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Craven MD. Repurposing medical devices as "button" esophagostomy tubes for extended nutritional support. J Vet Intern Med 2021; 36:196-203. [PMID: 34786762 PMCID: PMC8783322 DOI: 10.1111/jvim.16313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background Esophagostomy tubes (E‐tubes) are widely utilized for extended nutritional support in dogs and cats. Problems associated with their use include the unwieldy excess (10‐20 cm) of external tubing, constant need for neck wraps and necessity for skin sutures, suture tract infection, and tube loss if sutures fail. Objectives To evaluate 2 different, low profile (LP) “button” products intended for use in people as enteral (jejunostomy [J] and gastrojejunostomy [G‐J]) feeding tubes for suitability as LP E‐tubes in dogs and cats. Animals A young giant breed dog that required extended (>6 months) nutritional and fluid support during recovery from severe neurological illness with protracted adipsia, anorexia, and dysphagia. Methods Prospective evaluation of 2 commercially available LP feeding devices after placement of a standard E‐tube. An LP J‐tube and an LP G‐J tube were assessed in consecutive 4‐week trials, for tube retention, patient comfort, stoma health, and functionality. Results Both products performed extremely and equally well as LP E‐tubes in this clinical patient, enhancing patient freedom and comfort by eliminating external tubing, skin sutures, and bandaging. The dual port G‐J tube allows medication delivery (eg, sucralfate) to the entire esophagus, but for safety alone (ie, to avoid aspiration), the single port J‐tube appears the best device for client‐owned patients. Conclusions and Clinical Importance The LP enteral feeding tubes from the human medical field can be successfully used as LP E‐tubes in dogs and cats, offering superior patient comfort, with no obvious detriment to the patient and main drawback of higher cost.
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Affiliation(s)
- Melanie D Craven
- Western College of Veterinary Medicine, 52 Campus Dr., Saskatoon, Saskatchewan, S7N 5B4, Canada
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Lhuillery E, Etchepareborde S. Surgical management of a cervical esophageal diverticulum in and long-term outcome for a five-month-old cat. J Am Vet Med Assoc 2021; 259:396-400. [PMID: 34337966 DOI: 10.2460/javma.259.4.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 5-month-old domestic shorthair cat was presented for recurrent regurgitation and hypersalivation after eating, which had been evident since adoption 2 months earlier. CLINICAL FINDINGS Physical examination was unremarkable. Plain thoracic radiography, positive contrast esophagography, endoscopy, CT, electromyography, and blood analysis were performed. A caudal cervical esophageal diverticulum, likely congenital, was diagnosed. TREATMENT AND OUTCOME A diverticulectomy was performed with a surgical stapler while an endoscope was in the esophageal lumen. No intra- or postoperative complications were reported. Postoperative and short-term outcomes were excellent, with resolution of clinical signs and no endoscopic esophageal abnormality 3 months after surgery. The cat remained without clinical signs 8 months after surgery. CLINICAL RELEVANCE An esophageal diverticulum in a cat is rare. The cat of this report had a good outcome following surgical management of a cervical esophageal diverticulum. Surgery is worth considering for similarly affected cats, but additional cases are required to confirm the benefit of surgery versus conservative management.
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Griffin MA, Culp WTN, Garcia TC, Glaiberman CB, Giuffrida MA, Balsa IM, Mayhew PD, Johnson EG, Marks SL. Percutaneous radiologically guided gastrostomy tubes: Procedural description and biomechanical comparison in a canine model. Vet Surg 2020; 49:1334-1342. [PMID: 32537766 DOI: 10.1111/vsu.13454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/02/2020] [Accepted: 05/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the novel placement of percutaneous radiologically guided gastrostomy (PRG) tubes in a canine cadaveric model and to biomechanically compare PRG and percutaneous endoscopic gastrostomy (PEG) tube constructs. STUDY DESIGN Descriptive and biomechanical experimental study. ANIMALS Fifteen large breed (>25 kg) canine cadavers. METHODS Percutaneous endoscopic gastrostomy tubes, low-profile PRG tubes, and standard PRG tubes were each placed in five canine cadavers. Body wall and stomach (with attached gastrostomy tube constructs) were harvested and biomechanically tested. Data regarding the maximal load to failure and procedure time were statistically analyzed. RESULTS Percutaneous endoscopic gastrostomy and PRG tube placement was successful in all cadavers with no procedure-related complications. Gastrostomy tube placement time was longer for the PEG group vs the low-profile PRG (P = .005) and standard PRG (P = .037) groups. Peak construct strength was lower for the PEG group vs the low-profile PRG (P = .002) and standard PRG (P = .010) groups. The site of failure varied among groups. CONCLUSION Percutaneous radiologically guided gastrostomy tubes were successfully placed in all cases with shorter placement time and greater peak construct strength compared with PEG tubes. CLINICAL SIGNIFICANCE Due to the increased load to failure as well as decreased placement time recorded for PRG tubes relative to PEG tubes, PRG tubes may be considered as an alternative minimally invasive gastrostomy option in large breed canine patients. Further evaluation in clinical animals is required. Results of this work were presented at the 2019 American College of Veterinary Surgeons Surgery Summit; October 16-19, 2019; Las Vegas, Nevada.
