Effect of early enteral nutrition on intestinal permeability, intestinal protein loss, and outcome in dogs with severe parvoviral enteritis

The effect of feeding on serum concentrations of cobalamin, folate, trypsin-like immunoreactivity, and pancreatic lipase immunoreactivity in dogs with signs of chronic gastrointestinal disease

BACKGROUND

It is unknown if serum concentrations of cobalamin, folate, canine pancreatic lipase immunoreactivity (cPLI), and canine trypsin-like immunoreactivity (cTLI) obtained postprandially are equivalent to measurements obtained after withholding food in dogs with suspected gastrointestinal disease.

HYPOTHESIS/OBJECTIVES

Measurements of serum concentrations of cobalamin, folate, cPLI, and cTLI postprandially will be equivalent to measurements after 12 hours of withholding food in dogs with signs of chronic gastrointestinal disease. Changes observed will not alter clinical interpretation.

ANIMALS

51 client-owned dogs with signs of gastrointestinal disease.

METHODS

Prospective single arm clinical trial. Serum concentrations of cobalamin, folate, cPLI and cTLI 2, 4, and 8 hours postprandially were compared by equivalence testing to values after withholding food for 12 hours (baseline).

RESULTS

Mean serum cobalamin concentrations 2 hours (498.1 ± 213.1 ng/L; P = 0.024) and 4 hours (501.9 ± 207.4 ng/L; P = 0.008) postprandial were equivalent to baseline (517.3 ± 211.5 ng/L). Mean serum cTLI 2 hours (31.3 ± 14 μg/L; P < 0.001) and 4 hours (29.6 ± 13.1 μg/L; P = 0.027) postprandial were equivalent to baseline (31.1 ± 15 μg/L). Mean serum folate concentration 2 hours postprandial (15 ± 7.7 μg/L) was equivalent to baseline (13.7 ± 8.3 μg/L; P < 0.001). Equivalence could not be assessed for cPLI due to results below the lower limit of quantification. Feeding altered the clinical interpretation in 27% (cobalamin), 35% (folate), 20% (cTLI), and 12% (cPLI) of dogs.

CONCLUSIONS AND CLINICAL IMPORTANCE

The clinical interpretation for a substantial number of samples changed after feeding, therefore withholding food before sample collection is prudent.

Assisted Enteral Feeding of Exotic Companion Animals

Malnutrition is a known concern during hospitalization for humans, dogs, and cats. The same nutrition principals to reduce the risk of malnutrition can be applied to exotic companion animal patients. However, it's important to understand that many nutritional requirements are ill defined for specific species and prudent clinical judgment is required.

Tolerability of naso-esophageal feeding tubes in dogs and cats at home: Retrospective review of 119 cases

BACKGROUND

The use of naso-esophageal feeding tubes (NFT) at home could represent an alternative way to reduce the costs for owners and facilitate enteral feeding until recovery of a spontaneous appetite.

OBJECTIVE

To describe the use of NFT at home in dogs and cats and evaluate the satisfaction of owners and their capacity to handle the device.

ANIMALS

One hundred nineteen client-owned animals (90 cats and 29 dogs) which remained anorexic during hospitalization and were discharged with NFT for at least 24 hours after placement.

METHODS

Medical records were reviewed retrospectively, and owners were contacted by telephone calls. Complications were reported according to their relative severity (minor and major). Owners were asked to report their experience and comfort with NFT management.

RESULTS

Naso-esophageal feeding tubes were kept in place at home for a median of 6 days (range, 1-17) and 62.2% (95% confidence interval [CI]: 53.3-70.7) of animals recovered a spontaneous appetite while wearing NFT, 60% (95% CI: 44.4-75.6) of the remaining animals recovered a spontaneous appetite after removal. Overall complication rate was 65.5% (95% CI: 57.0-74.0), but only 18.5% (95% CI: 11.5-25.5) required a consultation and no life-threatening complication occurred. Owners were satisfied in 94.1% (95% CI: 89.9-98.3) of cases.

CONCLUSION AND CLINICAL IMPORTANCE

Although most animals discharged with NFT at home presented complications, no major adverse effects were reported and NFT were easily handled by owners. This study provides evidence that NFT can be well tolerated at home.

Comparison of 4 point-of-care techniques to detect correct positioning of nasogastric tubes in dogs (2020-2021)

OBJECTIVE

To compare 4 point-of-care (POC) techniques to assess nasogastric (NG) tube placement versus radiographs as a reference standard. POC methods included air inflation with auscultation, fluid aspiration with pH measurement, ultrasonography, and capnography.

DESIGN

Prospective observational study in hospitalized dogs between 2020 and 2021.

SETTING

University teaching hospital.

ANIMALS

Fifty-one dogs requiring NG tube placement as part of their normal care.

INTERVENTIONS

After standard blind NG tube placement, each POC method was performed following standardized instructions. All POC methods were scored as to whether the investigator believed the tube to be in the gastrointestinal tract (as indicated by positive auscultation of borborygmus during insufflation, positive fluid aspiration with pH ≤5, presence of hyperechoic shadow in the esophagus, or absence of capnographic waveform). Subsequently, radiographs were taken to determine NG tube position as a gold standard. The sensitivity, specificity, and accuracy of each test as compared to 2-view thoracic radiographs were determined.

MEASUREMENTS AND MAIN RESULTS

Sensitivity, specificity, and accuracy for each POC technique were as follows: air auscultation (84.4%, 50.5%, and 80.4%, respectively), neck ultrasound (95.6%, 83.3%, and 94.1%, respectively), capnography (91.1%, 33.3%, and 84.3%, respectively), and fluid aspiration with pH measurement (22.2%, 100%, and 31.4%, respectively).

CONCLUSIONS

Among the 4 techniques evaluated, neck ultrasound had the best overall performance for assessing NG tube placement. Fluid aspiration with pH measurement might also have potential due to perfect specificity, but its clinical utility may be limited by low sensitivity and accuracy. Nonetheless, 2-view thoracic radiography should still be considered the standard method for confirmation of NG tube placement as none of the 4 POC techniques investigated showed both high sensitivity and perfect specificity.

