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Leung YB. Assisted Enteral Feeding of Exotic Companion Animals. Vet Clin North Am Exot Anim Pract 2024; 27:115-134. [PMID: 37709602 DOI: 10.1016/j.cvex.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
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.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ramesh M, Brooks AC, Thomovsky E, Johnson P, Fulkerson C, Parnell N, Weng HY. Comparison of 4 point-of-care techniques to detect correct positioning of nasogastric tubes in dogs (2020-2021). J Vet Emerg Crit Care (San Antonio) 2023; 33:501-508. [PMID: 37561112 DOI: 10.1111/vec.13327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 08/11/2023]
Abstract
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.
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Affiliation(s)
- Meera Ramesh
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
- Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Aimee C Brooks
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Elizabeth Thomovsky
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
- Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Paula Johnson
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
- Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Carrie Fulkerson
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
- Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Nollie Parnell
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
- Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Hsin-Yi Weng
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
- Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
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Citarella G, Corona D, Parsons E, Giannikaki S, Rioja E. The Outcomes of an Opioid-Free Anaesthetic Plan in Fourteen Dogs Undergoing Enucleation Using an Ultrasound-Guided Supra-Temporal Retrobulbar Block: A Retrospective Case Series. Animals (Basel) 2023; 13:2059. [PMID: 37443857 DOI: 10.3390/ani13132059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The objective of this retrospective case series is to report the outcomes of an opioid-free anesthetic plan in dogs undergoing enucleation surgery. A total of 14 dogs were admitted for enucleation between March and December 2020. A multimodal approach to perioperative analgesia was used, with a focus on retrobulbar anesthesia. A combination of an ultrasound-guided retrobulbblock with a supratemporal approach in association with ketamine, dexmedetomidine and non-steroidal anti-inflammatory drugs was used in the reported cases. Intraoperative nociception was defined as an increase of 20% from the baseline in one or more of the following parameters: heart rate, respiratory rate or mean arterial pressure. An ultrasound-guided retrobulbar block in an opioid-free anesthesia regime was effective at managing the perioperative analgesia of 13 out of 14 dogs. In only one case, a bolus of fentanyl was administered to treat intraoperative nociception. Recovery was uneventful in all the dogs, and the postoperative pain scores remained below the intervention threshold at all time points. To the authors' knowledge, this is the first reported case series of opioid-free anesthesia for enucleation in dogs.
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Affiliation(s)
- Gerardo Citarella
- Section of Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Daniele Corona
- Section of Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | | | | | - Eva Rioja
- Optivet Referrals, Ltd., Havant, PO9 2NJ, UK
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Brunet A, Bouzouraa T, Cadore JL, Hugonnard M. Use of feeding tubes in 112 cats in an internal medicine referral service (2015-2020). J Feline Med Surg 2022; 24:e338-e346. [PMID: 35833503 PMCID: PMC10812294 DOI: 10.1177/1098612x221108835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aims of this study were to describe diseases, complications and outcomes associated with the use of feeding tubes in a population of sick cats with appetite disturbance managed at an internal medicine referral service. METHODS Clinicopathological data from cats receiving nasoenteral (NE) or oesophagostomy (O) tubes were studied. Cats were categorised according to their underlying disease and divided into subgroups (NE or O tube). The following factors associated with survival were analysed: disease category, type of tube and return to appetite. RESULTS Included in the study were 112 cats, representing 118 cases. Of the 118 cases, 98 (83%) and 20 (17%) received NE or O tubes, respectively. The most common underlying conditions were digestive (13.5%), hepatobiliary (11%) and upper urinary tract (11%) disorders. Hepatobiliary (50%) and upper respiratory tract (30%) conditions were predominant in the O tube group. Digestive (15%) and upper urinary tract (12%) diseases were more common in the NE tube group. Complications following tube placement occurred in 22/118 cases (18.6%). The global survival rate was 73% and did not differ between NE (71.4%) and O tube (80%) groups (P = 1.00) or disease categories (P = 0.61). Return of appetite before feeding tube removal occurred in 56 cases (47%), within a median of 3 days (range 1-30) and was not associated with mirtazapine administration (P = 1.00). Appetite returned earlier for cats with NE tubes (3 days, range 1-17) than for those with O tubes (33 days, range 5-60; P <0.05). Voluntary food intake was positively associated with survival (odds ratio 15.17). After discharge and feeding tube retrieval, return of appetite was observed in 67% of cases. CONCLUSIONS AND RELEVANCE Feeding tubes were predominantly placed for the management of appetite disturbance in cats with digestive, hepatobiliary and upper urinary tract diseases. While complications were frequent, they were mostly mild, easily managed and did not preclude feeding tube use. Return to appetite occurred in a large proportion of cats during or after assisted enteral feeding and was associated with survival.
