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Dumont R, Lemetayer J, Desquilbet L, Darnis E. Tolerability of naso-esophageal feeding tubes in dogs and cats at home: Retrospective review of 119 cases. J Vet Intern Med 2023; 37:2315-2321. [PMID: 37878245 PMCID: PMC10658475 DOI: 10.1111/jvim.16732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/18/2023] [Indexed: 10/26/2023] Open
Abstract
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.
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Affiliation(s)
- Renaud Dumont
- Internal Medicine DepartmentVeterinary Hospital FrégisArcueilFrance
| | - Julie Lemetayer
- Internal Medicine DepartmentVeterinary Hospital AdvetiaVélizy‐VillacoublayFrance
| | - Loïc Desquilbet
- Biostatistics and Clinical Epidemiology DepartmentNational Veterinay School of AlfortMaisons‐AlfortFrance
| | - Elodie Darnis
- Internal Medicine DepartmentVeterinary Hospital FrégisArcueilFrance
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2
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Hedley J, Fayers B, Abou-Zahr T. Complications associated with esophagostomy tube placement in chelonian patients. J Exot Pet Med 2021. [DOI: 10.1053/j.jepm.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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3
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Thompson BJ, Sherman RA. Comprehensive Review of Biliary Peritonitis. Top Companion Anim Med 2021; 44:100532. [PMID: 33781985 DOI: 10.1016/j.tcam.2021.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
Biliary peritonitis is a growing concern in the canine patient and a thorough understanding of the disease will lead to better treatment outcomes. This article reviews the human and veterinary literature pertaining to biliary peritonitis including both scientific reviews and original publications. Compared to human medicine, biliary peritonitis can be difficult to diagnose preoperatively. Multiple risk factors exist increasing the likelihood of development of biliary peritonitis. Treatment recommendations center on stabilization, surgical cholecystectomy, and postoperative supportive care. Clinically, further studies on treatment and prevention in veterinary medicine are warranted.
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4
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Nutritional Management for Dogs and Cats with Gastrointestinal Diseases. Vet Clin North Am Small Anim Pract 2021; 51:669-684. [PMID: 33653539 DOI: 10.1016/j.cvsm.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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5
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Forman MA, Steiner JM, Armstrong PJ, Camus MS, Gaschen L, Hill SL, Mansfield CS, Steiger K. ACVIM consensus statement on pancreatitis in cats. J Vet Intern Med 2021; 35:703-723. [PMID: 33587762 PMCID: PMC7995362 DOI: 10.1111/jvim.16053] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022] Open
Abstract
Background Pancreatitis in cats, although commonly diagnosed, still presents many diagnostic and management challenges. Objective To summarize the current literature as it relates to etiology, pathogenesis, diagnosis, and management of pancreatitis in cats and to arrive at clinically relevant suggestions for veterinary clinicians that are based on evidence, and where such evidence is lacking, based on consensus of experts in the field. Animals None. Methods A panel of 8 experts in the field (5 internists, 1 radiologist, 1 clinical pathologist, and 1 anatomic pathologist), with support from a librarian, was formed to assess and summarize evidence in the peer reviewed literature and complement it with consensus clinical recommendations. Results There was little literature on the etiology and pathogenesis of spontaneous pancreatitis in cats, but there was much in the literature about the disease in humans, along with some experimental evidence in cats and nonfeline species. Most evidence was in the area of diagnosis of pancreatitis in cats, which was summarized carefully. In contrast, there was little evidence on the management of pancreatitis in cats. Conclusions and Clinical Importance Pancreatitis is amenable to antemortem diagnosis by integrating all clinical and diagnostic information available, and recognizing that acute pancreatitis is far easier to diagnose than chronic pancreatitis. Although both forms of pancreatitis can be managed successfully in many cats, management measures are far less clearly defined for chronic pancreatitis.