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Affiliation(s)
- Maureen A Griffin
- Veterinary Medical Teaching Hospital, University of California-Davis, Davis, California, United States
| | - William T N Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, United States
| | - Tanya C Garcia
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, United States
| | | | - Michelle A Giuffrida
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, United States
| | - Ingrid M Balsa
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, United States
| | - Philipp D Mayhew
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, United States
| | - Eric G Johnson
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, United States
| | - Stanley L Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, California, United States
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Bishop BA, Gallagher AE. Biomechanical comparison of two percutaneous gastropexy techniques for securing percutaneous endoscopic gastrostomy tubes in canine cadavers. Am J Vet Res 2020; 80:1020-1025. [PMID: 31644345 DOI: 10.2460/ajvr.80.11.1020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To biomechanically assess outcomes for 2 percutaneous gastropexy techniques and determine the amount of time necessary to perform the techniques for securing percutaneous endoscopic gastrostomy (PEG) tubes in canine cadavers. ANIMALS 18 canine cadavers. PROCEDURES 6 cadavers were assigned to each of 3 groups (PEG tube only, PEG tube with T-fastener gastropexy, and PEG tube with U-stitch gastropexy). Time to completion of placement of a PEG tube and gastropexy was recorded. After tubes were placed, the stomach and body wall on the left side of the abdomen were removed and biomechanically tested. Maximum tension at the time of initial failure of the PEG tube or gastropexy was recorded. RESULTS Significantly more force was required to induce failure for the T-fastener and U-stitch techniques than for the PEG tube only technique. In addition, both the T-fastener and U-stitch techniques required significantly more time for placement than did the PEG tube only technique. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that performing a T-fastener or U-stitch gastropexy may decrease the risk of early dislodgement of a PEG tube in dogs. However, studies conducted with these techniques in live dogs would be necessary to confirm this hypothesis. The additional amount of time needed to perform the T-fastener or U-stitch gastropexy would likely be clinically unimportant.
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Elmenhorst K, Pérez López P, Belch A, Demetriou JL. Retrospective study of complications associated with surgically-placed gastrostomy tubes in 43 dogs with septic peritonitis. J Small Anim Pract 2019; 61:116-120. [PMID: 31763703 DOI: 10.1111/jsap.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the safety of surgically-placed gastrostomy feeding tubes in dogs with septic peritonitis. MATERIALS AND METHODS Retrospective analysis of 43 dogs with septic peritonitis that had undergone surgical exploration and gastrostomy tube (de Pezzer or Foley) placement as part of the surgical procedure. Postoperative recovery times, hospitalisation times, complication rates and overall survival times were documented. RESULTS The most common cause of septic peritonitis was dehiscence of an enterotomy or enterectomy site. Fifteen dogs had a Foley gastrostomy tube placed and 28 had a de Pezzer gastrostomy tube placed. The median time from surgery to the start of enteral nutrition was 16 hours (range 3 to 28 hours). There were no major complications relating to the gastrostomy tube; minor complications occurred in 11 (26%) patients. The overall median time spent in hospital was 5 days (range 3 to 29 days) for patients surviving to discharge and 22 (51%) dogs survived overall. CLINICAL SIGNIFICANCE Gastrostomy feeding tubes provide a safe way to provide enteral nutrition to dogs with septic peritonitis; they are associated with a low complication rate in these patients.
