ANSWERS

1. List the factors that would indicate the necessity for specific nutritional support.
   • Reduced oral intake.
   • Acute weight loss.
   • Actual body weight 15% or more below optimum body weight.
   • Hypoalbuminaemia.
   • Trauma, surgery or sepsis resulting in anorexia.
2. What is meant by cachectic?
   Extremely underweight and the resultant poor bodily condition.
3. Define pica.
   A depraved appetite.
4. What is meant by hypo- and hyper-metabolism?
   • Hypometabolism = Lowered metabolism overriding the adaptive mechanisms to food deprivation in conditions of stress or trauma.
   • Hypermetabolism = Accelerated metabolism designed to support the healing of wounds and resistance to infection.
5. Describe protein-energy malnutrition (PEM).
   A condition that may arise from a cumulative drain on the tissues. It is detrimental to the patient in that it can delay recovery and increase susceptibility to shock and infection. Clinical signs include muscle wasting and weakness. In addition, the immune function may be impaired increasing the risk of infection. Extreme cases may result in death due to sepsis and failure of the heart and lungs.
6. List the therapeutic benefits of appropriate nutritional support.
   • Increased longevity.
   • Improved tolerance to invasive procedures.
   • Decreased risk of infection.
   • More rapid healing of wounds.
   • More rapid return to mobility.
   • Shorter periods of hospitalisation.
7. Define dietary sensitivity.
   An abnormal clinical response to a particular food. There are 2 classifications:
   • Food intolerance = a clinically abnormal response to a dietary component due to indigestibility as a result of the absence of a specific enzyme, or from pharmacological, metabolic or toxic reactions.
   • True food allergy (hypersensitivity) = an immune mediated response to a particular dietary component.
8. List the possible presenting signs of a patient with dietary sensitivity.
   
   • Gastro-enteritis.
   • Pruritis.
   • Otitis externa in dogs.
   • Miliary dermatitis in cats.
   • Eosinophilic plaque in cats.
9. What breed is prone to gluten-sensitive enteropathy?
   The Irish setter.
10. What chronic conditions have been reported in which dietary insensitivity is thought to play a role?
    
    • Inflammatory bowel disease in cats.
    • Idiopathic chronic colitis in dogs.
11. What foods are most commonly associated with food sensitivity?
    
    • Dietary proteins.
    • Cow's milk, beef and fish in cats.
    • Cow's milk, beef and cereal in dogs.
12. What is an elimination diet?
    A hypoallergenic diet for an individual containing a novel protein source such as lamb, rabbit, venison, catfish or capelin. Rice or potatoes are suitable additions.
13. What is a suitable time period for a food trial?
    A minimum of 21 days. If the desired response is not met within 60 days it is likely that dietary sensitivity is not the cause of the problem, other factors may be contributing to the clinical signs, or that the animal is sensitive to the novel protein source.
14. What is the most common form of malnutrition seen in small animal practice?
    Obesity. Obesity is covered in Part 2 - Module 1 - General Nursing.
15. Define hypertrophy and hyperplasia.
    
    • Hypertrophy = an increase in fat cell size.
    • Hyperplasia = an increase in fat cell numbers in the growing animal.
16. Why is hyperplasia detrimental?
    The animal retains a lifelong predisposition to weight gain.
17. What condition may affect dieting cats that lose weight too rapidly?
    Hepatic lipidosis.
18. List the properties of a diet suitable for weight loss.
    
    • Lowered calorie content.
    • High fibre content to ensure that the animal feels satisfied.
19. Why is fasting often recommended in cases of gastrointestinal disorders?
    This enables the bowels to rest. Food is usually withheld for 24-72 hours. During this period fluid and electrolyte status is maintained either enterally or parenterally.
20. Describe the feeding of a patient with mega-oesophagus.
    Small quantities of a soft but textured diet should be fed from an elevated position in order to allow food to enter the stomach assisted by gravity.
21. Describe the feeding of a patient prone to gastric dilation (volvulus syndrome).
    Small, frequent meals of a highly digestible meat-based diet should be fed in order to encourage gastric emptying and reduce stomach distension. Large volumes of food and water should never be offered within 1 hour of exercise.
22. List properties of a diet suitable for cases of diarrhoea.
    