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Affiliation(s)
- Marnin A Forman
- Cornell University Veterinary Specialists, Stamford, Connecticut, USA
| | - Joerg M Steiner
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - P Jane Armstrong
- College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA
| | - Melinda S Camus
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Lorrie Gaschen
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Louisiana, USA
| | - Steve L Hill
- Flagstaff Veterinary Internal Medicine Consulting, Flagstaff, Arizona, USA
| | | | - Katja Steiger
- Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
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6
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Černá P, Kilpatrick S, Gunn-Moore DA. Feline comorbidities: What do we really know about feline triaditis? J Feline Med Surg 2020; 22:1047-1067. [PMID: 33100169 PMCID: PMC10814216 DOI: 10.1177/1098612x20965831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PRACTICAL RELEVANCE Feline triaditis describes concurrent pancreatitis, cholangitis and inflammatory bowel disease (IBD). The reported prevalence is 17-39% in ill referral patients. While the aetiology is poorly understood, it is known to include infectious, autoimmune and physical components. What is not known is whether different organs are affected by different diseases, or the same process; indeed, triaditis may be part of a multiorgan inflammatory disease. Feline gastrointestinal tract anatomy plays its role too. Specifically, the short small intestine, high bacterial load and anatomic feature whereby the pancreatic duct joins the common bile duct before entering the duodenal papilla all increase the risk of bacterial reflux and parenchymal inflammation. Inflammation may also be a sequela of bowel bacterial translocation and systemic bacteraemia. DIAGNOSTIC CHALLENGES Cholangitis, pancreatitis and IBD manifest with overlapping, vague and non-specific clinical signs. Cholangitis may be accompanied by increased serum liver enzymes, total bilirubin and bile acid concentrations, and variable ultrasonographic changes. A presumptive diagnosis of pancreatitis is based on increased serum pancreatic lipase immunoreactivity or feline pancreas-specific lipase, and/or abnormal pancreatic changes on ultrasonography, though these tests have low sensitivity. Diagnosis of IBD is challenging without histopathology; ultrasound findings vary from normal to mucosal thickening or loss of layering. Triaditis may cause decreased serum folate or cobalamin (B12) concentrations due to intestinal disease and/or pancreatitis. Triaditis can only be confirmed with histopathology; hence, it remains a presumptive diagnosis in most cases. EVIDENCE BASE The literature on feline triaditis, pancreatitis, cholangitis and IBD is reviewed, focusing on histopathology, clinical significance and diagnostic challenges. Current management recommendations are provided. Further studies are needed to understand the complex pathophysiology, and in turn improve diagnosis and treatment.
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Affiliation(s)
- Petra Černá
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, and Small Animal Clinic, The University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | | | - Danielle A Gunn-Moore
- The Royal (Dick) School of Veterinary Studies, and The Roslin Institute, University of Edinburgh, UK
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7
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Chan DL. Nutritional Support of the Critically Ill Small Animal Patient. Vet Clin North Am Small Anim Pract 2020; 50:1411-1422. [PMID: 32814627 DOI: 10.1016/j.cvsm.2020.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
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.
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Affiliation(s)
- Daniel L Chan
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, RVC, Hawkshead Lane, North Mymms, Hertfordshire AL97TA, UK.
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8
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Guo YB, Liu Y, Ma J, Cai Y, Jiang XM, Zhang H. Effect of early enteral nutrition support for the management of acute severe pancreatitis: A protocol of systematic review. Medicine (Baltimore) 2020; 99:e21569. [PMID: 32769901 PMCID: PMC7593012 DOI: 10.1097/md.0000000000021569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This study aims to assess the effect of early enteral nutrition support (EENS) for the management of acute severe pancreatitis (ASP). METHODS This study will search Cochrane Library, PUBMED, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, CNKI, and WANGFANG from their inception to the present without language limitations. In addition, this study will also search clinical trial registry and reference lists of included trials. Eligible comparators will be standard care, medications, and any other interventions. Two authors will independently scan all citations, titles/abstracts, and full-text studies. The study methodological quality will be appraised using Cochrane risk of bias tool. If it is possible, we will pool out data and perform meta-analysis. Strength of evidence for each main outcome will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation. RESULTS This study will summarize the most recent evidence to assess the effect of EENS for the management of ASP. CONCLUSION The findings of this study will help to determine whether EENS is effective for patients with ASP. STUDY REGISTRATION INPLASY202070009.