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Affiliation(s)
- K Elmenhorst
- Dick White Referrals, Cambridgeshire, CB8 0UH, UK
| | | | - A Belch
- Small Animal Referral Hospital, University of Bristol, Bristol, BS40 5DU, UK
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Hansen SC, Hlusko KC, Matz BM, Bacek LM. Retrospective evaluation of 24 cases of gastrostomy tube usage in dogs with septic peritonitis (2009-2016). J Vet Emerg Crit Care (San Antonio) 2019; 29:514-520. [PMID: 31448863 DOI: 10.1111/vec.12882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/05/2017] [Accepted: 11/01/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To describe the postoperative use of gastrostomy tubes (GT) in dogs with septic peritonitis. A secondary objective was to identify factors associated with GT placement and use that may be related to outcome. DESIGN Retrospective study. SETTING University teaching hospital. ANIMALS Twenty-four dogs diagnosed with septic peritonitis with GT placement at the time of exploratory laparotomy. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Eighteen dogs (75%) survived to discharge. Eighteen dogs (75%) had a gastrointestinal source of septic peritonitis. Complications were reported in 12/24 (50%) patients. Four dogs (16.6%) had non-GT-related complications such as vomiting, regurgitation, or increased gastric residual volume. GT-related complications occurred in 8/24 (33.3%) dogs, the majority of which (6/8 [75%]) were minor and did not necessitate removal of the GT. Two dogs had major complications that required removal of the GT. Significant differences between survivors and nonsurvivors were found between the length of time after placement of the GT to when they began eating and outcome (discharge versus death versus euthanasia) (P = 0.03), and GT dwell time (length of time the GT was in place) and outcome (P = 0.006). Clinically relevant correlations were found between the time after placement of the GT until feeding and time after placement until voluntarily eating (P = 0.0349), time after placement of the GT until voluntarily eating and length of hospitalization (P = 0.0391), and time after placement of the GT until feeding and length of hospitalization (P = 0.036). CONCLUSIONS GTs can be placed during exploratory laparotomy in dogs with septic peritonitis. They facilitate early enteral nutrition and are associated with few clinically significant complications. Prospective studies are needed to determine the optimal postoperative feeding plan and the effects of early enteral nutrition on serum albumin concentration in this patient population.
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Affiliation(s)
- Sonya C Hansen
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL
| | - Katelyn C Hlusko
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL
| | - Brad M Matz
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL
| | - Lenore M Bacek
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL
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Reid SA. Permanent percutaneous endoscopic gastrotomy tube placement in a Hermann’s tortoise. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2017-000567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Aguiar J, Chang YM, Garden OA. Complications of Percutaneous Endoscopic Gastrostomy in Dogs and Cats Receiving Corticosteroid Treatment. J Vet Intern Med 2016; 30:1008-13. [PMID: 27214641 PMCID: PMC5089586 DOI: 10.1111/jvim.13969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/19/2016] [Accepted: 04/28/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Corticosteroid treatment is commonly required in veterinary patients for treatment of inflammatory, immune-mediated, neurologic, and neoplastic diseases, which also may require assisted enteral nutrition via percutaneous endoscopic gastrostomy (PEG). OBJECTIVE To evaluate complications associated with PEG use in dogs and cats receiving corticosteroid treatment. ANIMALS Forty-two animals were included in the study: 12 dogs and 2 cats in the steroid group and 26 dogs and 2 cats in the control group. METHODS Medical records, between January 2006 and March 2015, were reviewed. Patients were included if the PEG tube was in use for at least 24 hours and if complete medical records were available. Patients were assigned to the control group if they were not treated with corticosteroids during PEG use or to the steroid group if they had received corticosteroids during PEG tube use. Complications were classified as minor, moderate, and major in severity. Maximum severity complication rate was compared between groups. RESULTS The general prevalence of complications was found to be similar between groups (P = .306), but in the steroid group, 43% of the cases developed a major severity complication compared with 18% of the control group (P = .054). CONCLUSION AND CLINICAL IMPORTANCE Owners of dogs and cats receiving corticosteroids, in which PEG is planned, should be counseled about possible complications beyond those associated with PEG tube usage alone.