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Affiliation(s)
- Audrey Brunet
- University of Lyon, VetAgro Sup, Veterinary Campus of Lyon, Department of Companion Animals, Marcy L’Etoile, France
| | - Tarek Bouzouraa
- University of Lyon, VetAgro Sup, Veterinary Campus of Lyon, Department of Companion Animals, Marcy L’Etoile, France
- VetAlpha, 1305 Route de Lozanne, ZA des Grandes Terres, Dommartin 69380, France
| | - Jean-Luc Cadore
- University of Lyon, VetAgro Sup, Veterinary Campus of Lyon, Department of Companion Animals, Marcy L’Etoile, France
| | - Marine Hugonnard
- University of Lyon, VetAgro Sup, Veterinary Campus of Lyon, Department of Companion Animals, Marcy L’Etoile, France
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Montague B, Summers A, Bhawal R, Anderson ET, Kraus-Malett S, Zhang S, Goggs R. Identifying potential biomarkers and therapeutic targets for dogs with sepsis using metabolomics and lipidomics analyses. PLoS One 2022; 17:e0271137. [PMID: 35802586 PMCID: PMC9269464 DOI: 10.1371/journal.pone.0271137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/23/2022] [Indexed: 11/19/2022] Open
Abstract
Sepsis is a diagnostic and therapeutic challenge and is associated with morbidity and a high risk of death. Metabolomic and lipidomic profiling in sepsis can identify alterations in metabolism and might provide useful insights into the dysregulated host response to infection, but investigations in dogs are limited. We aimed to use untargeted metabolomics and lipidomics to characterize metabolic pathways in dogs with sepsis to identify therapeutic targets and potential diagnostic and prognostic biomarkers. In this prospective observational cohort study, we examined the plasma metabolomes and lipidomes of 20 healthy control dogs and compared them with those of 21 client-owned dogs with sepsis. Patient data including signalment, physical exam findings, clinicopathologic data and clinical outcome were recorded. Metabolites were identified using an untargeted mass spectrometry approach and pathway analysis identified multiple enriched metabolic pathways including pyruvaldehyde degradation; ketone body metabolism; the glucose-alanine cycle; vitamin-K metabolism; arginine and betaine metabolism; the biosynthesis of various amino acid classes including the aromatic amino acids; branched chain amino acids; and metabolism of glutamine/glutamate and the glycerophospholipid phosphatidylethanolamine. Metabolites were identified with high discriminant abilities between groups which could serve as potential biomarkers of sepsis including 13,14-Dihydro-15-keto Prostaglandin A2; 12(13)-DiHOME (12,13-dihydroxy-9Z-octadecenoic acid); and 9-HpODE (9-Hydroxyoctadecadienoic acid). Metabolites with higher abundance in samples from nonsurvivors than survivors included 3-(2-hydroxyethyl) indole, indoxyl sulfate and xanthurenic acid. Untargeted lipidomic profiling revealed multiple sphingomyelin species (SM(d34:0)+H; SM(d36:0)+H; SM(d34:0)+HCOO; and SM(d34:1D3)+HCOO); lysophosphatidylcholine molecules (LPC(18:2)+H) and lipophosphoserine molecules (LPS(20:4)+H) that were discriminating for dogs with sepsis. These biomarkers could aid in the diagnosis of dogs with sepsis, provide prognostic information, or act as potential therapeutic targets.
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Affiliation(s)
- Brett Montague
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - April Summers
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - Ruchika Bhawal
- Proteomics and Metabolomics Facility, Cornell University, Ithaca, New York, United States of America
| | - Elizabeth T. Anderson
- Proteomics and Metabolomics Facility, Cornell University, Ithaca, New York, United States of America
| | - Sydney Kraus-Malett
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - Sheng Zhang
- Proteomics and Metabolomics Facility, Cornell University, Ithaca, New York, United States of America
| | - Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
- * E-mail:
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Jaffey JA. Canine extrahepatic biliary disease: what have we learned? J Small Anim Pract 2021; 63:247-264. [PMID: 34935155 DOI: 10.1111/jsap.13468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/01/2021] [Accepted: 12/02/2021] [Indexed: 12/07/2022]
Abstract
Extrahepatic biliary disease in dogs is commonly encountered in clinical practice worldwide. Diseases in this segment of the biliary tract are diverse and can manifest with mild clinical signs or can be life-threatening. In the last decade there have been advances in diagnostic tests, imaging modalities and therapeutic interventions as well as the identification of novel prognostic variables that could improve outcomes in dogs with extrahepatic biliary disease. Therefore, the objective of this review was to summarise clinically relevant updates of extrahepatic biliary disease in dogs.
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Affiliation(s)
- J A Jaffey
- Department of Specialty Medicine, Midwestern University, College of Veterinary Medicine, Glendale, AZ, 85308, USA
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Fages A, Soler C, Fernández-Salesa N, Conte G, Degani M, Briganti A. Perioperative Outcome in Dogs Undergoing Emergency Abdominal Surgery: A Retrospective Study on 82 Cases (2018-2020). Vet Sci 2021; 8:vetsci8100209. [PMID: 34679039 PMCID: PMC8540698 DOI: 10.3390/vetsci8100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
Emergency abdominal surgery carries high morbidity and mortality rates in human medicine; however, there is less evidence characterising the outcome of these surgeries as a single group in dogs. The aim of the study was to characterise the clinical course, associated complications and outcome of dogs undergoing emergency abdominal surgery. A retrospective study was conducted. Dogs undergoing emergency laparotomy were included in the study. Logistic regression analysis was performed to identify variables correlated with death and complications. Eighty-two dogs were included in the study. The most common reason for surgery was a gastrointestinal foreign body. Overall, the 15-day mortality rate was 20.7% (17/82). The median (range) length of hospitalisation was 3 (0.5-15) days. Of the 82 patients, 24 (29.3%) developed major complications and 66 (80.5%) developed minor complications. Perioperative factors significantly associated with death included tachycardia (p < 0.001), hypothermia (p < 0.001), lactate acidosis (p < 0.001), shock index > 1 (p < 0.001), leukopenia (p < 0.001) and thrombocytopenia (p < 0.001) at admission, as well as intraoperative hypotension (p < 0.001) and perioperative use of blood products (p < 0.001). The results of this study suggest that mortality and morbidity rates after emergency abdominal surgery in dogs are high.
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Affiliation(s)
- Aida Fages
- Department of Veterinary Sciences, Veterinary Teaching Hospital “Mario Modenato”, University of Pisa, 56122 Pisa, Italy; (M.D.); (A.B.)
- Veterinary Teaching Hospital, Catholic University of Valencia “San Vicente Mártir”, UCV, 46018 Valencia, Spain; (C.S.); (N.F.-S.)
- Correspondence: ; Tel.: +34-659-654-391
| | - Carme Soler
- Veterinary Teaching Hospital, Catholic University of Valencia “San Vicente Mártir”, UCV, 46018 Valencia, Spain; (C.S.); (N.F.-S.)