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Affiliation(s)
- Yong-bo Guo
- Department of Critical Care Medicine, The Affiliated Hongqi Hospital of Mudanjiang Medical University
| | - Yan Liu
- Department of Critical Care Medicine, The Affiliated Hongqi Hospital of Mudanjiang Medical University
| | - Jing Ma
- Department of Critical Care Medicine, The Affiliated Hongqi Hospital of Mudanjiang Medical University
| | - Ying Cai
- Department of Critical Care Medicine, First Affiliated Hospital of Mudanjiang Medical University, Mudanjiang
| | - Xiao-ming Jiang
- Department of Critical Care Medicine, Beijing Mentougou District Hospital, Beijing, China
| | - Hong Zhang
- Department of Critical Care Medicine, The Affiliated Hongqi Hospital of Mudanjiang Medical University
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9
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Hinden SE, Schweighauser A, Francey T. Evaluation of a novel non-surgical post-pyloric feeding technique in dogs with severe acute kidney injury. J Vet Emerg Crit Care (San Antonio) 2020; 30:384-395. [PMID: 32613669 DOI: 10.1111/vec.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/04/2018] [Accepted: 06/29/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the placement and the performance of a new post-pyloric feeding (PPF) system, and compare it to esophageal (E) feeding in dogs with severe acute kidney injury (AKI). DESIGN Prospective study. SETTING University teaching hospital. ANIMALS Twenty client-owned dogs with severe AKI treated with hemodialysis. INTERVENTIONS Dogs were randomly assigned to 2 feeding techniques, PPF or E feeding; for PPF, an 8-Fr jejunal (J) tube was introduced through a standard 18-Fr E-tube and advanced endoscopically through the pylorus. A commercial liquid diet was administered at a continuous rate for at least 5 days. After the removal of the internal J-tube, feeding was continued through the E-tube. Control dogs were fed blended food 5 times daily through an E-tube. Placement technique, nutritional efficiency, and metabolic response to nutritional support were compared between the groups. MEASUREMENTS AND MAIN RESULTS Feeding tubes were placed a medium of 1 day (interquartile range, 0.8 d) after presentation. Median procedure-time in the group PPF was 26.5 min (11.5 min), including 8.5 min (2.7 min) for the E-tube and 17.5 min (5.0 min) for the J-tube. J-tubes were used for 5 days (1.5 d) with oral displacement observed in 3/10 dogs. The goal to administer 130% resting energy requirement within 3 days was reached in 13/20 dogs (8/10 PPF, 5/10 E). Despite nutritional support, dogs lost 1.2% body weight per day (1.1%), with no difference between the groups. The metabolic improvement was comparable between the groups, despite marked differences in the diet composition. CONCLUSIONS This new feeding technique can be recommended as an efficient method for early nutritional support in dogs with severe AKI. The protein-energy wasting observed despite active nutritional support suggests, however, the necessity for increased feeding targets or qualitative changes in diet composition for dogs with AKI.
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Affiliation(s)
- Sandro E Hinden
- Department of Clinical Veterinary Medicine, Division of Small Animal Internal Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Ariane Schweighauser
- Department of Clinical Veterinary Medicine, Division of Small Animal Internal Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Thierry Francey
- Department of Clinical Veterinary Medicine, Division of Small Animal Internal Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
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10
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Hill TL. Gastrointestinal Tract Dysfunction With Critical Illness: Clinical Assessment and Management. Top Companion Anim Med 2019; 35:47-52. [PMID: 31122688 DOI: 10.1053/j.tcam.2019.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 12/29/2022]
Abstract
The gut is the site of digestion and absorption as well as serving as an endocrine and immune organ. All of these functions may be affected by critical illness. This review will discuss secondary effects of critical illness on the gut in terms of gastrointestinal function that is clinically observable and discuss consequences of gut dysfunction with critical illness to patient outcome. Because there is little evidence-based medicine in the veterinary field, much of our understanding of gut dysfunction with critical illness comes from animal models or from the human medical field. We can extrapolate some of these conclusions and recommendations to companion animals, particularly in dogs, who have similar gastrointestinal physiology to people. Additionally, the evidence regarding gut dysfunction in veterinary patients will be explored. By recognizing signs of dysfunction early and taking preventative measures, we may be able to increase success with treatment of critical illnesses.