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Affiliation(s)
- J Aguiar
- Department of Veterinary Clinical Sciences, Queen Mother Hospital for Animals, Royal Veterinary College, London, United Kingdom
| | - Y M Chang
- Research Office, Royal Veterinary College, London, United Kingdom
| | - O A Garden
- Department of Veterinary Clinical Sciences, Queen Mother Hospital for Animals, Royal Veterinary College, London, United Kingdom.,Immune Regulation Laboratory, Royal Veterinary College, London, United Kingdom
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Tart KM, Babski DM, Lee JA. Potential risks, prognostic indicators, and diagnostic and treatment modalities affecting survival in dogs with presumptive aspiration pneumonia: 125 cases (2005-2008). J Vet Emerg Crit Care (San Antonio) 2010; 20:319-29. [PMID: 20636985 DOI: 10.1111/j.1476-4431.2010.00542.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate a clinical population of dogs diagnosed with presumptive aspiration pneumonia (AP) and determine diagnostic and treatment modalities contributing to survival. DESIGN Retrospective study. SETTING A university veterinary teaching hospital in an urban setting. ANIMALS One hundred and twenty-five dogs with presumed AP treated from 2005 to 2008. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Dogs with presumptive AP identified by a review of medical records had an overall survival of 81.6% (102/125). Male large-breed dogs (mean 24.9 kg; 82/125) were overrepresented and were more likely to develop AP in this study population. Recent anesthesia had been performed in 16% (20/125), and vomiting was reported in 64% (80/125). The most common radiographic findings were a predominantly alveolar pattern (187/272, [68.8%] total lung lobes) in the right middle lung lobe (80/115, [69.6%]). A mean of 2 lung lobes were involved radiographically, and the relationship between survival and the number of lung lobes affected was statistically significant (P=0.04). Neutrophilia with a left shift was common with no significant change on consecutive daily evaluations. The mean PaO(2) was 77.7 mm Hg (SD, 17.5 mm Hg) (range, 40.7-100 mm Hg) with a median alveolar-arterial gradient of 41.1 mm Hg (range, 8.1-81.8 mm Hg). In this study population, 37.6% (47/125) of dogs had microbial cultures performed and of these, 76.6% (36/47) were positive for growth; Escherichia coli (38.8%), Mycoplasma spp. (21.3%), Pasturella spp. (19.1%), and Staphylococcus spp. (17%) were the most common isolates in either single or multiagent infections. No treatment modality was statistically associated with increased survival. Colloid therapy was a negative prognostic indicator. CONCLUSIONS In this study the overall prognosis for AP was good. Patients with only 1 affected lung lobe appeared more likely to survive. Supportive treatment modalities are warranted for the hospitalized patient, although no individual treatment method was found to be clearly superior to others.
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Affiliation(s)
- Kelly M Tart
- Section of Emergency and Critical Care, Department of Veterinary Clinical Sciences, C339 Veterinary Medical Center, College of Veterinary Medicine, University of Minnesota, St Paul, MN 55108-6192, USA
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Smith GW, Gerard MP, Campbell NB, Foster DM, Smith SM, Davis JL. Third-compartment cannulation in alpacas using a polyurethane gastrostomy tube. Aust Vet J 2009; 87:487-91. [PMID: 19930165 DOI: 10.1111/j.1751-0813.2009.00510.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a simple and effective surgical technique for third-compartment cannulation in alpacas. DESIGN Prospective study using six adult male alpacas. METHODS General anaesthesia was induced and a polyurethane gastrostomy tube was surgically implanted into the distal portion of the third compartment. RESULTS Three of the alpacas retained their cannulas for a 100-day period; however, three cannulas were dislodged during the study. Two of the three dislodged cannulas were replaced during a second surgical procedure. Cannulas were well tolerated by the alpacas and all animals remained clinically healthy during the study period. Third compartment contents did not leak from the cannulation site. The tubes were manually removed following the completion of the study and the small defect in the body wall quickly healed over in all animals. CONCLUSION Surgical placement of polyurethane tubes designed for percutaneous endoscopic gastrostomy is a useful method of cannulating the third compartment in camelids. This technique can be used for experimental studies and possibly could be used for nutritional support and fluid therapy in sick camelids that might need long-term care.
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Affiliation(s)
- G W Smith
- Department of Population Health and Pathobiology, North Carolina State University, Raleigh, 27606, USA.
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Schildt JC, Jutkowitz LA, Beal MW. Potpourri oil toxicity in cats: 6 cases (2000-2007). J Vet Emerg Crit Care (San Antonio) 2008. [DOI: 10.1111/j.1476-4431.2008.00350.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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SONG EDDIEKUGJU, MANN F(TONY, WAGNER-MANN COLETTEC. Comparison of Different Tube Materials and Use of Chinese Finger Trap or Four Friction Suture Technique for Securing Gastrostomy, Jejunostomy, and Thoracostomy Tubes in Dogs. Vet Surg 2008; 37:212-21. [DOI: 10.1111/j.1532-950x.2008.00368.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Campbell SJ, Marks SL, Yoshimoto SK, Riel DL, Fascetti AJ. Complications and outcomes of one-step low-profile gastrostomy devices for long-term enteral feeding in dogs and cats. J Am Anim Hosp Assoc 2007; 42:197-206. [PMID: 16611931 DOI: 10.5326/0420197] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sixteen dogs and cats with a variety of primary diseases were retrospectively evaluated following endoscopic placement of a one-step low-profile gastrostomy device. Overall, the devices were well tolerated, with most complications being minor in nature. Complications included bloody or purulent peristomal discharge, peristomal swelling, peristomal inflammation, discomfort associated with the device, leaking through the device, chewing at the device, premature removal of the device, peritonitis, and aspiration pneumonia. Dogs survived for up to 2241 days, and cats survived for up to 593 days after initial device placement. The median survival time after device insertion for dogs was 89 days, and for cats it was 87 days.