- Small Animal Medicine and Surgery Department, Catholic University of Valencia “San Vicente Mártir”, UCV, 46018 Valencia, Spain
| | - Nuria Fernández-Salesa
- Veterinary Teaching Hospital, Catholic University of Valencia “San Vicente Mártir”, UCV, 46018 Valencia, Spain; (C.S.); (N.F.-S.)
| | - Giuseppe Conte
- Department of Agriculture, Food and Environment, University of Pisa, 56100 Pisa, Italy;
| | - Massimiliano Degani
- Department of Veterinary Sciences, Veterinary Teaching Hospital “Mario Modenato”, University of Pisa, 56122 Pisa, Italy; (M.D.); (A.B.)
| | - Angela Briganti
- Department of Veterinary Sciences, Veterinary Teaching Hospital “Mario Modenato”, University of Pisa, 56122 Pisa, Italy; (M.D.); (A.B.)
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Lopez DJ, Holm SA, Korten B, Baum JI, Flanders JA, Sumner JP. Comparison of patient outcomes following enterotomy versus intestinal resection and anastomosis for treatment of intestinal foreign bodies in dogs. J Am Vet Med Assoc 2021; 258:1378-1385. [PMID: 34061615 DOI: 10.2460/javma.258.12.1378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To quantify the relative risk of intestinal dehiscence in dogs undergoing intestinal resection and anastomosis (IRA), compared with enterotomy, for surgical management of small intestinal foreign bodies, and to evaluate the association between nasogastric tube placement for early enteral nutrition (EEN) and hospitalization time. ANIMALS 211 dogs undergoing 227 surgeries for intestinal foreign body removal. PROCEDURES Medical records were reviewed for dogs undergoing a single-site sutured enterotomy or IRA for foreign body intestinal obstruction between May 2008 and April 2018. Multivariable logistic regression was used to quantify the association between surgical procedure and dehiscence. Multiple linear regression was used to quantify the association of nasogastric tube placement with total hospitalization time. RESULTS Dehiscence rates were 3.8% (7/183) and 18.2% (8/44) for enterotomy and IRA, respectively. Overall dehiscence rate for all surgeries was 6.6% (15/227). The odds of intestinal dehiscence for IRA were 6.09 times (95% CI, 1.89 to 19.58) the odds for enterotomy. An American Society of Anesthesiologists score > 3 (OR, 4.49; 95% CI, 1.43 to 14.11) and an older age (OR, 1.02 [95% CI, 1.01 to 1.02] for each 1-month increase in age) were significantly associated with greater odds of intestinal dehiscence, regardless of surgical procedure. Placement of a nasogastric tube was not associated with intestinal dehiscence or decreased total hospitalization time when controlling for the year of surgery. CONCLUSIONS AND CLINICAL RELEVANCE Patients undergoing IRA were at a significantly higher risk of intestinal dehiscence, compared with patients undergoing enterotomy. Although this finding should not be used to recommend enterotomy over IRA, this information may be useful in guiding owner expectations and postoperative monitoring.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Summers AM, Vezzi N, Gravelyn T, Culler C, Guillaumin J. Clinical features and outcome of septic shock in dogs: 37 Cases (2008-2015). J Vet Emerg Crit Care (San Antonio) 2020; 31:360-370. [PMID: 33382202 DOI: 10.1111/vec.13038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 10/11/2019] [Accepted: 10/17/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To describe patient characteristics of dogs with septic shock, investigate markers of disease severity, and assess treatment impact on outcome. DESIGN Retrospective study. SETTING Single center, university veterinary teaching intensive care unit. ANIMALS Thirty-seven dogs with septic shock. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Mean number of organ dysfunction was 3.24 ± 1.0, and included cardiovascular (100%), respiratory (73%), hematologic (68%), renal (49%), and hepatic (32%) dysfunction. The gastrointestinal tract was the most common source of sepsis. Mean blood pressure prior to resuscitation was 50 ± 8 mm Hg. All dogs were given IV fluids before vasopressor therapy with a mean rate of 12.1 ± 11.0 mL/kg/h. All dogs were given antimicrobials, administered within a mean of 4.3 ± 5.7 hours after diagnosis. Dopamine or norepinephrine was administered IV, respectively in 51.3% and 37.8% of dogs, with a mean duration of hypotension of 2.6 ± 3.0 hours. Mortality rate was 81.1%. Survivors were more likely to have a feeding tube (P = 0.007) and to have gastrointestinal sepsis (P = 0.012), and less likely to have respiratory dysfunction (P < 0.001). APPLEFull scores (P = 0.014) and time to antimicrobial therapy (P = 0.047) were identified as predictors of mortality. Treatment bundles consisting of 7 interventions that may improve outcomes in people with septic shock were evaluated. Survivors received 4.1 ± 1.3 interventions, whereas nonsurvivors received 2.4 ± 1.4 (P = 0.003). CONCLUSIONS Septic shock in dogs confers a guarded prognosis. Early antimicrobial therapy and the utilization of treatment bundles may increase survivability in dogs with septic shock. More research is warranted to investigate the impact of specific interventions on survival.
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Affiliation(s)
| | - Noel Vezzi
- Veterinary Medical Center of Central New York, East Syracuse, New York
| | - Tara Gravelyn
- Michigan State University, College of Veterinary Medicine, East Lansing, Michigan
| | - Christine Culler
- Veterinary Specialty Hospital of the Carolinas, Cary, North Carolina
| | - Julien Guillaumin
- Colorado State University, College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO
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Teixeira FA, Queiroz MR, Oba PM, Olivindo RFG, Ernandes MC, Duarte CN, Rentas MF, Brunetto MA. Brazilian owners perception of the body condition score of dogs and cats. BMC Vet Res 2020; 16:463. [PMID: 33246455 PMCID: PMC7694915 DOI: 10.1186/s12917-020-02679-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/13/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The knowledge of how owners view the body condition of their animals is an important factor for the success of the prevention/treatment of obesity and the engagement/adherence to nutritional interventions, which are fundamental to improve the animal prognosis. For this reason, the objective of this study was to evaluate the perception of the owners regarding the body condition score of their animals, compare the perception between cat vs. dog owners, and owners from the countryside vs. metropolitan region of São Paulo State in Brazil. RESULTS 601 dogs and 110 cats were included in this study. There was no significant difference in body condition score assigned by owners by species. Owners of dogs and cats classified by the veterinarian as ideal, overweight, and obese who disagree with body condition score assigned by veterinarian mainly underestimate the body condition score of their animals, while lean dogs' owners overestimate it. Countryside dog owners had a higher rate of disagreement with the veterinarian and more often underestimate the body condition score than owners from the metropolitan region. The owners of lean cats have the same judgments with veterinarians. CONCLUSIONS Owners of dogs and cats have difficulty assessing the body condition score, especially owners from countryside.