Immunoinformatics for Novel Multi-Epitope Vaccine Development in Canine Parvovirus Infections

Canine parvovirus (CPV-2) is one of the most important pathogens of dogs of all ages, causing pandemic infections that are characterized by fatal hemorrhagic enteritis. The CPV-2 vaccine is recommended as a core vaccine for pet animals. Despite the intensive practice of active immunization, CPV-2 remains a global threat. In this study, a multi-epitope vaccine against CPV-2 was designed, targeting the highly conserved capsid protein (VP2) via in silico approaches. Several immunoinformatics methods, such as epitope screening, molecular docking, and simulation were used to design a potential vaccine construct. The partial protein sequences of the VP2 gene of CPV-2 and protein sequences retrieved from the NCBI were screened to predict highly antigenic proteins through antigenicity, trans-membrane-topology screening, an allergenicity assessment, and a toxicity analysis. Homologous VP2 protein sequences typically linked to the disease were identified using NCBI BLAST, in which four conserved regions were preferred. Overall, 10 epitopes, DPIGGKTGI, KEFDTDLKP, GTDPDDVQ, GGTNFGYIG, GTFYFDCKP, NRALGLPP, SGTPTN, LGLPPFLNSL, IGGKTG, and VPPVYPN, were selected from the conserved regions to design the vaccine construct. The molecular docking demonstrated the higher binding affinity of these epitopes with dog leukocyte antigen (DLA) molecules. The selected epitopes were linked with Salmonella enterica flagellin FliC adjuvants, along with the PADRE sequence, by GGS linkers to construct a vaccine candidate with 272 nucleotides. The codon adaptation and in silico cloning showed that the generated vaccine can be expressed by the E. coli strain, K12, and the sequence of the vaccine construct showed no similarities with dog protein. Our results suggest that the vaccine construct might be useful in preventing canine parvoviral enteritis (CPE) in dogs. Further in vitro and in vivo experiments are needed for the validation of the vaccine candidate.

Serum cobalamin and methylmalonic acid concentrations in juvenile dogs with parvoviral enteritis or other acute enteropathies

BACKGROUND

Low serum cobalamin concentrations have been associated with ileal malabsorption in dogs with chronic enteropathy. Increased serum methylmalonic acid (MMA) concentrations indicate cobalamin deficiency on a cellular level. Few studies have evaluated serum cobalamin concentrations or methylmalonic acid concentrations in juvenile dogs with parvoviral enteritis or nonparvoviral acute enteropathies.

OBJECTIVES

Evaluate serum cobalamin and methylmalonic acid concentrations in juvenile dogs (6 weeks to 10 months old) with parvoviral enteritis or nonparvoviral acute enteropathy.

ANIMALS

Thirty-one juvenile dogs with parvoviral enteritis, 29 dogs with nonparvoviral acute diarrhea (NPVAD), and 40 healthy juvenile control dogs.

METHODS

Single-center, prospective, observational, cross-sectional study. Serum cobalamin and, when sufficient serum was available, MMA concentrations were measured.

RESULTS

Most serum cobalamin concentrations were within the adult reference interval. Serum cobalamin concentrations in healthy dogs (median, 848 ng/L; range, 293-1912 ng/L) were significantly higher than in dogs with parvoviral enteritis (P = .0002; median, 463 ng/L; range, <150-10 000 ng/L) or dogs with NPVAD (P = .02; median, 528 ng/L; range, 160-8998 ng/L). Serum MMA concentrations were not significantly different between groups (healthy dogs: median, 796 nmol/L; range, 427-1933 nmol/L; parvoviral enteritis: median, 858 nmol/L; range, 554-3424 nmol/L; NPVAD: median, 764 nmol/L; range, 392-1222 nmol/L; P = .1).

CONCLUSIONS AND CLINICAL IMPORTANCE

Juvenile dogs with parvoviral enteritis or NPVAD had lower serum cobalamin concentrations than healthy juvenile dogs. However, based on serum MMA concentrations cellular cobalamin deficiency was not apparent.

Coagulation Abnormalities in Dogs with Parvoviral Enteritis

Hemostatic alterations have been documented in dogs with canine parvoviral enteritis. This study's aims were to measure the standard coagulation parameters, and to assess the relationship between them and the clinical variables in dogs with canine parvoviral enteritis. Nine client-owned dogs with a canine parvoviral infection were included in a prospective, observational clinical study. Clinical score and coagulation status were assessed at admission. All nine dogs showed alterations of three or more standard coagulation variables. A correlation analysis evidenced a significantly high positive correlation between the activated partial thromboplastin time and clinical score. The present study concurs that dogs with canine parvoviral enteritis have coagulation disorders that are detectable by measuring the standard coagulation parameters.

Randomized controlled trial demonstrates nutritional management is superior to metronidazole for treatment of acute colitis in dogs

OBJECTIVE

To describe the outcome of dietary management of canine noninfectious acute colitis with or without concurrent oral administration of metronidazole using a randomized controlled clinical trial.

ANIMALS

59 client-owned dogs with noninfectious acute colitis.

PROCEDURES

Dogs with acute noninfectious colitis were enrolled in a 30-day diet trial after exclusion of parasitic infectious etiologies (fecal centrifugation floatation, Giardia/Cryptosporidium antigen testing) and systemic disease (CBC, biochemistry, urinalysis). Dogs were randomized into 3 placebo-controlled groups: group 1, easily digestible diet + placebo tablet; group 2, easily digestible diet + metronidazole tablet; and group 3, psyllium-enhanced easily digestible diet + placebo tablet. Dogs were evaluated serially using fecal scoring for time to remission, average fecal score, relapse after remission, and dysbiosis index.

RESULTS

Median remission time was significantly different among the 3 groups (P < .01) with median times of 5 days (range, 4 to 10) for group 1, 8.5 days (range, 7 to 12) for group 2, and 5 days (range, 3 to 6) for group 3. Metronidazole addition affected the fecal dysbiosis index negatively at days 7 to 10. No adverse effects or complications were noted throughout the study.

CLINICAL RELEVANCE

For canine noninfectious acute colitis, dietary management with an easily digestible diet with or without psyllium enhancement proved a superior management strategy compared to metronidazole. The omission of metronidazole reduced the adverse impact significantly on intestinal microbiota. Longitudinal clinical trials are necessary to compare the long-term response, stability, and complications associated with dietary management alone versus combined dietary and antimicrobial therapy for canine acute colitis.

Canine parvovirus-2: An Emerging Threat to Young Pets

Canine parvovirus-2 (CPV-2) is a highly contagious and key enteropathogen affecting the canine population around the globe by causing canine parvoviral enteritis (CPVE) and vomition. CPVE is one of the the leading causes of morbidity and mortality in puppies and young dogs. Over the years, five distinct antigenic variants of CPV-2, namely CPV-2a, CPV-2b, new CPV-2a, new CPV-2b, and CPV-2c, have emerged throughout the world. CPV-2 infects a diverse range of wild animals, and the newer variants of CPV-2 have expanded their host range to include felines. Despite the availability of highly specific diagnostics and efficacious vaccines, CPV-2 outbreaks have been reported globally due to the emergence of newer antigenic variants, expansion of the viral host range, and vaccination failures. The present chapter describes the latest information pertaining to virus properties and replication, disease manifestations in animals, and an additional recent updates on diagnostic, prevention and control strategies of CPV-2.

Serum cobalamin concentrations in dogs infected with canine parvoviral enteritis

OBJECTIVE

To compare the serum cobalamin concentrations in canine parvovirus (CPV)-infected dogs with those of healthy control dogs.

Animals

45 dogs with CPV enteritis and 17 healthy age-matched control dogs.