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Affiliation(s)
- Scott J Campbell
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, California 95616, USA
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Michel KE, Higgins C. Investigation of the percentage of prescribed enteral nutrition actually delivered to hospitalized companion animals. J Vet Emerg Crit Care (San Antonio) 2006. [DOI: 10.1111/j.1476-4431.2006.00131.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Ahmed AF, Constable PD, McCallister MM, Misk NA. Abomasal cannulation in the milk-fed calf using a 7 mm polyurethane tube. ACTA ACUST UNITED AC 2005; 52:39-42. [PMID: 15703009 DOI: 10.1111/j.1439-0442.2004.00686.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The main objective of this study was to develop a simple and effective surgical technique for abomasal cannulation in neonatal calves. General anaesthesia was induced in 12, 3-day-old male dairy calves and a polyurethane cannula surgically implanted in the abomasal body (n = 12) and pyloric antrum (n = 6) through a right paracostal incision. Fifteen cannulae remained in situ from day 3 to 34 of life (mean: 29 days), and three cannulae were extruded 13-14 days after placement. Calves were clinically healthy and gained weight during the study. Cannulae were well tolerated by the calves and abomasal contents did not leak from the cannula sites. Necropsy examination revealed firm adhesions between the abomasum and parietal peritoneum at the cannula sites with no evidence of leakage or peritonitis. We conclude that surgical placement of polyurethane tubes designed for percutaneous endoscopic gastrostomy provided a useful method for cannulation of the abomasum of neonatal calves. The cannulation technique can be used for experimental studies, as well as for nutritional and fluid support of sick calves that cannot be managed by oral treatment.
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Affiliation(s)
- A F Ahmed
- Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
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Moore LE. Survival of childhood polycystic kidney disease following renal transplantation: the impact of advanced hepatobiliary disease. Pediatr Transplant 2004; 18:250-3. [PMID: 14738206 DOI: 10.1016/s1096-2867(03)00071-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Childhood PKD encompasses the diagnoses of AR and ADPKD, glomerulocystic disease, and syndromes such as tuberous sclerosis or Jeune's syndrome. Given the fact that a majority of PKD children with ESRD carry the diagnosis of ARPKD, natural history studies assessing the long-term prognosis of PKD patients following renal transplantation must focus on morbidity and mortality issues related to complications from congenital hepatic fibrosis. Using the NAPRTCS registry, we analyzed the patient and graft survival rates of 203 PKD patients and 7044 non-PKD patients undergoing renal transplantation between 1987 and 2001. Deceased PKD patients, all with a diagnosis of ARPKD, were further identified and characterized using a special questionnaire submitted to the principal investigators. Overall graft and patient survival rates were not significantly different between PKD and non-PKD patients. No differences in rates of acute rejection or time to first rejection were noted between PKD and non-PKD patients. The relative risk of living longer than 3 yr in the PKD patients was not significantly different from non-PKD patients (RR = 0.70, p = 0.28). Sepsis was identified as a likely factor in the cause of death in nine (64%) ARPKD patients and was comfirmed with a positive blood culture in four patients. Despite similar graft and patient survival rates among PKD and non-PKD children following renal transplantation, our results suggest that ARPKD transplant recipients appear to be at increased risk for sepsis that may be related to hepatic fibrosis and ascending cholangitis. The utility of early liver transplantation in ARPKD patients with significant hepatobiliary disease is discussed.
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Affiliation(s)
- Lisa E Moore
- Veterinary Medical Teaching Hospital, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506, USA
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Abstract
Complications of enteral nutritional support include mechanical problems related to the feeding device, gastrointestinal side effects, metabolic disturbances, and infectious complications. Although the sickest patients are often the ones that we feel will most likely benefit from nutritional support, they are generally more challenging to feed and least likely to tolerate complications arising from assisted feeding. Many of the problems that can occur with enteral nutritional support can be anticipated, which may allow them to be avoided or possibly aid in early detection and thereby minimize consequences to the patient. Therefore, knowledge of the types of complications that can occur with enteral nutritional support will aid in the process of deciding whether and how a patient should receive assisted feeding, and what parameters to monitor while a patient is receiving nutritional support.