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Affiliation(s)
- Fabio Alves Teixeira
- Department of Animal Nutrition and Production, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Duque de Caxias Norte, 255, Pirassununga, SP, São Paulo, Brazil
| | - Mariana Ramos Queiroz
- Department of Animal Nutrition and Production, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Duque de Caxias Norte, 255, Pirassununga, SP, São Paulo, Brazil
| | - Patrícia Massae Oba
- Department of Animal Sciences , University of Illinois at Urbana-Champaign , Illinois, Urbana, USA
| | - Rodrigo Fernando Gomes Olivindo
- Department of Animal Nutrition and Production, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Duque de Caxias Norte, 255, Pirassununga, SP, São Paulo, Brazil
| | - Mariane Ceschin Ernandes
- Department of Animal Nutrition and Production, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Duque de Caxias Norte, 255, Pirassununga, SP, São Paulo, Brazil
| | - Caio Nogueira Duarte
- Department of Animal Nutrition and Production, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Duque de Caxias Norte, 255, Pirassununga, SP, São Paulo, Brazil
| | - Mariana Fragoso Rentas
- Department of Animal Nutrition and Production, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Duque de Caxias Norte, 255, Pirassununga, SP, São Paulo, Brazil
| | - Marcio Antonio Brunetto
- Department of Animal Nutrition and Production, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Duque de Caxias Norte, 255, Pirassununga, SP, São Paulo, Brazil.
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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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Lumbis RH, de Scally M. Knowledge, attitudes and application of nutrition assessments by the veterinary health care team in small animal practice. J Small Anim Pract 2020; 61:494-503. [PMID: 32725907 DOI: 10.1111/jsap.13182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/25/2020] [Accepted: 05/20/2020] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- R H Lumbis
- Department of Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, AL9 7TA, UK
| | - M de Scally
- Hilton Veterinary Hospital, 72 Hilton Ave, Leonard, Hilton, 3245, South Africa
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15
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Viall AK, McNamee AL, Olsen LE, Deitz KL, Hostetter SJ. Prognostic value of dyslipidemia for sick dogs hospitalized in the intensive care unit of a veterinary teaching hospital. J Am Vet Med Assoc 2020; 254:699-709. [PMID: 30835179 DOI: 10.2460/javma.254.6.699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the lipidemia status and serum concentrations of cholesterol and triglycerides of dogs when initially examined for hospitalization in the intensive care unit (ICU) of a veterinary teaching hospital and to determine whether these variables were predictive of survival to hospital discharge. DESIGN Retrospective cohort study. ANIMALS 549 client-owned sick (n = 398) and healthy (151) dogs. PROCEDURES Medical records of sick dogs hospitalized in the ICU at a veterinary teaching hospital between January 1, 2012, and September 30, 2015, and of healthy dogs evaluated at the teaching hospital during the same time frame were reviewed. Data collection included signalment, results of initial physical and clinicopathologic examinations, treatments, diagnosis, and survival to hospital discharge. Lipidemia status and serum concentrations of cholesterol and triglycerides were compared between healthy and sick dogs and between sick dogs that did and did not survive to hospital discharge. Regression analysis was performed to determine whether these variables were predictive of survival to hospital discharge in dogs. RESULTS Factors associated with increased odds of sick dogs not surviving to hospital discharge were hypocholesterolemia (OR, 1.87; 95% confidence interval [CI], 1.04 to 3.34), hypertriglyceridemia (OR, 3.20; 95% CI, 2.00 to 5.13), and concurrent hypocholesterolemia and hypertriglyceridemia (OR, 55.7; 95% CI, 3.2 to 959.6) at the time of initial evaluation. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that hypocholesterolemia and hypertriglyceridemia, alone or in combination, at initial examination were negative prognostic indicators for survival of dogs hospitalized in the ICU and that these conditions were easily identified with routine serum clinicopathologic analyses. (J Am Vet Med Assoc 2019;254:699-709).
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Fantinati M, Trnka J, Signor A, Dumond S, Jourdan G, Verwaerde P, Priymenko N. Appetite-stimulating effect of gabapentin vs mirtazapine in healthy cats post-ovariectomy. J Feline Med Surg 2020; 22:1176-1183. [PMID: 32462966 DOI: 10.1177/1098612x20916391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the appetite-stimulating effect of gabapentin by comparing it with mirtazapine in healthy cats in the first 8 h after ovariectomy surgery. METHODS This double-masked, placebo-controlled, prospective clinical trial included 60 healthy cats presented to the hospital for ovariectomy: 20 received gabapentin, 21 received mirtazapine and 19 received a placebo immediately before and 6 h after surgery. Food was offered at 2, 4, 6 and 8 h post-ovariectomy. After each meal, food intake was measured. Data were analysed using repeated-measure ANOVA and a linear mixed-model analysis. Post-hoc Tukey's honest significant difference test was performed for multiple comparisons. RESULTS Food intake increased in both treatment groups vs placebo. No statistically significant difference was found between cats treated with gabapentin or mirtazapine. CONCLUSIONS AND RELEVANCE Cats receiving gabapentin ate more than cats in the placebo group. Thirty percent of cats in the gabapentin group covered their resting energy requirements, while none of the cats in the placebo group did. Gabapentin and mirtazapine produced similar effects on food intake.
