eating a fatty meal causes V, depression and
  abdominal pain
• Dietary factors
• Car sickness/unsuitable foods/over eating/excess
  activity or eating grass
• Foreign bodies
• Corn cobs/stones etc cause blockage in SI dog
  will vomit up stomach contents after eating. May
  or may not have abdo pain
• Liver/renal/middle ear
• May be sick and anorexic as well
• Toxins-
• Pyometra causes vomiting/PU/PD depression
• Infection
• Bacterial infections/ Food poisoning/ viral
  infections/intestinal parasites

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Management of Vomiting

• Acute infrequent bouts can be treated by resting
  the stomach- fast for 4-12 hrs then introduce
  small bland meals
• If V continues for more than 24 hrs seek Vet
  attention
• Unproductive Vomiting needs Vet attention
• Vomit/ drink /vomit will dehydrate the animal
  further- dont allow access to water- seek Vet
  attention
• Chronic retching, bloody vomit, projectile
  vomiting and faecal vomiting require immediate
  Vet attention

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Diarrhoea

• Change in the frequency and consistency of bowel
  movements
• Can be mild or severe
• Bloody or not
• Smelly or not
• Flatulence, rumbly guts
• Abdominal distention
• With or without vomiting

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Causes

• Dietary Sensitivity
• Sudden Change of Diet
• Parasites
• Viral or Bacterial Infections
• Garbage Eating
• Medication
• Overfeeding

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Infectious Causes

• Bacterial
• Camphylobacter, Salmonella, E coli,
• Can be spread to people
• Viral
• Distemper, Corona, Parvo
• Severe bloody D
• Parasitic
• Giardia, Coccidia, Hookworms, Whipworms

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Mechanisms of Diarrhoea

• Interference with the digestion or absorption of
  nutrients
• Increased secretion of fluid into the intestine
• Increased intestinal permeability due to mucosal
  damage
• Altered intestinal motility

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Interference with the digestion or absorption of
nutrients

• Retained nutrients exert an osmotic effect within
  the intestinal lumen leading to the retention of
  water and diarrhoea.
• seen with nutritional overload- over feeding!!!
• with any condition where there is a deficiency of
  enzymes
• including exocrine pancreatic insufficiency
  (EPI),
• lactase deficiency.

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Increased secretion of fluid into the intestine

• By bacterial toxins
• By degradation of bile acids and dietary fat.

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Increased intestinal permeability due to mucosal
damage

• from severe inflammation
• conditions such as cardiac disease or lymphatic
  obstruction that increase intestinal hydrostatic
  pressure.
• If the pore size is large, fluid and plasma
  proteins escape, creating a protein-losing
  diarrhoea.

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Altered intestinal motility

• stagnation of intestinal contents
• bacterial proliferation
• degradation of nutrients.
• The increased faecal volume stimulates secondary
  peristaltic contractions causes hypermotility. 

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Differences between small intestinal and large intestinal diarrhoea Differences between small intestinal and large intestinal diarrhoea Differences between small intestinal and large intestinal diarrhoea
Clinical Finding Small Intestine Large Intestine
Frequency of defaecation Normal or slightly increased Increased
Faecal volume Increased Small amounts
Urgency or tenesmus Absent Usually present
Blood in faeces Dark blood (digested) Red blood (fresh)
Mucus in faeces Usually absent Abundant
Steatorrhoea May be present Absent
Appetite Normal or increased Normal or reduced
Weight loss May be present Rare but may occur if long term problem
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Acute Diarrhoea

• Less than 5 caused by enteral bacteria
• Dietary indiscretion, such as scavenging,
  overfeeding or sudden dietary change, is the
  major cause generally self-limiting and do not
  result in significant dehydration.
• Viral infections are usually severe enough to
  cause dehydration
• Can often be managed by providing a short period
  (24 hours) of dietary rest and re-hydration
  therapy followed by the introduction of a bland
  diet once fluid and electrolyte balance is
  restored.

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Chronic Diarrhoea

• Need to know
• Duration and severity of d
• Faecal characteristics
• Appetite
• Body weight changes
• Breed, age, diet and environment
• Tests that can be done
• Faecal float, endoscopy, biopsy and bloods

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Chronic Diarrhoea

• Need to determine if small or large bowel in
  origin.
• Could be
• primary gastrointestinal disease or
• systemic conditions, including cardiac, renal and
  hepatic disease, hypoadrenocorticism and
  infectious disease.