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Affiliation(s)
- Tracy L Hill
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, The University of Georgia, Athens, GA, USA.
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11
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Risselada M, Griffith E, Kapler M, McDonald-Lynch M. Evaluation of various gastrojejunostomy tube constructs for enteral support of small animal patients. J Am Vet Med Assoc 2018; 252:1239-1246. [PMID: 29701521 DOI: 10.2460/javma.252.10.1239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the feasibility of manufacturing gastrojejunostomy tubes from jejunostomy and gastrostomy tubes that would allow for gastric and enteral feeding of and aspiration of gastric contents from small animal patients. DESIGN In vitro study. SAMPLE 9 gastrojejunostomy constructs. PROCEDURES Commercially available gastrostomy and jejunostomy tubes were combined to create 9 constructs. Three investigators tested each construct with 4 solutions (tap water, a commercial enteral diet, and 2 canned food-water mixtures) and 3 syringe sizes for ease of injection through the gastrostomy and jejunostomy tubes and aspiration through the gastrostomy tube. Flow rates were calculated and analyzed to evaluate effects of tube diameter and syringe size for each solution. RESULTS The 20F/8F, 24F/8F, 28F/8F, and 28F/10F (gastrostomy tube/jejunostomy tube) constructs allowed for injection and aspiration of all solutions. The 5F jejunostomy tubes allowed only water to be injected, whereas the 8F jejunostomy tubes did not allow injection of the canned food-water mixtures. The 20F/10F construct did not allow injection or aspiration through the gastrostomy tube, whereas the 18F/8F construct allowed injection but not aspiration through the gastrostomy tube. Faster flow rates through the gastrostomy tube were associated with larger gastrostomy tube diameter, smaller jejunostomy tube diameter, and smaller syringe size. Faster flow rates through the jejunostomy tube were associated with smaller jejunostomy tube diameter. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that homemade gastrojejunostomy constructs would allow for administration of a variety of enteral diets. Limitations to the administration and aspiration of various enteral diets as well as patient needs should be considered before a gastrojejunostomy tube combination is chosen.
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12
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Harris JP, Parnell NK, Griffith EH, Saker KE. Retrospective evaluation of the impact of early enteral nutrition on clinical outcomes in dogs with pancreatitis: 34 cases (2010-2013). J Vet Emerg Crit Care (San Antonio) 2017; 27:425-433. [DOI: 10.1111/vec.12612] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 05/26/2016] [Accepted: 06/02/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Jessica P. Harris
- Departments of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University; Raleigh NC 27607
| | - Nolie K. Parnell
- the Department of Veterinary Clinical Sciences; College of Veterinary Medicine, Purdue University; West Lafayette IN 47906
| | - Emily H. Griffith
- Statistics; College of Veterinary Medicine, North Carolina State University; Raleigh NC 27607
| | - Korinn E. Saker
- Departments of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University; Raleigh NC 27607
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13
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Hoffberg JE, Koenigshof A. Evaluation of the Safety of Early Compared to Late Enteral Nutrition in Canine Septic Peritonitis. J Am Anim Hosp Assoc 2017; 53:90-95. [DOI: 10.5326/jaaha-ms-6513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
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.
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Affiliation(s)
- Jamie Elizabeth Hoffberg
- From MedVet Medical & Cancer Centers for Pets, Chicago, Illinois (J.E.H.); and Michigan State University College of Veterinary Medicine, East Lansing, Michigan (A.K.)
| | - Amy Koenigshof
- From MedVet Medical & Cancer Centers for Pets, Chicago, Illinois (J.E.H.); and Michigan State University College of Veterinary Medicine, East Lansing, Michigan (A.K.)
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Abstract
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.