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Affiliation(s)
- Marco Fantinati
- Nutrition Department, National Veterinary School of Toulouse (ENVT), Toulouse, France
| | - Julien Trnka
- Nutrition Department, National Veterinary School of Toulouse (ENVT), Toulouse, France
| | - Amélia Signor
- Nutrition Department, National Veterinary School of Toulouse (ENVT), Toulouse, France
| | - Séverine Dumond
- Anaesthesia Department, National Veterinary School of Toulouse (ENVT), Toulouse, France
| | - Géraldine Jourdan
- Anaesthesia Department, National Veterinary School of Toulouse (ENVT), Toulouse, France
| | - Patrick Verwaerde
- Emergency, Critical Care and Anaesthesia Department, National Veterinary School of Alfort (ENVA), Maisons-Alfort, France
| | - Nathalie Priymenko
- Nutrition Department, National Veterinary School of Toulouse (ENVT), Toulouse, France
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Mulreany LM, Kinney ME, Clancy MM, Lamberski N, Werre SR. RETROSPECTIVE EVALUATION OF THE USE OF PARENTERAL NUTRITION IN HOSPITALIZED NONDOMESTIC RUMINANTS. J Zoo Wildl Med 2020; 50:853-60. [PMID: 31926515 DOI: 10.1638/2019-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2019] [Indexed: 11/21/2022] Open
Abstract
Parenteral nutrition (PN) is one method of providing nutrient support to hospitalized, nondomestic ruminants that have a decreased appetite in hospital or have high metabolic demands caused by illness. There are a limited number of published reports of the use of PN in nondomestic ruminants. A retrospective evaluation of PN use in adult (>6 mo of age) hospitalized ruminants at the San Diego Zoo Safari Park was conducted from 2014 to 2018 (n = 24). Discharge rate for animals that received PN was 34%. Poor survival was likely caused by case selection of animals that had severe disease or malnutrition necessitating the need for PN. Common metabolic changes among the study animals included the following: hypokalemia, hyperglycemia, and hyperphosphatemia or hypophosphatemia. Bivariable analysis revealed no clinically significant factors that influenced odds of survival. There was little evidence of adverse effects with the administration of PN during the study period. Parenteral nutrition requires specialized equipment and technical skills, but is a viable means of nutrient support for hospitalized nondomestic ruminants.
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Elmenhorst K, Pérez López P, Belch A, Demetriou JL. Retrospective study of complications associated with surgically-placed gastrostomy tubes in 43 dogs with septic peritonitis. J Small Anim Pract 2019; 61:116-120. [PMID: 31763703 DOI: 10.1111/jsap.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the safety of surgically-placed gastrostomy feeding tubes in dogs with septic peritonitis. MATERIALS AND METHODS Retrospective analysis of 43 dogs with septic peritonitis that had undergone surgical exploration and gastrostomy tube (de Pezzer or Foley) placement as part of the surgical procedure. Postoperative recovery times, hospitalisation times, complication rates and overall survival times were documented. RESULTS The most common cause of septic peritonitis was dehiscence of an enterotomy or enterectomy site. Fifteen dogs had a Foley gastrostomy tube placed and 28 had a de Pezzer gastrostomy tube placed. The median time from surgery to the start of enteral nutrition was 16 hours (range 3 to 28 hours). There were no major complications relating to the gastrostomy tube; minor complications occurred in 11 (26%) patients. The overall median time spent in hospital was 5 days (range 3 to 29 days) for patients surviving to discharge and 22 (51%) dogs survived overall. CLINICAL SIGNIFICANCE Gastrostomy feeding tubes provide a safe way to provide enteral nutrition to dogs with septic peritonitis; they are associated with a low complication rate in these patients.
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Affiliation(s)
- K Elmenhorst
- Dick White Referrals, Cambridgeshire, CB8 0UH, UK
| | | | - A Belch
- Small Animal Referral Hospital, University of Bristol, Bristol, BS40 5DU, UK
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19
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Pedrinelli V, Porsani MYH, Lima DM, Teixeira FA, Duarte CN, Vendramini THA, Brunetto MA. Predictive equations of maintenance energy requirement for healthy and chronically ill adult dogs. J Anim Physiol Anim Nutr (Berl) 2019; 105 Suppl 2:63-69. [PMID: 31637773 DOI: 10.1111/jpn.13184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/28/2022]
Abstract
Maintenance energy requirement (MER) is the energy amount necessary for dogs to maintain their weight and body condition. Some factors can influence the MER, such as gender, age, neutering status and also diseases. The present retrospective study aimed to evaluate MER of adult dogs with several diseases and compare with the MER of healthy adult dogs, observing the influence of parameters such as body condition score (BCS), neutering status, gender, age, diagnosis and type of food on MER of these dogs. A total of 165 adult dogs with weight changes of ≤5% were included and divided in groups according to diagnosis. Mean MER for healthy dogs was 86.09 kcal/BW0.75 , which differed from NRC and FEDIAF recommendations for inactive adult dogs (p = .047). Lowest MERs were of the endocrinopathies (78.52 ± 19.32 kcal/BW0.75 ), orthopaedic diseases (59.71 ± 19.30 kcal/BW0.75 ) and neurologic diseases (78.83 ± 32.66 kcal/BW0.75 ) groups. Gastrointestinal diseases (99.59 ± 20.36 kcal/BW0.75 ), orthopaedic diseases (59.71 ± 19.30 kcal/BW0.75 ) and neoplasia (95.61 ± 21.02 kcal/BW0.75 ) groups were the only groups that differed from the mean MER of healthy adult dogs. Regarding BCS, for each increasing point in a 9-point scale, there was a decrease of 9.8 kcal/BW0.75 on MER, independent of diagnosis (p < .0001; r2 = .55). There was no difference regarding breed size gender and age, but neutered dogs presented lower MER (p = .031). Based on data obtained from the present study, it can be concluded that it is necessary to consider BCS, age, neutering status and diagnosis when calculating MER, both in healthy dogs and chronically ill dogs.