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Affiliation(s)
- Kathryn E Michel
- Department of Clinical Studies-Phila, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-6010, USA
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Abstract
Endoscopic examination of the upper gastrointestinal (GI) tract in dogs and cats is a relatively recent development. It was just over 20 years ago, in 1978, that the first series report of GI endoscopy in dogs and cats was presented. In those initial days, endoscopy was truly a novelty, and the primary uses for endoscopes were to retrieve foreign objects or visualize the esophagus and stomach. It was not until the mid-1980s that technology and training made gastroduodenoscopy standard practice. The evolution in endoscopic technology has also mirrored the evolution in computers and imaging modalities. The original fiberoptic endoscopes, although still available, are giving way to video endoscopy and digital imaging capabilities that provide spectacular images and an ability to generate hard copy images for medical records, teaching purposes, and research data that was previously not possible.
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Affiliation(s)
- D L Zoran
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, Texas A & M University, College Station, Texas, USA.
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Stevenson MA, Stiffler KS, Schmiedt CW. One-step placement of a percutaneous nonendoscopic low-profile gastrostomy port in cats. J Am Vet Med Assoc 2000; 217:1636-41. [PMID: 11110450 DOI: 10.2460/javma.2000.217.1636] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- M A Stevenson
- Department of Small Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens 30602-7390, USA
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Elliott DA, Riel DL, Rogers QR. Complications and outcomes associated with use of gastrostomy tubes for nutritional management of dogs with renal failure: 56 cases (1994-1999). J Am Vet Med Assoc 2000; 217:1337-42. [PMID: 11061386 DOI: 10.2460/javma.2000.217.1337] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate complications and outcomes associated with use of gastrostomy tubes in dogs with renal failure. DESIGN Retrospective study. ANIMALS 56 dogs. PROCEDURE Medical records were reviewed for dogs with renal failure that were treated by use of gastrostomy tubes. RESULTS Mean +/- SD BUN concentration was 134 +/- 79 mg/dl and mean serum creatinine concentration was 9.0 +/- 3.8 mg/dl. Low-profile gastrostomy tubes were used for initial placement in 10 dogs, and traditional gastrostomy tubes were used in 46 dogs. Mild stoma-site complications included discharge, swelling, erythema, and signs of pain in 26 (46%) of dogs. Twenty-six gastrostomy tubes were replaced in 15 dogs; 11 were replaced because of patient removal, 6 were replaced because of tube wear, and 3 were replaced for other reasons. Six tubes were replaced by low-profile gastrostomy tubes. Gastrostomy tubes were used for 65 +/- 91 days (range, 1 to 438 days). Eight dogs gained weight, 11 did not change weight, and 17 lost weight; information was not available for 20 dogs. Three dogs were euthanatized because they removed their gastrostomy tubes, 2 were euthanatized because of evidence of tube migration, and 1 died of peritonitis. CONCLUSIONS AND CLINICAL RELEVANCE Gastrostomy tubes appear to be safe and effective for improving nutritional status of dogs with renal failure.
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Affiliation(s)
- D A Elliott
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis 95616, USA
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21
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Mason NJ, Michel KE. Subcutaneous emphysema, pneumoperitoneum, and pneumoretroperitoneum after gastrostomy tube placement in a cat. J Am Vet Med Assoc 2000; 216:1096-9, 1074-5. [PMID: 10754670 DOI: 10.2460/javma.2000.216.1096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 17-year-old spayed female domestic shorthair cat developed subcutaneous emphysema, pneumoperitoneum, and pneumoretroperitoneum during endoscopic placement of a gastrostomy feeding tube after gastric insufflation and cannula insertion. The cat underwent exploratory laparotomy to investigate the possibility of gastric rupture but only a 2- to 3-mm defect was found in the gastric fundus at the site of cannula insertion. Pasteurella multocida and Enterobacter spp were cultured aerobically from the peritoneal cavity. The cat recovered without complications.
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Affiliation(s)
- N J Mason
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia 19104-6010, USA
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22
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Waddell LS, Michel KE. Critical care nutrition: routes of feeding. CLINICAL TECHNIQUES IN SMALL ANIMAL PRACTICE 1998; 13:197-203. [PMID: 9842111 DOI: 10.1016/s1096-2867(98)80003-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Nutrition is an integral part of the management of the critically ill patient. Nutritional support can be provided by either parenteral or enteral routes. Whenever possible, enteral nutrition is the method of choice, as it reduces complication rates and improves outcome. Potential choices for enteral feeding include nasoesophageal, esophagostomy, gastrostomy, jejunostomy, and transpyloric feeding tubes. The modes of parenteral and enteral nutrition are reviewed individually, including indications and selection of appropriate routes of feeding, methods of tube placement, and benefits and risks associated with each feeding approach.