Procedures

Infection was confirmed by visualization of CPV-2 through fecal electron microscopy. All dogs received supportive care. Serum samples taken at admission were used to determine cobalamin, C-reactive protein, and albumin concentrations.

Results

Serum cobalamin concentrations were significantly lower in the CPV-infected group (median [interquartile range], 173 pmol/L [< 111 to 722 pmol/L]) than in healthy control dogs (379 pmol/L [193 to > 738 pmol/L). There was no association between cobalamin concentration and C-reactive protein or albumin concentration.

Clinical Relevance

While hypocobalaminemia was common in CPV-infected dogs, the clinical relevance of this finding remains to be determined. Studies assessing markers of cellular cobalamin deficiency in dogs with CPV infection appear warranted.

Antimicrobial Resistance (AMR) of Bacteria Isolated from Dogs with Canine Parvovirus (CPV) Infection: The Need for a Rational Use of Antibiotics in Companion Animal Health

Canine parvovirus type 2 (CPV-2) represents a major viral threat to dogs. Considering the potential effects of pets on antimicrobial resistance, information on the CPV and associated bacterial co-infections is limited. The aim of this study was to analyze the antimicrobial susceptibility and multidrug-resistance profiles of bacterial species from tissue samples of dogs with canine parvovirus infection. A set of PCR assays and sequence analyses was used for the detection and the molecular characterization of the CPV strains and other enteric viruses. Bacterial isolation, the determination of antimicrobial susceptibility via the disk diffusion method, and the determination of the minimum inhibitory concentration were performed. The detection of β-lactamase genes and toxin genes for specific bacteria was also carried out. CPV infection was confirmed in 23 dogs. Forty-three bacterial strains were isolated and all showed phenotypic resistance. Seventeen multidrug-resistant bacteria and bacteria with high resistance to third- and fourth-generation cephalosporins and metronidazole were detected. Almost 50% of the isolated Enterobacteriaceae were positive for at least one β-lactamase gene, with the majority carrying more genes as well. The evidence for multi-resistant bacteria with the potential for intra- or cross-species transmission should be further considered in a One Health approach.

The effect of short term peripheral parenteral nutrition on treatment outcomes and mortality in critically ill pediatric canine patients

Background

Peripheral parenteral nutrition (PPN) is increasingly considered as an alternative to central parenteral nutrition (CPN) given the higher cost and more frequent clinical complications associated with the latter. However, the assessment of potential risks and benefits of PPN in critically ill pediatric canine patients has not been extensively performed. In this study, we aimed to explore the effect of short-term, hypocaloric PPN on weight loss, length of hospital stay, the incidence of complications, adverse effects, and mortality in critically ill pediatric canine patients.

Results

Between August 2015 and August 2018, a total of 59 critically ill pediatric canine patients aged from 1 to 6 months admitted at the Veterinary Sciences Research Institute of the Autonomous University of Baja California were included in this non-randomized clinical trial. Canine pediatric patients were initially allocated to 3 groups: 11 in group 1 receiving parenteral nutrition (PN) supplementation equivalent to 40% of the resting energy requirement (RER), 12 in group 2 receiving supplementation of 50% of the RER, and 36 in group 3 receiving no PN supplementation. After establishing that there was no significant difference between 40 and 50% of PN supplementation, these groups were not separated for downstream analysis.

Similar lengths of hospital stays were noted among study subjects who received PN supplementation and those who did not (4.3 ± 1.5 vs. 5.0 ± 1.5, days, p = 0.097). No metabolic-, sepsis- or phlebitis-related complications were observed in any animal in the PPN supplemented group. Higher mortality (19.4% vs. 0%, p = 0.036), and a greater percentage of weight loss (9.24% vs. 0%, p <  0.001) were observed in patients who received no supplementation.

Conclusion

Even though short-term, hypocaloric PPN did not reduce the length of hospital stay, it was associated with lower mortality and resulted in mitigation of weight loss. In contrast to previous studies evaluating central and peripheral parenteral nutrition protocols, we observed a lower frequency of metabolic, septic, and phlebitis complications using a 40–50% parenteral nutrition treatment. The parenteral nutrition therapeutic intervention used in our study may reduce PN-related adverse effects and promote a favorable disease outcome in critically ill canine patients. Larger studies will be needed to confirm these observations.

Effect of withholding food on serum concentrations of cobalamin, folate, trypsin-like immunoreactivity, and pancreatic lipase immunoreactivity in healthy dogs

OBJECTIVE

To evaluate the effects of withholding food on the results for measurements of serum concentrations of cobalamin, folate, canine pancreatic lipase immunoreactivity (cPLI), and canine trypsin-like immunoreactivity (cTLI) in healthy dogs.

ANIMALS

11 healthy employee- or student-owned dogs.

PROCEDURES

Food was withheld from the dogs for 12 hours, baseline blood samples were collected, then dogs were fed. Postprandial blood samples collected 1, 2, 4, and 8 hours later were assessed. A mixed-effects ANOVA model with fasting duration (time) as a fixed factor and dog as a random effect was fit for each analyte variable. Additionally, a mixed-effects ANOVA model controlling for the variable of time was fit to assess whether lipemia affected serum concentrations of the analytes.

RESULTS

The median serum cobalamin concentration was lower at 4 hours (428 ng/L) and 8 hours (429 ng/L) postprandially, compared with baseline (479 ng/L), but this difference was not clinically meaningful. Although there were no substantial differences in serum concentrations of folate, cPLI, or cTLI, postprandial changes in serum concentrations of cTLI or folate could potentially affect diagnoses in some dogs.

CONCLUSIONS AND CLINICAL RELEVANCE

Although results indicated that feedings rarely resulted in clinically important differences in the median serum concentrations of cobalamin, folate, cPLI, or cTLI in healthy dogs, given the further processing required for lipemic samples, withholding food for at least 8 hours is an appropriate recommendation when measuring these analytes. Similar research is needed in dogs with gastrointestinal disease to determine whether the withholding of food is necessary when measuring these analytes in affected dogs.

Nutritional Management for Dogs and Cats with Gastrointestinal Diseases

Gastrointestinal (GI) disease encompasses a wide variety of conditions, often with similar clinical signs. In order to optimize diet selection and nutritional management for dogs and cats with GI disease, it is important to consider a patient's nutritional assessment, problem list, specific nutrients of concern, and other factors. This review summarizes the process of utilizing this information to select a diet for a patient with GI disease as well as target levels for nutrients of concern. Overall, it is important to make an individualized recommendation and reassess the patient to make additional adjustments to the nutritional plan as needed as well as establishing target levels for nutrients of concern.

