GI lutd liver spring 08


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GI lutd liver spring 08

  1. 1. Therapeutic Nutrition III : Lower Urinary Tract Disease Gastrointestinal Disease Liver Disease “ Fella” 9 yrs old M(I) Beagle
  2. 3. <ul><li>Inflammation </li></ul><ul><li>Infection </li></ul><ul><li>Blockages </li></ul><ul><li>Formation of Uroliths </li></ul>© Hill’s Pet Nutrition, Inc.
  3. 4. Source: University of California – San Diego Struvite Calcium Oxalate Usually associated with bacterial urinary tract infection High sodium, calcium and oxalate correlation
  4. 5. Canine Profile Average Age Gender Breeds Calcium Oxalate 8 years Males > Female Min. Schnauzers, Min. Poodles, Yorkies, Bichons, Shih Tzus Struvite 6 years Female> Male Min. Schnauzers, Min. Poodles, Cocker Spaniels, Bichons
  5. 6. Source: University of California – San Diego Struvite Calcium Oxalate Persistent alkaline urine pH Persistent acidic urine pH
  6. 7. Feline Profile Avg. Age Gender & Neuter Status BCS & Environment Breeds Calcium Oxalate Older cats Neutered Males Obese, indoor, multiple cats Himalayan,Burmese, Persian Struvite Younger Cats Non-specific Neutered Obese, indoor, multiple cats Non-specific
  7. 8. <ul><li>Identify urolith type </li></ul><ul><li>Dissolve – struvite only </li></ul><ul><li>Treat infection if present </li></ul><ul><li>Target appropriate pH </li></ul><ul><li>Increase water intake in order to promote diluted urine </li></ul>
  8. 9. <ul><li>Water, water, water! </li></ul><ul><ul><li> Increases urine volume </li></ul></ul><ul><ul><li> More dilute urine </li></ul></ul><ul><ul><li> Decreased mineral concentration in urine </li></ul></ul><ul><ul><li> Increased frequency of urinating </li></ul></ul><ul><ul><li> Decreased urine retention </li></ul></ul><ul><ul><li> Less time for crystals to form </li></ul></ul>DIETARY MANAGEMENT IS MOST EFFECTIVE!!!!
  9. 11. UR Urinary ® St/Ox Urinary S - Low pH/S  Feline dry & canned Urinary O - Moderate pH/O  Feline dry & canned Prescription Diet ® c/d Multicare (for cats) Prescription Diet ® s/d Prescription Diet ® u/d Prescription Diet ® x/d Prescription Diet ® r/d Prescription Diet® w/d Urinary SO 30  Urinary SO 13  Dissolution Formula  Vegetarian Formula 
  10. 12. Samantha, 9-years old, Standard Poodle
  11. 13. <ul><li>Normal GI Function </li></ul><ul><li>Digestion of ingredients </li></ul><ul><li>Absorption of nutrients </li></ul><ul><li>Move food through GI tract </li></ul><ul><li>Eliminate waste (undigested) or by-products (bile acids, nitrogen) </li></ul>
  12. 14. “ Gracie Whitesox” 2 yrs ©GBS 2006
  13. 15. <ul><li>Gastritis & Enteritis </li></ul><ul><li>Vomiting </li></ul><ul><li>Diarrhea </li></ul><ul><ul><li>Volume </li></ul></ul><ul><ul><li>Consistency </li></ul></ul><ul><ul><li>Frequency </li></ul></ul>“ Going to California” 2yrs F(n) Miniature Pinscher
  14. 16. <ul><li>Gastric Dilatation & Volvulus </li></ul><ul><li>“ Bloat” </li></ul><ul><li>Secondary damage to GI mucosa </li></ul><ul><li>Tissue necrosis </li></ul><ul><li>Impaired digestion, absorption </li></ul>Source: Long Beach Animal Hospital; Long Beach, CA
  15. 17. <ul><li>Maldigestion/Malabsorption </li></ul><ul><li>Inability to absorb nutrients </li></ul><ul><li>Inability to digest/metabolize </li></ul>Mink, 14 yrs © G. Santiago 2002