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Affiliation(s)
- L S Waddell
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia 19014-6010, USA
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23
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Glaus TM, Cornelius LM, Bartges JW, Reusch C. Complications with non-endoscopic percutaneous gastrostomy in 31 cats and 10 dogs: a retrospective study. J Small Anim Pract 1998; 39:218-22. [PMID: 9631355 DOI: 10.1111/j.1748-5827.1998.tb03637.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Percutaneous gastrostomy tubes were placed non-endoscopically in 31 cats and 10 dogs using either a rigid insertion tube (n = 13) or an Eld gastrostomy tube applicator (n = 28). Tubes were placed successfully in 38 of the 41 animals and the consequent feeding was of therapeutic benefit to 31 of the animals. Six of 41 died or were euthanased for reasons unrelated to gastrostomy. In four cases (10 per cent), gastrostomy failed with respect to correct tube placement or tube feeding. Overall complications occurred in 18 of 41 animals. Severe procedural complications occurred in two cats; a cardiorespiratory arrest during pharyngeal manipulation and erroneous tube placement through the distal oesophagus. Moderate late complications included peristomal food leakage (n = 2), peristomal abscess (n = 2) and pyloric outflow obstruction by a migrated tube (n = 1). Complications associated with the feeding procedure, nausea and vomiting (n = 3), led to aspiration pneumonia in one case.
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Affiliation(s)
- T M Glaus
- Department of Veterinary Internal Medicine, University of Zurich, Switzerland
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24
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Abstract
The enteral route is the preferred method of nutritional support in patients with functional gastrointestinal tracts. Many techniques for obtaining enteral access are available, and the decision regarding which one to use depends on several issues, including the functional integrity of each part of the gastrointestinal tract, the duration of anticipated nutritional support, and the risk of aspiration and gastroesophageal reflux. Nasoesophageal tubes are useful for short-term supplementation; however, patients needing nutritional support for longer than 2 weeks may be better served with a more permanent tube. Blenderized pet food diets are recommended for nutritional support because these diets do not need to be supplemented with protein or micronutrients. Commercial human enteral formulas provide a useful alternative for patients with specific nutrient requirements or for feeding via nasoesophageal or jejunostomy tubes.
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Affiliation(s)
- S L Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, USA
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25
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Waschak MJ, Payne JT, Pope ER, Jones BD, Wagner-Mann CC. Evaluation of percutaneous gastrostomy as a technique for permanent gastropexy. Vet Surg 1997; 26:235-41. [PMID: 9150562 DOI: 10.1111/j.1532-950x.1997.tb01491.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study was designed to evaluate right-sided percutaneous endoscopic gastrostomy (PEG) as a method for creation of a permanent gastropexy. STUDY DESIGN Percutaneous endoscopic gastrostomy adhesions were evaluated by gross examination and by mechanical testing and the results were compared with those obtained by conventional incisional gastropexy. ANIMALS OR SAMPLE POPULATION Fourteen mixed-breed dogs. METHODS Incisional gastropexies were performed on the dogs of group one (N = 7) and PEG tubes were placed in the dogs of group 2 (N = 7). All skin sutures (group 1) and PEG tubes (group 2) were removed on day 14. The animals were maintained for an additional 44 days before euthanasia and immediate necropsy. Gastropexy adhesions were evaluated and collected for biomechanical evaluation using a materials testing machine. RESULTS The duration of the procedure for group 2 was less (32.86 min +/- 7.65) than for group 1 (56.29 min +/- 8.28). The number of complications was not significantly different between group 1 and group 2 (P = .103). Gastroperitoneal adhesions were present in 7 of 7 dogs in group 1 and 4 of 7 dogs in group 2. The adhesion lengths and widths were significantly lager in dogs in group 1 compared with those in group 2. The adhesions present in group 1 dogs sustained significantly greater tensile loads to failure (61.98 +/- 14.65 N), compared with the adhesions present in group 2 dogs (22.31 +/- 26.87 N). CONCLUSIONS Right-sided PEG inconsistently formed a weak gastropexy and the procedure was associated with a trend toward greater morbidity than incisional gastropexy. CLINICAL RELEVANCE Right-sided PEG is not recommended as a means of prophylactic gastropexy.