Habitat selection and populations of Corynosoma (Acanthocephala) in the intestines of sea otters (Enhydra lutris) and seals

Acanthocephalans are common intestinal parasites of marine mammals, the most widespread of which is the genus Corynosoma. In this study, parasite infrapopulations of two closely related species of Corynosoma were examined: Corynosoma enhydri from sea otters (Enhydra lutris) in Alaska (n = 12) and California (n = 19), and Corynosoma strumosum from seals in Germany (n = 22). Prevalence of C. enhydri was 100% in Californian otters, with a mean abundance of 30, and 83% in Alaskan otters, with a mean abundance of 232. In seals, C. strumosum had a prevalence of 65%, with a mean abundance of 33. Female C. enhydri dominated both Californian (82%) and Alaskan (79%) infections, while, in seals, female C. strumosum made up 68% of the parasite population. Reproduction rates for C. enhydri, with 16% (California) and 18% (Alaska) of females mated, were low compared to C. strumosum in seals, of which 40% of females were mated. Habitat selection also differed significantly between the two species. Corynosoma enhydri was found most frequently in the second and third fifths of the small intestine, while C. strumosum was found most frequently in the fourth. The differences in habitat selection and prevalence analysed in this study may be related to a trade-off between growth and reproduction between the two species.

Molecular investigation on the presence of canine parvovirus in Egypt

Canine parvovirus type 2 (CPV-2) causes a highly contagious gastroenteritis disease of dogs and wild canids. To investigate the CPV-2 prevalence in Dakahlia Governorate, Egypt, a total of 50 fecal swabs were collected from suspected diseased dogs during 2016-2017. Out of 50 collected samples, 35 samples (70 %) presented positive results for CPV-2 using immuno-chromatography (IC) as a rapid test. CPV-2DNA was detected in 42 samples (84 %) by using polymerase chain reaction (PCR). The frequencies of CPV-2 were significantly higher in German shepherd breed (46 %; 23/50) and in age groups less than 6 months (76%; 38/50). We evaluated the breed, age, sex, rapid test results and clinical signs as predictors for classification of animal status into infected and not infected. The best predictors for classification process were rapid test result and clinical signs. Both CPV-2b and CPV-2c subtypes were detected by CPV2-VP2 gene sequences analysis. Deduced amino acid sequences alignment showed substitutions at 3 sites (Arg453Pro, Ala574Glu and Gln457Leu). Further investigations are needed to reveal the genetic and antigenic relation between field and vaccinal strains of CPV-2 in Egypt.

Update on Canine Parvoviral Enteritis

Canine parvoviral enteritis is one of the most common causes of morbidity and mortality in dogs worldwide. Tests can detect viral antigen in feces, and characteristic decreases in total leukocyte, neutrophil, and lymphocyte counts can increase the index of suspicion in affected cases and can be used to prognosticate morbidity and mortality. The standard of care for infected animals includes IV crystalloid and sometimes colloid fluids, antiemetics, broad-spectrum antibiotics, and early enteral nutrition. Vaccination induces protective immunity in most dogs. Vaccination, along with limiting exposure in young puppies, is the most effective means of preventing parvoviral enteritis in dogs.

Nutritional Support of the Critically Ill Small Animal Patient

Over the past couple of decades, a component of veterinary critical care was simply to ensure that nutritional support formed some part of the treatment plan. Great emphasis was made on early placement of feeding tubes in critically ill veterinary patients to facilitate enteral feeding. Progress has been made on techniques for nutritional provision, establishing feasibility of nutritional interventions in various patient populations and establishing that nutritional support does have an important role in veterinary critical care. Some refinement of appropriate caloric targets in critically ill animals has decreased complications relating to overfeeding, but further work is required to establish optimal feeding regimes.

Acute Diarrhea in Dogs: Current Management and Potential Role of Dietary Polyphenols Supplementation

Acute diarrhea is one of the most common reasons why pet owners seek veterinary care for their canine companions. In many cases, signs resolve spontaneously or with symptomatic therapy without a specific cause being discovered. However, life-threatening cases can occur. The etiology is complex, including infectious diseases (endoparasites, virus, bacteria, protozoa, fungal agents) by both zoonotic and non-zoonotic pathogens, dietary indiscretion, endocrine diseases, and stress (e.g., travel or environmental changes). In the last years, the role played by oxidative stress in the pathogenesis of acute and chronic enteropathies, independently from the initial noxa, has been highlighted by many researches in both humans and animals. As a result, a series of dietary antioxidant compounds have been studied for their potential use in the treatment of intestinal inflammation. This review summarizes the traditional therapeutic and nutritional options to manage canine acute diarrhea, highlighting the need to explore the role of oxidative stress and potential antioxidant supplementation, especially polyphenols, during acute diarrheic episodes.

Knowledge, attitudes and application of nutrition assessments by the veterinary health care team in small animal practice

OBJECTIVES

To assess the impact of the WSAVA Global Nutrition Committee's work in promoting nutrition as the fifth vital assessment and enhancing knowledge of nutrition. Further objectives were to ascertain use of existing Global Nutrition Committee assessment tools, identify potential new tools and determine which members of the veterinary health care team are responsible for carrying out nutrition assessments, planning and intervention in practice.

MATERIALS AND METHODS

A 16-question online questionnaire on the awareness, use and frequency of nutritional assessment was completed by 2740 veterinary health care team members. Statistical association was tested between the reported frequency of nutritional assessment in practice and the likely establishment of normal dietary regime, calculation of energy requirements and creation of nutritional plans.

RESULTS

Most respondents (95%) currently had responsibility for providing small animal nutrition education, yet only 27% were aware of the WSAVA guidelines. Over half (64%) recognised nutritional evaluation as the fifth vital assessment. Only 4% consistently used WSAVA tools to perform a systematic nutritional assessment. Veterinarians and veterinary nurses/technicians were the most frequent source of nutritional advice in practice, with the consultation recognised as the most important contact point with clients.

CLINICAL SIGNIFICANCE

Awareness of nutritional assessment is apparent, yet implementation in practice is inconsistent. These findings will help the WSAVA Global Nutrition Committee prioritise future activities to support the veterinary health care team and pet owners with nutrition-related knowledge, tools and resources.

Clinical evaluation of hyperimmune plasma for treatment of dogs with naturally occurring parvoviral enteritis

OBJECTIVE

To evaluate the clinical efficacy of a single infusion of hyperimmune plasma (HIP) in dogs with canine parvovirus (CPV).

DESIGN

Prospective, randomized, placebo-controlled clinical trial.

SETTING

University teaching hospital.

ANIMALS

Client-owned dogs with naturally occurring CPV.

INTERVENTIONS

Dogs presenting for CPV treatment (n = 31) underwent cardiovascular resuscitation and were randomized to receive a single dose of either HIP (10 mL/kg IV) or placebo (0.9% sodium chloride [10 mL/kg IV]) during the first 6 hours of hospitalization. All dogs were treated with a standardized treatment protocol (IV fluid therapy [120 mL/kg/d isotonic crystalloids], cefoxitin [30 mg/kg IV q 8 h], maropitant [1 mg/kg IV q 24 h], and buprenorphine [0.01-0.02 mg/kg IV q 8 h]) until hospital discharge.