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Affiliation(s)
- Bobbi J Conner
- Emergency & Critical Care, University of Florida College of Veterinary Medicine, 2015 Southwest 16th Avenue, PO Box 100116, Gainesville, FL 32610, USA.
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15
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Kasiraj AC, Harmoinen J, Isaiah A, Westermarck E, Steiner JM, Spillmann T, Suchodolski JS. The effects of feeding and withholding food on the canine small intestinal microbiota. FEMS Microbiol Ecol 2016; 92:fiw085. [PMID: 27106050 DOI: 10.1093/femsec/fiw085] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2016] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Alyssa C Kasiraj
- Department of Small Animal Clinical Sciences, Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474, USA
| | - Jaana Harmoinen
- Department of Equine and Small Animal Medicine, Helsinki University, 00014 Helsinki, Finland
| | - Anitah Isaiah
- Department of Small Animal Clinical Sciences, Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474, USA
| | - Elias Westermarck
- Department of Equine and Small Animal Medicine, Helsinki University, 00014 Helsinki, Finland
| | - Jörg M Steiner
- Department of Small Animal Clinical Sciences, Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474, USA
| | - Thomas Spillmann
- Department of Equine and Small Animal Medicine, Helsinki University, 00014 Helsinki, Finland
| | - Jan S Suchodolski
- Department of Small Animal Clinical Sciences, Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474, USA
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16
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Swann JW, Maunder CL, Roberts E, McLauchlan G, Adamantos S. Prevalence and risk factors for development of hemorrhagic gastro-intestinal disease in veterinary intensive care units in the United Kingdom. J Vet Emerg Crit Care (San Antonio) 2015; 26:419-27. [PMID: 26641416 DOI: 10.1111/vec.12434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/21/2014] [Accepted: 05/30/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the prevalence of hemorrhagic gastro-intestinal (GI) disease developing in dogs and cats admitted for management of non-GI disease in veterinary intensive care units (ICUs). DESIGN Retrospective study of animals presented between October 2012 and July 2013. SETTING Three ICUs located in veterinary teaching hospitals in the United Kingdom. ANIMALS Dogs (n = 272) and cats (n = 94) were consecutively enrolled from 3 ICUs if they were hospitalized in the unit for at least 24 hours. Cases were excluded if they had hemorrhagic GI disease in the 48-hour period before presentation or in the 24-hour period after admission. Cases were also excluded if they suffered skull fracture, epistaxis, or hemoptysis, if they underwent surgical procedures of the GI or upper respiratory tracts, or if they were presented for management of GI disease. MEASUREMENTS AND MAIN RESULTS Hemorrhagic GI disease was observed in dogs at all 3 units, but at different rates (Center 1: 10.3%, Center 2: 4.8%, Center 3: 2.2%). Hemorrhagic GI disease was not observed in cats at any of the participating centers. Construction of a multivariable logistic regression model revealed that serum albumin concentration, administration of prophylactic gastro-protectant drugs, and institution were significantly associated with the development of hemorrhagic GI disease in dogs. Development of hemorrhagic GI disease and placement of a feeding tube were significantly associated with mortality during the period of hospitalization in dogs. Thirty-seven (13.6%) dogs and 12 (12.8%) cats died or were euthanized while hospitalized, with a higher mortality rate (42.1%) in dogs with hemorrhagic GI disease. CONCLUSIONS Hemorrhagic GI disease does develop in dogs hospitalized for management of non-GI disease, but this phenomenon was not observed in cats. Development of hemorrhagic GI disease appeared to have a significant impact on survival in veterinary ICUs.