    • Moderate to high protein content of a high biological value; chicken is ideal.
    • Bland (ideally restricted to 1 - 2 ingredients).
    • Highly digestible carbohydrate source such as rice.
    • High fibre in chronic cases in order to improve contractility of the smooth muscle of the colon and bind faecal water.
23. Why are high fibre diets only beneficial in the prevention of constipation?
    Fibre increases faecal bulk and increases colonic motility and results in more forceful contractions.
24. Describe the properties of a diet suitable for cases of exocrine pancreatic insufficiency.
    
    • Highly digestible.
    • Low in fat.
    • Low in fibre.
25. Describe the properties of a diet suitable for cases of pancreatitis.
    
    • Highly digestible.
    • Low in fat.
    • Moderately reduced protein of a high biological value.
    • High in carbohydrate.
26. Describe the properties of a diet suitable for cases of liver disease.
    
    • Moderately restricted protein of a high biological value.
    • Moderately restricted fat content.
    • Inclusion of complex carbohydrates.
    • Vitamin B and E supplementation.
    • Zinc supplementation.
    • Restricted copper.
    • Restricted sodium.
27. Describe the properties of a diet suitable for cases of hepatic lipidosis.
    
    • Highly digestible.
    • Moderately reduced fat content.
    • Relatively high protein content.
    • Zinc supplementation.
    • Vitamin E, K & B supplementation.
28. Describe a diet suitable for the long-term nutrition of a dog suffering from diabetes mellitus.
    
    • High in complex carbohydrates.
    • High in fibre.
    • Low in fat.
29. Explain why semi-moist foods should not be fed to diabetic patients.
    They are high in simple sugars that are rapidly absorbed and promote wide fluctuations in blood sugar levels. Simple sugars should only be used in the emergency treatment of hypoglycaemia.
30. List the properties of a diet suitable for animals with renal dysfunction.
    
    • Restricted phosphorous.
    • Moderately restricted protein.
    • Protein of a high biological value.
    • Energy dense.
    • Highly palatable.
    • Supplementation with potassium and calcium if indicated.
    • Moderately restricted sodium.
    • Supplementation with B-complex vitamins.
31. List the properties of a diet suitable for animals prone to struvite crystalluria.
    
    • Moderately restricted magnesium.
    • Moderately restricted phosphorous.
    • High moisture content.
    • Highly digestible.
    • Enhanced levels of taurine and potassium.
    • Moderately restricted protein.
    • Promotes urinary acidification.
    • Promotes increased urine volume and frequency of urination.
32. List the properties of a diet suitable for animals prone to calcium oxalate crystalluria.
    
    • Moderately increased magnesium.
    • Restricted calcium and oxalate.
33. Describe how the dissolution and prevention of cystine uroliths may be achieved.
    
    • Increasing water intake and subsequent urine production.
    • Reducing protein.
    • Reducing sodium.
    • Alkalisation of the urine.
    • Administration of compounds which convert cystine to a more soluble compound.
34. Describe how the dissolution and prevention of ammonium urate uroliths may be achieved.
    
    • Increasing water intake.
    • Restriction of protein.
    • Supplementation with potassium citrate (to promote neutral or slightly alkaline urine).
    • Administration of allopurinol (to inhibit uric acid production).
35. What condition may result following deficiencies in essential fatty acids, protein, zinc, and vitamins A, E and B complex?
    Seborrhoea.
36. In what food are the omega-3 series fatty acids found?
    Marine fish oil. The omega-3 fatty acids are beneficial in the management of pruritis.
37. Describe a diet suitable for a patient with congestive heart failure.
    
    • High energy density.
    • Restricted sodium.
    • Moderately restricted protein of a high biological value.