MEASUREMENTS AND MAIN RESULTS

Dogs treated with HIP (n = 16) demonstrated a lower shock index at 24 hours (median = 0.77, range: 0.5-1.5) than those treated with placebo (n = 15, median = 1.34, range: 0.5-1.7; P = 0.02). Plasma lactate concentration was lower at 24 hours in HIP-treated dogs (median = 1.3 mmol/L, range: 0.9-3.4 mmol/L) than in placebo-treated dogs (median = 2.1 mmol/L, range: 1.1-3.4 mmol/L; P = 0.01). There was no difference in duration of hospitalization when comparing HIP-treated dogs (median = 3.2 days, range: 0.83-10 days) to placebo-treated dogs (median = 2.83 days, range: 1-8.38 days; P = 0.35). Survival was 16 of 16 (100%) for the HIP group and 14 of 15 (93.3%) for the placebo group (P = 0.32).

CONCLUSIONS

HIP at 10 mL/kg IV administered to dogs with CPV within the first 6 hours of hospitalization improves markers of shock during the initial 24 hours of hospitalization. No effects were observed on duration of hospitalization or mortality; however, this study was underpowered to evaluate these effects. HIP was well tolerated in this population of critically ill dogs.

Prognostic value of systemic inflammatory response syndrome and serum concentrations of acute phase proteins, cholesterol, and total thyroxine in cats with panleukopenia

Background

Feline parvovirus (FPV) is a common and potentially lethal infectious agent in cats.

Objective

To assess the prognostic value of age, neuter status, serum concentrations of serum amyloid A (SAA), haptoglobin, cholesterol and total thyroxine (tT4), and the presence of systemic inflammatory response syndrome (SIRS) in cats with panleukopenia.

Animals

Client‐owned cats with FPV infection diagnosed by a positive fecal ELISA test, positive PCR on feces or blood or both.

Methods

Retrospective cohort study. The electronic medical database was searched for cats with FPV infection presented between January 2010 and January 2018. Cats were divided into survivors and nonsurvivors according to their survival status 28 days after hospital admission. The prognostic importance of each variable was investigated univariately and by multivariable Cox's proportional‐hazards regression. Finally, receiver operator characteristic (ROC) curve analysis was used to identify the best cutoff value for discriminating survivors from nonsurvivors for the statistically significant prognostic predictors identified by multivariable analysis.

Results

Seventy cats were enrolled in the study. Multivariable analysis determined that only serum tT4 concentration at hospital admission was significantly (P = .01) associated with survival. A cutoff value of 0.82 μg/dL was identified by ROC curve analysis for serum tT4 concentration in discriminating survivors from nonsurvivors. Sensitivity at this cutoff was 73.9% and specificity was 82.9% (area under the curve, 0.783; 95% confidence interval, 0.668‐0.873; P < .0001).

Conclusion and Clinical Relevance

Serum tT4 concentration at hospital admission has prognostic value in cats with FPV infection.

Serum D-lactate concentrations in dogs with parvoviral enteritis

BACKGROUND

Dogs infected with canine parvovirus (CPV) have compromised intestinal epithelial barrier integrity. Production of D-lactate by enteric bacteria may directly reflect disease severity or contribute to metabolic acid-base status in these dogs.

HYPOTHESIS

Serum D-lactate concentration will be increased in CPV dogs compared to healthy controls and correlate with markers of disease severity and acid-base status.

ANIMALS

Dogs with CPV undergoing treatment (n = 40) and healthy control dogs (n = 9).

METHODS

Prospective observational study. Dogs with CPV had a baseline and daily CBC, venous blood gas with serum electrolyte concentrations, composite clinical severity score, and serum D-lactate concentration performed. A single serum D-lactate measurement was obtained from healthy control dogs.

RESULTS

The CPV dogs had a higher D-lactate concentration (mean ± SD) of 469 ± 173 μM compared to controls, 306 ± 45 μM (P < .001). There was no difference in baseline D-lactate concentrations for CPV survivors (474 ± 28 μM), versus nonsurvivors (424 ± 116 μM; P = .70). D-lactate concentration decreased over the first 4 days of treatment (-9.6 μM/d; P = .46). Dogs hospitalized for <4 days had lower baseline D-lactate concentrations compared to those hospitalized ≥4 days (400 ± 178 μM versus 520 ± 152 μM; P = .03). No sustained correlation over time between serum D-lactate concentration and clinical severity score or recorded acid-base results.

CONCLUSIONS AND CLINICAL IMPORTANCE

Serum D-lactate concentrations are higher in dogs with CPV compared to healthy controls but do not appear to be clinically relevant. No relationship identified between serum D-lactate concentrations and markers of CPV disease severity, acid-base status, or outcome.

Retrospective evaluation of 24 cases of gastrostomy tube usage in dogs with septic peritonitis (2009-2016)

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.

Description of a novel technique for surgical placement of gastrostomy tubes in dogs

BACKGROUND

Early enteral nutrition in dogs with critical illnesses, including septic peritonitis, has been shown to have a positive influence on patient outcome. Surgical placement of a gastrostomy tube (GT) is one option for providing early enteral nutrition. Complications, including premature tube removal or separation of the stomach from the body wall, can result in leakage of gastric contents into the abdominal cavity and subsequent peritonitis. A safe and reliable technique for the placement of a GT is desirable to minimize such complications.

KEY CONCEPTS

A modified method for surgical placement of a GT is described. A thoracic trocar catheter (TTC) with an attached Pezzer tube is inserted through a gastrotomy incision and exited through the left gastric body and body wall. A left-sided tube gastropexy is performed using an interlocking box (ILB) pattern.

SIGNIFICANCE

GT placement using a TTC is efficient, requiring minimal additional anesthesia time. The gastric defect created by the TTC conforms well with the Pezzer tube. As such, placement and utilization of the ILB suture pattern enables removal of the GT in the early postoperative period, if appropriate.

Retrospective evaluation of the route and timing of nutrition in dogs with septic peritonitis: 68 cases (2007-2016)

OBJECTIVE

To determine the impact of route of nutrition on length of hospitalization and survival to discharge in dogs with septic peritonitis.

DESIGN

Retrospective study from 2007 to 2016.

SETTING

University teaching hospital.

ANIMALS

Sixty-eight dogs with septic peritonitis that survived ≥48 hours.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Nutritional strategy was categorized into 1 of 4 groups: voluntary, feeding tube, parenteral (PN), and combined feeding tube and PN. Body weight, body condition score, time without caloric intake before and during hospitalization, length of hospitalization, and percentage of resting energy requirements provided during the first 3 days of nutritional support were recorded. Overall, 54/68 dogs survived (79%). Survival Prediction Index 2 scores were not significantly different between groups. Dogs receiving PN only were less likely to survive than those receiving any enteral nutrition (OR 9.7; 95CI 1.84-58.75). Compared to dogs not receiving PN, dogs receiving any PN were significantly less likely to survive (OR 9.66; 95% CI 1.7-105.8), and were in hospital significantly longer (P = 0.025). Metabolic complications associated with PN were frequent but not associated with increased length of hospitalization or survival to discharge.

