ANSWERS

1. What is the difference between enteral and parenteral nutrition?
   Enteral means within the gastro-intestinal tract; enteral diets are those taken by mouth or via a feeding tube. Parenteral is defined as apart from the alimentary canal.
2. A hospitalised patient is reluctant to feed; how could you make the diet more palatable?
   • Offer smaller portions (feed little and often).
   • Cut up the food finely or liquidise.
   • Gently heat the food to body temperature.
   • Add a low salt gravy or small amount of vegetable oil to the meal.
   • Ask the owner what sort of diet the animal prefers and offer this (if not contra-indicated by the medical condition suffered by the patient).
3. What complication may arise from syringe feeding?
   Aspiration pneumonia.
4. Why might feeding by a stomach tube be dangerous?
   The patient may bite through the tube and swallow the lower portion.
5. What is the best proprietary diet for feeding via a naso-gastric or naso-oesophageal tube and why?
   A concentrated homogenous fluid feed.
6. List proprietary diets suitable for assisted feeding.
   • Hills A/D.
   • Reanimyl.
   • Waltham concentration diet.
   • Eukanuba recovery formula.
   • Fortum.
   • Liquivite.
7. What properties make the diets listed in question 6 suitable for assisted feeding?
   • They are liquid or semi-solid.
   • They are concentrated, which means that a smaller portion will still meet the animal's nutritional demand. This is useful since many patients become stressed during prolonged force/assisted feeding.
8. List 8 conditions that may necessitate force or assisted feeding.
   • Fractured jaw.
   • Severe stomatitis/gingivitis.
   • Dental extractions.
   • Cat flu (loss of olfaction).
   • Laryngitis.
   • Pharyngitis.
   • Dysphagia.
   • Pain.
9. What percentage dehydration shows a noticeable loss of skin elasticity?
   6% plus.
10. Name a fluid suitable for oral rehydration.
    Lectade.
11. What do the fluids in Q10 have in common?
    They are all isotonic (solutions that exert osmotic pressures equal to that of the body's fluid).
12. What are the disadvantages of oral rehydration?
    • A limited range (only isotonic fluids) may be used.
    • Contra-indicated in cases of vomiting, retching or unconsciousness.
    • Slow absorption rate.
    • Time consuming to administer.
    • Danger of inhalation pneumonia.
13. What tranquilliser may be used as an appetite stimulant in cats suffering partial anorexia?
    Diazepam (Valium).
14. Describe where a pharyngostomy tube is placed.
    Caudal to the epihyoid bone, lateral to the epiglottis and ventral to the mandibular and salivary glands.
15. What is a PEG tube?
    Percutaneous endoscopic guided (or surgically placed) gastrostomy tube. This requires a general anaesthetic for placement and carries the risk of peritonitis. The tube is placed directly into the stomach via an incision through the adjacent skin, muscle and fat. Once in place it is well tolerated and can be used for long term nutritional support.
    
    Note: A Key Notes section about feeding tubes accompanies this module.