  16. 18. Soluble vs. Insoluble Slowly Fermentable Rapidly Fermentable Fiber pectin guar gum soy fiber bran beet pulp soybean hulls peanut hulls cellulose Small Animal Clinical Nutrition, 4 th ed. Hand, Thatcher, Remillard, Roudebush
  17. 19. <ul><li>Restore fluid and electrolyte losses via oral or IV fluid therapy </li></ul><ul><li>Initially NPO to “rest” the entire GI tract </li></ul><ul><li>Gradual introduction of highly digestible </li></ul><ul><li>nutrients in small, controlled quantities </li></ul>Inflammatory GI Disease: Goals Examples: “Bloat”, Gastritis, Inflammatory Bowel Disease, Exocrine Pancreatic Insufficiency, GI Surgery
  18. 20. <ul><li>Provide low residue (low fiber) to reduce the work of the GI tract. </li></ul><ul><li>High digestibility to increase absorption </li></ul><ul><li>High fiber in colitis & constipation </li></ul>Inflammatory GI Disease: KNF
  19. 21. <ul><li>Reduce contributing causes </li></ul><ul><li>Provide “bulk” to stool </li></ul><ul><li>Highly digestible ingredients </li></ul><ul><li>Provide water absorption in colon </li></ul>Examples: Obstipation, Constipation, Mega Colon, Fiber Responsive Diarrhea
  20. 22. <ul><li>Increase water consumption </li></ul><ul><li>Increase insoluble fiber </li></ul><ul><ul><li>Start low, then increase slowly each week </li></ul></ul><ul><ul><li>Moderate fiber 10 – 15%; high fiber >15% </li></ul></ul><ul><li>Highly digestible fat & carbohydrates </li></ul><ul><li>Highly digestible protein </li></ul>
  21. 23. Would You Recommend an Increase or Decrease in Fiber? X X X X X X Parvo Virus Constipation Bloat Surgery Dietary Indiscretion or or or or
  22. 25. Needs decreased levels of fiber Needs increased levels of fiber
  23. 26. EN Gastroenteric ® DCO Dual Fiber Control® FortiFlora® Canine Nutritional Supplement Low-Residue  Feline & Canine formulas Prescription Diet ® d/d Prescription Diet ® z/d Prescription Diet ® i/d Prescription Diet® w/d Hypoallergenic HP 19  Sensitivity RC, LR, RD 30, VR  Diabetic HF 18 
  24. 27.
  25. 28. <ul><li>Drug and Toxin Metabolism </li></ul><ul><li>Ammonia detoxification </li></ul><ul><li>Protein catabolism </li></ul><ul><li>Fat synthesis and fat-soluble vitamin storage </li></ul><ul><li>Glucose mobilization storage </li></ul>
  26. 30. <ul><li>Acute </li></ul><ul><ul><li>Toxins </li></ul></ul><ul><ul><li>Feline Hepatic Lipidosis </li></ul></ul><ul><li>Chronic </li></ul><ul><ul><li>Portosystemic Shunt </li></ul></ul><ul><ul><li>Cirrhosis </li></ul></ul><ul><ul><li>Glucocorticoid Induced </li></ul></ul><ul><ul><li>Copper Storage Problems </li></ul></ul>
  27. 31. <ul><li>Highly digestible energy from carbohydrates and fat, to spare protein catabolism </li></ul><ul><li>Moderate levels of high quality protein Milk, egg or vegetable proteins are best </li></ul><ul><li>High vitamin level (Vitamins K, E, and C) </li></ul><ul><li>Reduced selected minerals (especially copper in some dog breeds) </li></ul>
  28. 32. <ul><li>High energy density </li></ul><ul><li>High fat </li></ul><ul><li>Controlled, high quality protein </li></ul><ul><li>High vitamin content, including antioxidants </li></ul><ul><li>Carnitine </li></ul>
  29. 33. EN Gastroenteric ® NF Kidney Function® Prescription Diet ® l/d Prescription Diet ® k/d Hepatic LS 14 Formula 