CONCLUSIONS

Dogs with septic peritonitis that received any PN were in hospital longer and less likely to survive but may have been sicker than those receiving other forms of nutritional support. Further studies are warranted to evaluate reasons for worse outcomes in dogs with septic peritonitis receiving PN.

Changes in salivary analytes in canine parvovirus: A high-resolution quantitative proteomic study

The present study evaluated the changes in salivary proteome in parvoviral enteritis (PVE) in dogs through a high-throughput quantitative proteomic analysis. Saliva samples from healthy dogs and dogs with severe parvovirosis that survived or perished due to the disease were analysed and compared by Tandem Mass Tags (TMT) analysis. Proteomic analysis quantified 1516 peptides, and 287 (corresponding to 190 proteins) showed significantly different abundances between studied groups. Ten proteins were observed to change significantly between dogs that survived or perished due to PVE. Bioinformatics' analysis revealed that saliva reflects the involvement of different pathways in PVE such as catalytic activity and binding, and indicates antimicrobial humoral response as a pathway with a major role in the development of the disease. These results indicate that saliva proteins reflect physiopathological changes that occur in PVE and could be a potential source of biomarkers for this disease.

Assessing the Efficacy of Maropitant Versus Ondansetron in the Treatment of Dogs with Parvoviral Enteritis

Antiemetics are commonly prescribed during the treatment of canine parvoviral enteritis. This blinded, randomized prospective study compared the quality of clinical recovery and duration of hospitalization in canine parvoviral dogs receiving either maropitant (1 mg/kg [0.45 mg/lb] IV q 24 hr, n = 11) or ondansetron (0.5 mg/kg [0.23 mg/lb] IV q 8 hr, n = 11). All dogs were treated with IV fluids, cefoxitin, and enteral nutrition. Frequency of vomiting and pain scoring were recorded twice daily. Rescue analgesics and antiemetics were administered as dictated by specific pain and vomiting criteria. Clinical severity scoring, body weight, and caloric intake were monitored daily. When comparing dogs receiving maropitant versus ondansetron, respectively, there were no differences in duration of hospitalization (3.36 ± 0.56 versus 2.73 ± 0.38 days, P = .36), requirement of rescue antiemetic (3/11 versus 5/11 dogs, P = .66), duration of vomiting (5 versus 4 days, P = .65), or days to voluntary food intake (2 versus 1.5 days, P = 1.0). Results of this study suggest that maropitant and ondansetron are equally effective in controlling clinical signs associated with parvoviral enteritis.

Evaluation of the Prevalence and Risk Factors for Undernutrition in Hospitalized Dogs

Hospitalized dogs are predisposed to undernutrition, which can potentially affect outcome. This study evaluated the prevalence of undernutrition in hospitalized dogs (measured as loss of body condition score, BCS and body weight, BW) and studied the risk factors that affect nutritional status, and outcome (discharge or death). Data was collected prospectively during 9 months from 500 hospitalized dogs with a hospitalization length longer than 24 h in a veterinary teaching hospital in Spain. The BCS and BW changes were modeled using multiple linear regression and outcome was modeled using logistic regression. The risk factors studied were energy intake, hospitalization length, initial BW and BCS, age, sex, severity of clinical signs, department of admission, fasting or nutritional interventions, and the presence of anorexia, vomiting or diarrhea at admission. Most of the dogs (84.0%) consumed less than 25% of their energy requirements and only 3.4% of the dogs met these requirements. The majority of hospitalized dogs maintained their BCS (78.2%) and BW (77%) during hospitalization. Older patients (P = 0.040), higher initial BCS (P < 0.001), and vomiting at admission (P = 0.030) were associated with a decrease of BCS status during hospitalization. BCS was also decreased in patients with low energy intake, particularly in patients with hospitalization length longer than 3 days (P < 0.001). Both longer hospitalization length (P < 0.001) and vomiting at admission (P = 0.004) were also associated with a decrease in BW. Dogs that consumed their theoretical energy requirements [P < 0.001; Odds Ratio (OR) 0.95, 95% CI: 0.92 to 0.98], and had a higher initial BCS (P < 0.001; OR 0.39, 95% CI: 0.22 to 0.63) had a lower odds of dying. Anorexia at admission (P < 0.001; OR 5.67, 95% CI: 2.23 to 15.47) was associated with a higher risk of death. The results from this study support the finding that undernutrition is relatively common during hospitalization, with age, hospitalization length, decreased energy intake, and vomiting at admission as risk factors for undernutrition. Furthermore, an association was found between inadequate energy intake and death.

Long-term effects of canine parvovirus infection in dogs

BACKGROUND

Canine parvovirus (CPV) is the most important viral cause of acute canine enteritis leading to severe damage of the intestinal barrier. It has been speculated that dogs might develop chronic disorders after surviving CPV infection. However, no studies regarding the long-term implications of CPV infection have been published to date. The aim of this study was to evaluate whether dogs that have survived CPV infection will have an increased risk for developing chronic gastroenteritis, atopic dermatitis, or cardiac disease.

METHODOLOGY/PRINCIPAL FINDINGS

Dogs that had been treated at the Clinic of Small Animal Medicine, LMU Munich, for CPV infection for which a follow-up of at least 12 months was available, were included in the study. Owners completed a questionnaire on the presence of chronic gastrointestinal and cutaneous signs, cardiac disease, and other potential disorders. An identical questionnaire was sent to owners of matched control dogs during the same time period. Seventy-one questionnaires of dogs with CPV infection and 67 of control dogs were analyzed. Significantly more CPV-infected dogs (30/71) compared to control dogs (8/67) had developed chronic gastrointestinal signs later in their lives (P < 0.001). No significant differences were observed regarding skin diseases (P = 1), cardiac problems (P = 0.160), or any other diseases (P = 0.173) later in life.

CONCLUSIONS

Results of this study suggest that dogs that survive CPV infection have a significantly higher risk (odds ratio = 5.33) for developing a chronic gastrointestinal disease. Further prospective studies to identify the trigger for the development of chronic diarrhoea and possible targeted treatment strategies are needed.

Bocavirus-Nachweis bei 4 Wochen alten Welpen mit akutem Durchfall

Zwei 4 Wochen alte, weibliche Dobermann-Welpen wurden mit akutem Durchfall und Erbrechen vorgestellt. Zusätzlich zeigten sie Niesen und Nasenausfluss. Aufgrund der klinischen Präsentation und einer Neutropenie bestand der hochgradige Verdacht einer Parvovirose. Die Tiere blieben mehrere Tage hospitalisiert und wurden symptomatisch therapiert. Eine parasitologische Kotuntersuchung sowie eine virologische Untersuchung des Kots auf eine Parvovirusinfektion (Polymerasekettenreaktion [PCR] und Immunelektronenmikroskopie) verliefen negativ. Mithilfe einer weiteren, neuen PCR ließ sich das Bocavirus identifizieren, sodass eine Infektion mit diesem Erreger als mögliche Diagnose infrage kommt. Dieser Fallbericht beschreibt eine noch wenig bekannte virale Welpenerkrankung mit erfolgreichem Therapieverlauf.