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Small Intestinal Disease

• Exocrine pancreatic insufficiency (EPI), dietary
  sensitivity, neoplasia, bile acid deficiency and
  short bowel syndrome.
• Small intestinal bacterial overgrowth (SIBO) is a
  common problem that may occur as a complication
  in up to 50 of dogs with chronic diarrhoea.
• Inflammatory bowel disease (IBD), is
  characterised most commonly by infiltration with
  lymphocytes, plasmacytes, or eosinophils

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Small Intestinal Disease

• Diet plays an important role in management
• should be highly digestible since many diseases
  are likely to interfere with digestive and
  absorptive function.
• In most circumstances, therefore, high fibre
  diets are contraindicated for the management of
  small intestinal disease.

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EPI

• Pancreatic enzymes are reduced or absent in EPI,
  leading to impaired digestion and absorption of
  fat and, to a lesser extent, carbohydrate and
  protein.
• This results in weight loss, despite a ravenous
  appetite, and diarrhoea with steatorrhoea.

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Management of EPI

• Provision of a low fat, highly digestible diet
• Feed amounts based on the dogs current (not
  ideal) body weight
• Divide food allowance into two meals per day
• Prescribe the appropriate amount of enzyme
  replacer Viokase
• If poor results, consider using H2 receptor
  antagonist (cimetidine) 30 minutes before feeding
  
• Once faecal character is restored, gradually
  increase food allowance and enzyme replacer to
  allow body weight gain over a period of weeks
• As body weight increases, expect a reduction in
  ravenous appetite and improvement in other
  clinical signs
• If diarrhoea recurs because of access to other
  food, or if the food allowance is increased too
  quickly, fast the animal for 24 hours before
  gradually reintroducing the regimen
• Use only the low fat diet during the period of
  stabilisation
• For long term maintenance, alternative (low or
  moderate fat) diets may be tried but all dietary
  changes should be made gradually and only after
  the dog has been stable for some time.
• Any diet changes may necessitate a change in
  dose of the enzyme supplement.

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Large Intestinal Disease

• Some idiopathic cases may respond to dietary
  supplementation with fibre and are termed
  fibre-responsive
• Dietary modification is a key element in the
  management of most large intestinal disorders.
• In contrast to small intestinal diseases, dietary
  fibre plays a major part in the management of
  diarrhoea of large intestinal origin.
• Some animals become sensitised to some dietary
  proteins and should be fed novel proteins such as
  kangaroo, fish or Z/D

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Dietary Fibre

• Adding a fibre source providing both insoluble
  and soluble forms may be beneficial in the
  symptomatic treatment of some large bowel
  diseases,
• fibre helps to normalise transit time and faecal
  water content.
• In addition, fibre can act as a significant
  nutrient in the large bowel by virtue of its
  partial fermentation by bacteria to short chain
  fatty acids
• and by virtue of their osmotic action they draw
  water into the stool, increasing bulking..

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Irritable Bowel Syndrome

• The clinical signs of irritable bowel syndrome
  are indistinguishable from colitis,
• no pathological changes are found on endoscopic
  examination or biopsy evaluation.
• The condition is thought to be associated with
  stressful situations that lead to altered
  intestinal motility.
• Treatment is aimed at identifying and removing
  the underlying stress factor although drug
  therapy with motility modifiers, spasmolytics or
  sedatives may also be required.
• Dietary fibre supplementation may be beneficial
  in some cases through its physical properties,
  which help to normalise colonic contractility.

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Idiopathic Chronic Colitis

• One of the most common causes of chronic
  diarrhoea in the dog (Bush, 1985).
• The underlying aetiology of this inflammatory
  large bowel disease is unclear.
• Commonly, therapy aims to treat the signs through
  control of inflammation.
• Anti-inflammatory drugs, motility modifiers,
  antibiotics and dietary manipulation have all
  been implemented with varying degrees of success
• Use hypo-allergenic diet, low fibre, restricted
  fat diet

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Special Diets

• Oral Care
• Sensitive Stomach
• Low Fibre
• Low Fat
• High Fibre
• Sensitive Skin
• High Energy

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Specialised Diets
There are "veterinary supply only" diets
available for many medical disorders (eg for the
treatment, control and prevention of obesity,
heart, kidney, liver problems,  bladder stones,
and skin allergy). examples are

• Reduced phos
• Low protein
• Medium protein
• Selected protein
• Low fat
• Low residue diets
• Joint Maintenance
• Cognitive Function

• Kidney
• Recovery
• Response
• Skin Coat
• Stress/Weight Gain
• Weight Loss
• Weight Maintenance
• Ultra Allergenic

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Prescription Diets
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End Of Presentation