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Affiliation(s)
- Vivian Pedrinelli
- School of Veterinary Medicine and Animal Science, University of Sao Paulo (USP), São Paulo, Brazil
| | | | - Daniel Magalhães Lima
- School of Veterinary Medicine and Animal Science, University of Sao Paulo (USP), Pirassununga, Brazil
| | - Fabio Alves Teixeira
- School of Veterinary Medicine and Animal Science, University of Sao Paulo (USP), São Paulo, Brazil
| | - Caio Nogueira Duarte
- School of Veterinary Medicine and Animal Science, University of Sao Paulo (USP), São Paulo, Brazil
| | | | - Márcio Antonio Brunetto
- School of Veterinary Medicine and Animal Science, University of Sao Paulo (USP), Pirassununga, Brazil
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20
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Hansen SC, Hlusko KC, Matz BM, Bacek LM. Retrospective evaluation of 24 cases of gastrostomy tube usage in dogs with septic peritonitis (2009-2016). J Vet Emerg Crit Care (San Antonio) 2019; 29:514-520. [PMID: 31448863 DOI: 10.1111/vec.12882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/05/2017] [Accepted: 11/01/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To describe the postoperative use of gastrostomy tubes (GT) in dogs with septic peritonitis. A secondary objective was to identify factors associated with GT placement and use that may be related to outcome. DESIGN Retrospective study. SETTING University teaching hospital. ANIMALS Twenty-four dogs diagnosed with septic peritonitis with GT placement at the time of exploratory laparotomy. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Eighteen dogs (75%) survived to discharge. Eighteen dogs (75%) had a gastrointestinal source of septic peritonitis. Complications were reported in 12/24 (50%) patients. Four dogs (16.6%) had non-GT-related complications such as vomiting, regurgitation, or increased gastric residual volume. GT-related complications occurred in 8/24 (33.3%) dogs, the majority of which (6/8 [75%]) were minor and did not necessitate removal of the GT. Two dogs had major complications that required removal of the GT. Significant differences between survivors and nonsurvivors were found between the length of time after placement of the GT to when they began eating and outcome (discharge versus death versus euthanasia) (P = 0.03), and GT dwell time (length of time the GT was in place) and outcome (P = 0.006). Clinically relevant correlations were found between the time after placement of the GT until feeding and time after placement until voluntarily eating (P = 0.0349), time after placement of the GT until voluntarily eating and length of hospitalization (P = 0.0391), and time after placement of the GT until feeding and length of hospitalization (P = 0.036). CONCLUSIONS GTs can be placed during exploratory laparotomy in dogs with septic peritonitis. They facilitate early enteral nutrition and are associated with few clinically significant complications. Prospective studies are needed to determine the optimal postoperative feeding plan and the effects of early enteral nutrition on serum albumin concentration in this patient population.
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Affiliation(s)
- Sonya C Hansen
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL
| | - Katelyn C Hlusko
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL
| | - Brad M Matz
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL
| | - Lenore M Bacek
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL
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21
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Hlusko KC, Hansen SC, Matz BM, Bacek LM, Boothe HW, Bellah JR, Tillson DM. Description of a novel technique for surgical placement of gastrostomy tubes in dogs. J Vet Emerg Crit Care (San Antonio) 2019; 29:564-567. [PMID: 31423701 DOI: 10.1111/vec.12884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 10/23/2017] [Accepted: 11/01/2017] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
| | - Sonya C Hansen
- Auburn University College of Veterinary Medicine, Auburn, AL
| | - Brad M Matz
- Auburn University College of Veterinary Medicine, Auburn, AL
| | - Lenore M Bacek
- Auburn University College of Veterinary Medicine, Auburn, AL
| | - Harry W Boothe
- Auburn University College of Veterinary Medicine, Auburn, AL
| | - Jamie R Bellah
- Auburn University College of Veterinary Medicine, Auburn, AL
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22
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Smith KM, Rendahl A, Sun Y, Todd JM. Retrospective evaluation of the route and timing of nutrition in dogs with septic peritonitis: 68 cases (2007-2016). J Vet Emerg Crit Care (San Antonio) 2019; 29:288-295. [PMID: 31021527 DOI: 10.1111/vec.12841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 07/24/2017] [Accepted: 08/04/2017] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Kristin M Smith
- Veterinary Medical Center, University of Minnesota, St Paul, MN
| | - Aaron Rendahl
- Veterinary Medical Center, University of Minnesota, St Paul, MN
| | - Yiwen Sun
- Veterinary Medical Center, University of Minnesota, St Paul, MN
| | - Jeffrey M Todd
- Veterinary Medical Center, University of Minnesota, St Paul, MN
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23
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Breheny CR, Boag A, Le Gal A, Hõim SE, Cantatore M, Anderson D, Nuttall T, Chandler ML, Gunn-Moore DA. Esophageal feeding tube placement and the associated complications in 248 cats. J Vet Intern Med 2019; 33:1306-1314. [PMID: 31001901 PMCID: PMC6524112 DOI: 10.1111/jvim.15496] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/29/2019] [Indexed: 12/26/2022] Open
Abstract
Background Esophageal feeding tubes are commonly used to provide enteral nutrition to cats, but their use is associated with adverse effects. Objectives To evaluate the complications associated with e‐tube placement in cats and to identify factors predisposing to these complications. Animals Cats that had an esophageal feeding tube placed (n = 248). Methods This was a retrospective case review in which clinical records were interrogated across 2 referral centers to identify records of cats that had esophageal tubes placed. Clinical data were collected for signalment, clinical indication, method of placement, time of removal, and any complications. Logistic regression was then employed to assess the odds of an increase in complications, including infection and death. Results For those cats that survived to discharge, tubes were in place for a median of 11 days, ranging from 1 to 93 days. Complications occurred in 35.8% of the cats, with the most common being tube dislodgement (14.5%), followed by stoma site infections (12.1%). Cats receiving glucocorticoids or oncolytic agents (OR = 3.91; 95% CI, 1.14‐13.44) and with discharge at the stoma site (OR = 159.8; CI, 18.9‐1351) were at an increased odds of developing a stoma site infection, whereas those with a lower weight (OR = 1.33; 95% CI, 1.02‐1.75) or (pancreatic [OR = 4.33; 95% CI, 1.02‐18.47], neoplastic [OR = 15.44; 95% CI, 3.67‐65.07], respiratory [OR = 19.66; 95% CI, 2.81‐137.48], urogenital [OR = 5.78; 95% CI, 1.15‐28.99], and infectious diseases [OR = 11.57; 95% CI, 2.27‐58.94]) had an increased odds of death. The duration of time in place and the cat being discharged with the tube in place were not associated with an increased risk of infection or death. Conclusions and clinical importance Owners should be made aware of the potential risks involved and their predisposing factors.