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Affiliation(s)
- James W Swann
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London
| | | | - Emma Roberts
- School of Veterinary Medicine, University of Glasgow, Glasgow, UK
| | | | - Sophie Adamantos
- The School of Veterinary Sciences, University of Bristol, Bristol
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17
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Mansfield C, Beths T. Management of acute pancreatitis in dogs: a critical appraisal with focus on feeding and analgesia. J Small Anim Pract 2015; 56:27-39. [PMID: 25586804 DOI: 10.1111/jsap.12296] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/22/2014] [Accepted: 05/26/2014] [Indexed: 12/31/2022]
Abstract
Knowledge about acute pancreatitis has increased recently in both the medical and veterinary fields. Despite this expansion of knowledge, there are very few studies on treatment interventions in naturally occurring disease in dogs. As a result, treatment recommendations are largely extrapolated from experimental rodent models or general critical care principles. General treatment principles involve replacing fluid losses, maintaining hydrostatic pressure, controlling nausea and providing pain relief. Specific interventions recently advocated in human medicine include the use of neurokinin-1 antagonists for analgesia and early interventional feeding. The premise for early feeding is to improve the health of the intestinal tract, as unhealthy enterocytes are thought to perpetuate systemic inflammation. The evidence for early interventional feeding is not supported by robust clinical trials to date, but in humans there is evidence that it reduces hospitalisation time and in dogs it is well tolerated. This article summarises the major areas of management of acute pancreatitis in dogs and examines the level of evidence for each recommendation.
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Affiliation(s)
- C Mansfield
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, 250 Princes Highway, Werribee, Victoria 3030, Australia
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Risselada M, Ellison GW, Winter MD, Giglio RF, Shih A, Hernandez JA, Griffith E. In vitro evaluation of bursting pressure and intestinal luminal area of three jejunostomy tube placement techniques in dogs. Am J Vet Res 2015; 76:467-74. [DOI: 10.2460/ajvr.76.5.467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Olan NV, Prittie J. Retrospective evaluation of ProcalAmine administration in a population of hospitalized ICU dogs: 36 cases (2010-2013). J Vet Emerg Crit Care (San Antonio) 2015; 25:405-12. [PMID: 25900575 DOI: 10.1111/vec.12306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/08/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the use of ProcalAmine as a source of parenteral nutrition in hospitalized dogs and to report complications possibly referable to its use. DESIGN Retrospective study. SETTINGS Private veterinary teaching hospital. ANIMALS Thirty-six dogs hospitalized in ICU receiving ProcalAmine between October 2010 and March 2013. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The most common underlying disease process in this population of dogs was trauma (n = 8). Median duration of administration was 4 days and median resting energy requirement provided via ProcalAmine was 33%. ProcalAmine was administered via central catheters in 86% of cases and via peripheral catheters in 14% of cases. The overall mechanical complication rate was 19%. Metabolic complications possibly associated with ProcalAmine administration were documented in 12/36 dogs. Hyponatremia was most commonly identified (n = 6) followed by hyperglycemia (n = 4), hypochloremia (n = 2), azotemia (n = 2), metabolic alkalosis (n = 2), hyperchloremia (n = 1), and metabolic acidosis (n = 1). CONCLUSION ProcalAmine appears to be relatively safe and a viable option for parenteral nutrition in ill and injured dogs. Due to the potential for electrolyte derangements and other metabolic complications, daily monitoring of these parameters is advisable.
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Affiliation(s)
- Natasha V Olan
- Department of Emergency and Critical Care, The Animal Medical Center New York, NY, 10065
| | - Jennifer Prittie
- Department of Emergency and Critical Care, The Animal Medical Center New York, NY, 10065
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Huynh M, Sabater M, Brandão J, Forbes NA. Use of an esophagostomy tube as a method of nutritional management in raptors: a case series. J Avian Med Surg 2014; 28:24-30. [PMID: 24881150 DOI: 10.1647/2012-063] [Citation(s) in RCA: 5] [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
We determined if esophagostomy tube placement is feasible for nutritional support in raptors. The clinical data were reviewed from 18 raptors admitted between 2006 and 2012, and in which esophagostomy tubes were placed. Indications for tube placement, complications associated with its placement and management, duration of treatment, and changes in patient body weight were evaluated. The most common indication was nutritional and medical support in stressed hospitalized animals, and intensive care cases. Complications were regurgitation, unexpected removal, and misplacement of the tube. The esophagostomy tube was well tolerated in all but 2 cases. A tube was replaced once in 2 patients. Five birds died during the treatment course. Mortality was not associated with the placement of the tube. Average duration of tube placement was 6.1 +/- 3.7 days. Most birds did not gain any weight with use of the feeding tubes. Esophagostomy tubes are well tolerated in raptors, but further studies are needed to demonstrate their efficiency.