Evaluation of the Safety of Early Compared to Late Enteral Nutrition in Canine Septic Peritonitis

Septic peritonitis is a relatively common condition in the veterinary intensive care unit, with a classically high mortality rate. Early enteral nutrition (EEN) in critically ill humans can lead to improved outcome. This study was performed to determine the safety of early postoperative feeding in canine septic peritonitis. In this retrospective case series, 56 dogs were identified. Sixteen dogs received EEN, defined as nutrition within 24 hr of surgery; 27 received late enteral nutrition (LEN) defined as nutrition more than 24 hours following surgery; and 13 dogs had no enteral nutrition in hospital (NEN). Signalment, physical examination findings, and occurrence of pre-admission vomiting, regurgitation, and length of anorexia were the same amongst all groups. There was no significant difference in the number of gastrointestinal complications postoperatively between the EEN, LEN, and NEN groups or in the occurrence of vomiting/regurgitation postoperatively compared to preoperatively. There was no difference in the length of hospitalization between any group, although fewer dogs in the NEN group survived compared to the EEN/LEN combined group (46% [6/13] versus 81% [37/40]). This study indicates it is safe to initiate EEN without additional risk of gastrointestinal complications. Prospective studies are needed to evaluate the potential benefits of EEN in dogs with septic peritonitis.

Bacterial translocation in critical illness

Bacterial translocation involves the passage of intestinal bacteria to extraintestinal sites and has been shown to increase morbidity and mortality in critical illness. This review outlines the pathophysiology of bacterial translocation, host defence mechanisms, and reviews the evidence for the clinical management of critically ill patients in order to minimise the negative outcomes associated with bacterial translocation.

Evaluation of an outpatient protocol in the treatment of canine parvoviral enteritis

OBJECTIVE

To compare 2 treatment protocols (standard in-hospital versus modified outpatient) in affecting the duration of treatment or survival of dogs with parvoviral enteritis.

DESIGN

Prospective, randomized study.

SETTING

University teaching hospital.

ANIMALS

Client-owned dogs with naturally acquired parvovirus were randomized to receive either an inpatient (n = 20) or outpatient (n = 20) treatment protocol.

INTERVENTIONS

Both groups received intravenous (IV) fluid resuscitation and correction of hypoglycemia at hospital admission. Following stabilization, basic inpatient interventions included administration of IV fluids, administration of cefoxitin (22 mg/kg IV q 8 h), and maropitant (1 mg/kg IV q 24 h). Basic outpatient interventions (provided in-hospital) included administration of subcutaneous (SC) fluid (30 mL/kg q 6 h), administration of maropitant (1 mg/kg SC q 24 h) and cefovecin (8 mg/kg SC once). Using daily electrolyte and glucose evaluations, dextrose and potassium supplementation was provided intravenously (inpatients) or orally (outpatients) as indicated. Rescue criteria were used in both groups for analgesia and nausea. All dogs were syringe fed a commercial canine convalescence diet (1 mL/kg PO q 6 h) until voluntary appetite returned.

MEASUREMENTS AND MAIN RESULTS

Protocol success, defined as survival to hospital discharge, was 90% (18/20) for the inpatient group compared to 80% (16/20) for the outpatient group (P = 0.66). There was no difference detected in duration of hospitalization for inpatient dogs (4.6 ± 2 days) versus outpatient dogs (3.8 ± 1.8 days, P = 0.20). Metabolic disturbances were frequent in the outpatient group, with 50% of dogs requiring dextrose supplementation and 60% of dogs requiring potassium supplementation.

CONCLUSIONS

An outpatient protocol may be a reasonable alternative for dogs that cannot receive standard in-hospital treatment for parvoviral enteritis. Diligent supportive care and monitoring are still required to optimize treatment of dogs with parvoviral enteritis in an outpatient setting.

Treating Hypoalbuminemia

Hypoalbuminemia is common and associated with a variety of disease processes, including those leading to systemic inflammatory response syndrome, gastrointestinal disorders, hepatic disorders, and glomerular diseases. Some animals develop clinical signs directly caused by low serum albumin concentration. There is strong evidence that hypoalbuminemia is associated with worse outcomes; however, evidence justifying albumin supplementation is lacking. Severe adverse events are frequently reported with administration of human serum albumin and there is little evidence of benefit from other products. Most patients will not require administration of albumin-containing products. Clinicians should consider early enteral nutritional supplementation in critically ill patients.

Palatability and Clinical Effects of an Oral Recuperation Fluid During the Recovery of Dogs With Suspected Parvoviral Enteritis

Dogs infected with canine parvovirus (CPV) can develop severe enteritis that requires supportive care until voluntary food and water consumption return. An oral recuperation fluid (ORF) may assist in the overall recovery from CPV. The hypotheses of the study were that dogs with naturally infected CPV would prefer the ORF to water and that dogs consuming the ORF would have a more rapid return to voluntary appetite and improved caloric intake during the initial recovery period compared with dogs consuming water. A total of 28 dogs with CPV were enrolled. Dogs were excluded if voluntary food or water intake was present at the time of study enrollment. Dogs were randomized to either an ORF or water group. The designated fluid was offered twice daily, followed by offering the opposite fluid 1 hour later if the designated fluid was refused. Dogs also received a standardized supportive treatment protocol. Beginning on day 2, all dogs were offered a gastrointestinal diet q8h, staggered with the fluid intake trials. A total of 40% (6/15) of dogs with CPV consumed the ORF as their designated fluid, and 31% (4/13) of dogs with CPV consumed water as their designated fluid (P = .71). For those dogs who refused their designated fluid, 56% (5/9) of the dogs consuming ORF ultimately consumed water, and 22% (2/9) of the dogs consuming water also consumed the ORF (P = .33). Dogs who consumed the ORF demonstrated a more rapid return to voluntary appetite (median = 1.5 days [range: 1-3]) compared with those that consumed water (median = 4.25 days [range: 1.5-5.5], P = .01) or neither fluid (median = 2 days [range: 1.5-5.5], P = .03). Additionally, those dogs consuming the ORF demonstrated greater caloric intake [median = 100% resting energy requirement (RER), range: 61%-100%] compared with those that consumed water (median = 19% RER; range: 9%-100%; P = .004) or neither fluid (median = 37% RER; range: 3-100; P = .05). This study suggests that some dogs with CPV voluntarily consume an ORF during the recovery phase of their illness and that consumption of the ORF may foster a more rapid return of voluntary appetite as well as improved caloric intake. Additional studies are warranted to further assess additional effects of this ORF during recovery from CPV.