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Affiliation(s)
- Craig R Breheny
- Department of Internal Medicine, Royal (Dick) School of Veterinary Studies, Ringgold Standard Institution-Internal Medicine, University of Edinburgh, Easter Bush, United Kingdom
| | - Alisdair Boag
- Department of Internal Medicine, Royal (Dick) School of Veterinary Studies, Ringgold Standard Institution-Internal Medicine, University of Edinburgh, Easter Bush, United Kingdom
| | - Alice Le Gal
- Department of Internal Medicine, Royal (Dick) School of Veterinary Studies, Ringgold Standard Institution-Internal Medicine, University of Edinburgh, Easter Bush, United Kingdom
| | - Sven-Erik Hõim
- Surgery Department, Anderson Moores, Winchester, United Kingdom
| | | | - Davina Anderson
- Surgery Department, Anderson Moores, Winchester, United Kingdom
| | - Tim Nuttall
- Department of Dermatology, Royal (Dick) School of Veterinary Studies, Ringgold Standard Institution-Internal Medicine, University of Edinburgh, Easter Bush, United Kingdom
| | - Marjoie L Chandler
- Nutrition Department, Vets Now-Nutrition, 11 Mavisbank Place, Lasswade, United Kingdom
| | - Danièlle A Gunn-Moore
- Department of Internal Medicine, Royal (Dick) School of Veterinary Studies, Ringgold Standard Institution-Internal Medicine, University of Edinburgh, Easter Bush, United Kingdom
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Molina J, Hervera M, Manzanilla EG, Torrente C, Villaverde C. Evaluation of the Prevalence and Risk Factors for Undernutrition in Hospitalized Dogs. Front Vet Sci 2018; 5:205. [PMID: 30211177 PMCID: PMC6123354 DOI: 10.3389/fvets.2018.00205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 08/07/2018] [Indexed: 01/04/2023] Open
Abstract
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.
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Affiliation(s)
- Jenifer Molina
- Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Departament de Ciència Animal i Dels Aliments, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Marta Hervera
- Expert Pet Nutrition, www.expertpetnutrition.com, Fermoy, Ireland
| | - Edgar Garcia Manzanilla
- Animal and Grassland Research and Innovation Centre, TEAGASC Moorepark, Fermoy, Ireland.,School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Carlos Torrente
- Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Departament de Medicina i Cirurgia Animal, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Abstract
Ghrelin is a hormone, secreted from cells in the stomach, which is important in the regulation of appetite and food intake in mammals. It exerts its action by binding to a specific G-protein-coupled receptor, the growth hormone secretagogue receptor 1a (GHS-R1a) which is found in areas of the brain associated with the regulation of food intake. Ghrelin causes a release of growth hormone (GH) through binding to GHS-R1a in the hypothalamus and pituitary gland. A class of compounds known as growth hormone secretagogues, or ghrelin receptor agonists, were developed for therapeutic use in humans for the stimulation of GH in the frail elderly, and have subsequently been studied for their effects on increasing appetite and food intake, increasing body weight, building lean muscle mass, and treating cachexia. Subsequent research has shown that ghrelin has anti-inflammatory and immunomodulatory effects. This article reviews the basic physiology of ghrelin and the ghrelin receptor agonists, including the available evidence of these effects in vitro and in vivo in rodent models, humans, dogs and cats. One of these compounds, capromorelin, has been FDA-approved for the stimulation of appetite in dogs (ENTYCE ®). The data available on the safety and effectiveness of capromorelin is reviewed, along with a discussion of the potential clinical applications for ghrelin receptor agonists in both human and veterinary medicine.