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Abstract
PRACTICAL RELEVANCE Pancreatitis is a frequent finding in cats, the chronic form being more common than the acute form. Despite the large number of diseases or conditions that may be associated with feline pancreatitis, in most cases no cause is diagnosed and the pancreatitis is said to be idiopathic. The chronic form can be mild and asymptomatic, and has a high prevalence in apparently healthy cats. This has generated debate concerning the clinical significance of chronic feline pancreatitis. However, several reports have demonstrated the severity of clinical signs in certain forms of acute feline pancreatitis, while other studies have reported a strong association between chronic pancreatitis and the development of comorbidities such as hepatic lipidosis, diabetes mellitus, inflammatory bowel disease or exocrine pancreatic insufficiency. This suggests that feline pancreatitis should not be overlooked. CLINICAL CHALLENGES Diagnosis of feline pancreatitis is complicated by the non-specific clinical signs and poor diagnostic value of basic biochemistry and haematology or imaging techniques. Development of a feline-specific pancreatic lipase immunoassay has improved our diagnostic ability in the past decade, but may have more limited application for mild and chronic forms of pancreatitis. Moreover, histopathology (the 'gold standard' diagnostic test) can be associated with false-negative results due to multifocal distribution of lesions or mild forms of the disease. With respect to treatment, it is important to take into account the idiosyncrasies of the feline species when considering medical therapies. EVIDENCE BASE This article reviews the literature on feline pancreatitis, focusing on the different forms and their relative clinical significance, while explaining difficulties inherent in the diagnosis of this disease. An overview of current recommendations for the management of cats with pancreatitis is also provided.
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Affiliation(s)
- Julien Bazelle
- Willows Veterinary Centre and Referral Service, Shirley, Solihull, West Midlands, B90 4NH, UK
| | - Penny Watson
- Queen’s Veterinary School Hospital, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
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Jensen KB, Chan DL. Nutritional management of acute pancreatitis in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2014; 24:240-50. [PMID: 24690138 DOI: 10.1111/vec.12180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 02/17/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review current and emerging nutritional approaches in the management of acute pancreatitis (AP) in people, dogs, and cats, and to provide a framework for further investigation in this field. DATA SOURCES Veterinary retrospective studies and reviews, human prospective clinical trials and reviews, and experimental animal studies focusing on nutritional management during AP. SUMMARY Nutritional management is an important part of the treatment plan for patients with AP. In human medicine, the general approach for providing nutrition in patients with AP has changed in recent years and favors enteral over parenteral nutrition with an emphasis on early enteral nutrition (EN). Although there are limited data available, there is increasing evidence in the veterinary literature that supports the beneficial role of EN in AP and contradicts previous assumptions about poor tolerance to enteral feeding in this patient population. Parenteral nutrition may be appropriate alone or in combination with EN as a temporary measure in malnourished patients that do not tolerate adequate EN; however, enteral feeding should be attempted first in most cases. Immunonutrition is being investigated for its positive role in modulating pancreatic inflammation and improving gut barrier function in cases of human AP. CONCLUSIONS The nutritional management of veterinary patients with AP remains challenging. Based on clinical evidence in people, experimental animal studies, and preliminary studies in dogs and cats, the choice of EN over parenteral nutritional support during AP in dogs and cats appears to be beneficial and well tolerated. Optimization of nutritional therapies in dogs and cats including the use of immunonutrition during AP warrants further investigation.
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Affiliation(s)
- Kristine B Jensen
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, Hertfordshire, United Kingdom
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Mansfield C. Acute Pancreatitis in Dogs: Advances in Understanding, Diagnostics, and Treatment. Top Companion Anim Med 2012; 27:123-32. [DOI: 10.1053/j.tcam.2012.04.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 04/30/2012] [Indexed: 12/26/2022]
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