Development and characterization of a technique for percutaneous radiologic gastrojejunostomy tube placement in the dog

OBJECTIVE

To develop and describe a technique for percutaneous radiologic gastrojejunostomy tube placement in the dog.

DESIGN

Prospective technique development study.

SETTING

University teaching hospital.

ANIMALS

Six healthy adult male Beagles.

INTERVENTIONS

Following anesthetic induction, fluoroscopic and ultrasound guidance were used to identify an appropriate gastropexy site on the left lateral abdomen. Gastropexy was performed using gastrointestinal suture anchors. An over-the-wire catheter technique using fluoroscopic guidance was used to achieve jejunal access. An 18F/8F, 58 cm, dual-lumen gastrojejunal feeding tube was placed via serial over-the-wire dilation of the body wall using an 18F peel-away introducer kit. Tube location was determined radiographically immediately following placement and on days 2, 4, after emesis on day 4, and at time of gastrojejunal feeding tube removal (day 16-18).

MEASUREMENTS AND MAIN RESULTS

Percutaneous radiologic gastrojejunostomy (PRGJ) tube placement was successful in all dogs. Median time to pyloric passage with the guide wire was 23.5 minutes (range, 9-93 minutes). Median total procedure time was 53 minutes (range, 49-113 minutes). Significant tube migration was not observed at any point during the study. One dog developed linear foreign body obstruction secondary to the tube on day 5 that was relieved by release of the jejunal component. Other complications were minor and included mild-to-moderate peristomal inflammation in all dogs and removal of the feeding tube on day 3 by 1 dog. Feedings were well tolerated in all dogs.

CONCLUSIONS

PRGJ tube placement in the dog is a safe and minimally invasive technique that allows for jejunal feeding without surgery or endoscopy. The high success rates, acceptable procedural times, and minimal complications are appealing for use in critically ill patients. Although additional evaluations are needed, PRGJ tube placement may be considered for dogs that require postpyloric feeding with or without gastric decompression.

Canine parvoviral enteritis: an update on the clinical diagnosis, treatment, and prevention

Canine parvovirus type 2 is the cause of a highly contagious acute enteritis associated with high morbidity and mortality, with very low survival rates in untreated dogs. Although severe clinical disease typically occurs in dogs younger than 6 months of age, adults with insufficient immunity may potentially be affected. In this article, the current state of knowledge is reviewed regarding the diagnostic aspects of parvoviral enteritis, with special emphasis placed on the clinical relevance of the detection of viral antigens in the feces, detection of viral antibodies in the serum, or the polymerase chain reaction-based amplification of the viral DNA in the feces. In addition, the components of the supportive and symptomatic treatment aiming to optimize the outcome of the disease in the clinical setting are thoroughly reviewed. Immunization guidelines for the prevention of the disease are also updated.

The effects of feeding and withholding food on the canine small intestinal microbiota

Prolonged lack of enteral feeding has a negative impact on gut physiology, potentially via microbiota modulation. The aims were to investigate the impact of fasting and post-prandial changes in canine jejunal microbiota. To study post-prandial effects, jejunal brushings were analyzed in 8 healthy fistulated dogs 15 min before feeding (baseline) and hourly for 8 h after feeding. To study effects of withholding food (WF), daily samples were collected for 15 days from 5 dogs. The first 5 days (PRE) dogs were fed regular diet. Food was withheld the next 5 days (days 6-10). For days 11-15 (POST), the original diet was reintroduced. Microbiota was characterized via denaturing gradient gel electrophoresis and 454-pyrosequencing of 16S rRNA genes. In the post-prandial study, no changes in microbiome structure were seen after feeding (ANOSIM, P = 0.28), but Betaproteobacteria (P = 0.04) and Bacteroidales decreased compared to baseline. Species richness decreased by 300 min (P = 0.04). During WF, microbiota structure differed from PRE and POST period (P = 0.001). During WF, species richness did not vary over time (P = 0.69). In conclusion, a prolonged period of food withholding results in altered jejunal microbiota. How these changes affect the microbiota metabolism warrants further studies.

Gastrointestinal dysmotility disorders in critically ill dogs and cats

OBJECTIVE

To review the human and veterinary literature regarding gastrointestinal (GI) dysmotility disorders in respect to pathogenesis, patient risk factors, and treatment options in critically ill dogs and cats.

ETIOLOGY

GI dysmotility is a common sequela of critical illness in people and small animals. The most common GI motility disorders in critically ill people and small animals include esophageal dysmotility, delayed gastric emptying, functional intestinal obstruction (ie, ileus), and colonic motility abnormalities. Medical conditions associated with the highest risk of GI dysmotility include mechanical ventilation, sepsis, shock, trauma, systemic inflammatory response syndrome, and multiple organ failure. The incidence and pathophysiology of GI dysmotility in critically ill small animals is incompletely understood.

DIAGNOSIS

A presumptive diagnosis of GI dysmotility is often made in high-risk patient populations following detection of persistent regurgitation, vomiting, lack of tolerance of enteral nutrition, abdominal pain, and constipation. Definitive diagnosis is established via radioscintigraphy; however, this diagnostic tool is not readily available and is difficult to perform on small animals. Other diagnostic modalities that have been evaluated include abdominal ultrasonography, radiographic contrast, and tracer studies.

THERAPY

Therapy is centered at optimizing GI perfusion, enhancement of GI motility, and early enteral nutrition. Pharmacological interventions are instituted to promote gastric emptying and effective intestinal motility and prevention of complications. Promotility agents, including ranitidine/nizatidine, metoclopramide, erythromycin, and cisapride are the mainstays of therapy in small animals.

PROGNOSIS

The development of complications related to GI dysmotility (eg, gastroesophageal reflux and aspiration) have been associated with increased mortality risk. Institution of prophylaxic therapy is recommended in high-risk patients, however, no consensus exists regarding optimal timing of initiating prophylaxic measures, preference of treatment, or duration of therapy. The prognosis for affected small animal patients remains unknown.

New biomarkers for intestinal permeability induced by lipopolysaccharide in chickens

Intestinal health is influenced by a complex set of variables involving the intestinal microbiota, mucosal immunity, digestion and absorption of nutrients, intestinal permeability (IP) and intestinal integrity. An increase in IP increases bacterial or toxin translocation, activates the immune system and affects health. IP in chickens is reviewed in three sections. First, intestinal structure and permeability are discussed briefly. Second, the use of lipopolysaccharide (LPS) as a tool to increase IP is discussed in detail. LPS, a glycolipid found in the outer coat of mostly Gram-negative bacteria, has been reported to increase IP in rats, mice and pigs. Although LPS has been used in chickens for inducing systemic inflammation, information regarding LPS effects on IP is limited. This review proposes that LPS could be used as a means to increase IP in chickens. The final section focuses on potential biomarkers to measure IP, proposing that the sugar-recovery method may be optimal for application in chickens.