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27
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Padula AM, Ong HM, Kelers K. Snake Envenomation in Domestic Animal Species in Australia. Clinical Toxinology in Australia, Europe, and Americas 2018. [DOI: 10.1007/978-94-017-7438-3_66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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29
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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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30
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Krentz T, Allen S. Bacterial translocation in critical illness. J Small Anim Pract 2017; 58:191-198. [PMID: 28186322 DOI: 10.1111/jsap.12626] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/18/2016] [Accepted: 11/08/2016] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- T Krentz
- Department of Emergency and Critical Care, Massachusetts Veterinary Referral Hospital, Woburn, MA, 01801, USA
| | - S Allen
- Department of Emergency and Critical Care, Massachusetts Veterinary Referral Hospital, Woburn, MA, 01801, USA
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31
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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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32
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Mack RM, Staiger B, Langlois DK, Mehler SJ, Lam N, Moore T, Brown A, Beal MW. Development and characterization of a technique for percutaneous radiologic gastrojejunostomy tube placement in the dog. J Vet Emerg Crit Care (San Antonio) 2016; 26:646-53. [PMID: 27428382 DOI: 10.1111/vec.12506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 12/08/2014] [Accepted: 12/21/2014] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Rebekah M Mack
- Upstate Veterinary Specialists, 393 Woods Lake Road, Greenville, SC, 29607
| | - Benjamin Staiger
- Red Bank Veterinary Hospital, 210 Route 206 S, Hillsborough, NJ, 08844
| | - Daniel K Langlois
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI, 48824
| | - Stephen J Mehler
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI, 48824
| | | | | | - Andrew Brown
- Animal Neurology & MRI Center, 1120 Welch Rd, Commerce Twp, MI, 48390
| | - Matthew W Beal
- the College of Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
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Whitehead K, Cortes Y, Eirmann L. Gastrointestinal dysmotility disorders in critically ill dogs and cats. J Vet Emerg Crit Care (San Antonio) 2016; 26:234-53. [PMID: 26822390 DOI: 10.1111/vec.12449] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 07/21/2015] [Accepted: 08/30/2014] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- KimMi Whitehead
- Emergency and Critical Care Department, Oradell Animal Hospital, Paramus, NJ, 07452
| | - Yonaira Cortes
- Emergency and Critical Care Department, Oradell Animal Hospital, Paramus, NJ, 07452
| | - Laura Eirmann
- the Nutrition Department (Eirmann), Oradell Animal Hospital, Paramus, NJ, 07452
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34
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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35
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Forbes JM, Bell A, Twedt DC, Martin LE, Lappin MR, Mathis JC, Sullivan LA. Palatability assessment of an oral recuperation fluid in healthy dogs during the perioperative period. Top Companion Anim Med 2015; 30:35-8. [PMID: 26041597 DOI: 10.1053/j.tcam.2015.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/13/2015] [Indexed: 01/22/2023]
Abstract
The objective of this study was to determine whether healthy dogs undergoing elective surgery will accept and prefer an oral recuperation fluid (ORF) to water during the perioperative time period and if the consumption of an ORF would lead to increased caloric intake during the final preoperative and first postoperative periods. This prospective, observational study was performed in the setting of a University Veterinary Teaching Hospital. A total of 67 healthy dogs were presented for routine ovariectomy (n = 30) or castration (n = 37). Before surgical intervention, dogs were offered an ORF to assess their voluntary acceptance of the fluid. After 2 hours, the ORF was offered alongside water to assess fluid preference. Routine castration or ovariectomy was then performed. During the immediate postoperative period, dogs were reassessed as to their acceptance and preference of the ORF. A high percentage of dogs accepted the ORF in both the preoperative (55/67, 82%) and postoperative (42/67, 63%) periods (P < .01 and P = .04, respectively). Of dogs that demonstrated a preference between the ORF and water, 87% (95% CI: 77%-93%) chose the ORF preoperatively, whereas 98% (95% CI: 87%-99.5%) chose the ORF postoperatively (P < .01 and P < .01, respectively). Dogs that consumed the ORF in each measurement period ingested a higher amount of food (measured as percentage of kilocalories offered) when compared with those that did not consume the ORF (preoperatively 83% vs. 49%, P < .01; postoperatively 51% vs. 27%, P = .01). A commercially manufactured veterinary ORF was found to be palatable, as determined by acceptance and preference testing, in healthy dogs during the preoperative and postoperative phases of routine sterilization. Further studies in dogs undergoing more intensive surgical procedures or recovering from nonsurgical illness or both are warranted.
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Affiliation(s)
- Jethro M Forbes
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Amy Bell
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - David C Twedt
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Laura E Martin
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Michael R Lappin
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Justin C Mathis
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Lauren A Sullivan
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA.
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36
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Adams RJ, Doyle RS, Bray JP, Burton CA. Closed Suction Drainage for Treatment of Septic Peritonitis of Confirmed Gastrointestinal Origin in 20 Dogs. Vet Surg 2014; 43:843-51. [DOI: 10.1111/j.1532-950x.2014.12258.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 03/01/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ronan S. Doyle
- Davies Veterinary Specialists; Higham Gobion United Kingdom
| | - Jonathan P. Bray
- Massey University Veterinary Teaching Hospital; Palmerston North New Zealand
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37
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Abstract
Barium peritonitis is extremely rare, but is difficult to treat and may be
life-threatening. Barium suspension leakage from the gastrointestinal tract into the
abdominal cavity has a time-dependent and synergistically deleterious effect in patients
who have generalized bacterial peritonitis. The severity of barium peritonitis is
dependent on the quantity of barium in the abdominal cavity. Barium sulfate leakage
results in hypovolemia and hypoproteinemia by worsening the exudation of extracellular
fluid and albumin. Abdominal fluid analysis is a useful and efficient method to diagnose
barium peritonitis. Serial radiographs may not be a reliable or timely diagnostic
technique. Initial aggressive fluid resuscitation and empirical broad-spectrum antibiotic
treatment should be instituted promptly, followed quickly by celiotomy. During exploratory
surgical intervention, copious irrigation and direct wiping with gauze are employed to
remove as much barium as possible. Omentectomy should be considered when needed to
expedite barium removal. Despite aggressive medical and surgical treatments, postoperative
prognosis is guarded to poor due to complications, such as acute vascular shock, sepsis,
diffuse peritonitis, hypoproteninemia, electrolyte imbalance, cardiac arrest, small bowel
obstruction related to progression of granulomas and adhesions in the abdominal cavity.
Therefore, intensive postoperative monitoring and prompt intervention are necessary to
maximize chances for a positive outcome. For those that do survive, small bowel
obstruction is a potential consequence due to progression of abdominal adhesions.
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Affiliation(s)
- Jae Jin Ko
- Department of Veterinary Medicine and Surgery, University of Missouri-Columbia Veterinary Medical Teaching Hospital, Columbia, MO 65201, U.S.A
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38
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39
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40
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Affiliation(s)
- Valerie J Parker
- – Clinical, The Ohio State University, 601 Vernon L. Tharp Street Columbus, OH 43210
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