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Affiliation(s)
- M J Waschak
- Department of Small Animal Medicine and Surgery, University of Missouri-Columbia Veterinary Medical Teaching Hospital, USA
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26
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Clary EM, Hardie EM, Fischer WD, Kyles AE. Nonendoscopic antegrade percutaneous gastrostomy: the effect of preplacement gastric insufflation on tube position and intra-abdominal anatomy. J Vet Intern Med 1996; 10:15-20. [PMID: 8965263 DOI: 10.1111/j.1939-1676.1996.tb02018.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Nonendoscopic tube gastrostomy was performed on 47 anesthetized dogs using the technique of Fulton and Dennis with or without gastric insufflation prior to tube placement. Immediately after tube placement, dogs were euthanized and postmortem examinations performed. When gastric insufflation was not performed (group I), gastrostomy tubes penetrated the visceral surface of the stomach in 25% of dogs. The deep leaf of the omentum was interposed between stomach and body wall in the majority of these dogs, exposing other intra-abdominal organs to potential injury. Additionally, displacement and tethering of the spleen cranial to the gastrostomy site were observed in 33% of dogs in group I. Similar results were obtained when preplacement gastric insufflation was performed after the orogastric tube was inserted sufficiently far to displace the stomach laterally against the body wall (group II). In contrast, consistent positioning of gastrostomy tubes through the parietal surface of the stomach was achieved when the stomach was insufflated prior to lateralizing the left abdominal wall with the gastric end of the orogastric tube (group III). It was concluded that the blind percutaneous gastrostomy technique is made safer by insufflating the stomach immediately prior to pushing the gastric wall laterally into contact with the parietal peritoneum.
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Affiliation(s)
- E M Clary
- Department of Companion Animals and Special Species, North Carolina State University, Raleigh, USA
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27
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Abstract
Over the past 5 to 7 years, the veterinary profession has benefitted from our increased ability to provide nutrition to the small animal patient who cannot or will not eat. The adaptation of the percutaneous endoscopic gastrostomy (PEG) for use in the dog and cat deserves a great deal of credit in advancing the level of care we can now give to the chronically ill or critical care patient. The PEG is a relatively simple technique that has proved to be a very cost-efficient way to maintain the nutritional status of the small animal patient. In the author's experience, owner acceptance of using the PEG in the home environment on a chronic basis has been excellent.
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Affiliation(s)
- R M Bright
- Department of Urban Practice, University of Tennessee College of Veterinary Medicine, Knoxville
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28
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Abstract
A historical perspective on the development of veterinary endoscopy is given. The current endoscopic requirements and indications are discussed. The diagnostic and therapeutic capabilities of gastrointestinal endoscopy are reviewed. Speculation on the diagnostic capabilities for the future in small animal gastrointestinal endoscopy is given.
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Affiliation(s)
- D C Twedt
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, Fort Collins
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29
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Lippert AC, Fulton RB, Parr AM. A retrospective study of the use of total parenteral nutrition in dogs and cats. Vet Med (Auckl) 1993; 7:52-64. [PMID: 8501697 DOI: 10.1111/j.1939-1676.1993.tb03170.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The records of all dogs and cats receiving total parenteral nutrition (TPN) over a 43-month period were examined retrospectively. Dextrose, amino acids, lipids, electrolytes, and vitamins were administered by central venous catheter according to published nutrient recommendations; 72 dogs and 12 cats were studied, accounting for 380 patient days of TPN. Duration of TPN administration was 1-14 days with a mean of 4.5 days. Most animals required TPN because of gastrointestinal dysfunction, and more than half of them gained weight during TPN administration. Mechanical complications were frequent. Metabolic complications, especially lipid and glucose intolerance, were also commonly seen. Septic complications were the least frequently encountered, but resulted in patient morbidity and may have contributed to mortality. Most animals receiving TPN were returned to enteral nutrition and discharged. For critically ill animals unable to tolerate enteral alimentation, TPN can be supportive therapy in the treatment of the primary disease.
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Affiliation(s)
- A C Lippert
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing
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32
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Abstract
The effect of malnutrition in patients with a variety of ailments is known to be deleterious to their overall quality of life, response and tolerance to therapy, and ultimate survival. These effects may be amplified in feline patients with infectious disease owing to the blunting of immunologic responsiveness that results from malnutrition. This vicious cycle of infection, ensuing malnutrition, and subsequent immunocompromise may not allow the patient to mount an attack on the invading pathogen adequately. The most logical means to reverse this cycle is to ensure an adequate nutritional state in the patient. Initial attempts at maintaining or increasing voluntary oral intake should be initiated in the short term. However, enteral or parenteral support should be instituted as quickly as possible if these should fail. Much is yet to be discerned about specific optimal supplementation techniques and dietary formulations for feline patients; however, the application of relatively simple and general principles of nutritional support offer our feline patients with infectious disease the best opportunity to overcome their disease.
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Affiliation(s)
- M W Jackson
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison
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