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Malnutrition 616.e3

PROGNOSIS & OUTCOME result in tumor control for more than 400 SUGGESTED READING
days after incomplete tumor excision of Liptak JM, et al: Soft tissue sarcomas. In Withrow
VetBooks.ir intermediate-grade tumors with appropriate PEARLS & CONSIDERATIONS ed 5, Philadelphia, 2013, Saunders, pp 356-380. Diseases and Disorders
soft-tissue sarcomas.
• Prognosis is excellent for histologically low- to
SJ, et al, editors: Small animal clinical oncology,
treatment, which includes surgical resec-
tion with clean histopathologic margins
or incomplete resection combined with Comments ADDITIONAL SUGGESTED
READING
radiation therapy. Aside from the giant cell variant, treatment and Waters CB, et al: Giant cell variant of malignant
• Dogs with the giant cell variant of this tumor prognosis of malignant fibrous histiocytoma fibrous histiocytoma in dogs: 10 cases (1986-1993).
often have metastases at the time of diagnosis should be considered like other soft-tissue J Am Vet Med Assoc 205:1420-1424, 1994.
or soon afterward, and prognosis is usually sarcomas. Tumors at injection sites in cats
poor despite treatment. Few cats with this should be treated like injection-site sarcomas RELATED CLIENT EDUCATION
variant develop metastases. (p. 550).
• Dogs with splenic tumors are more likely SHEETS
to develop metastases and therefore have a Technician Tips Consent to Perform Abdominal Ultrasound
poor prognosis. All masses in dogs and cats, even slow-growing Consent to Perform Fine-Needle Aspiration
• High-grade malignant fibrous histiocytoma: ones, should be aspirated to rule out malignant of Masses
as with other soft-tissue sarcomas, prognosis tumors. Consent to Perform Radiography
is considered guarded based on the increased
likelihood for metastases. Client Education AUTHOR: John Farrelly, DVM, MS, DACVIM, DACVR
• Palliative radiation after incomplete tumor Pet owners can be educated to monitor their EDITOR: Kenneth M. Rassnick, DVM, DACVIM
excision resulted in tumor control in 65% pets for palpable or visible masses and have
of dogs with soft-tissue sarcomas at 5 years them evaluated in a timely fashion. Early detec-
in one study. tion can allow easier treatment with surgery
• Metronomic chemotherapy using cyclophos- and may help avoid the need for radiation
phamide and piroxicam has been shown to therapy.

Malnutrition Client Education
Sheet

BASIC INFORMATION ASSOCIATED DISORDERS thiamin deficiency, skin signs for linoleic
• Decreased protein or calorie intake negatively acid deficiency)
Definition affects immune function and wound healing.
Malnutrition is the inappropriate intake of • Inadequate mineral intake can cause osteo- Etiology and Pathophysiology
calories or nutrients, resulting in deficiencies penia, bone deformity, or fracture, especially • Inadequate or excessive nutrient intake results
or excesses. Excessive caloric intake is addressed in growing animals. in malnutrition.
in the Obesity chapter (p. 700). • Decreased protein and nutrient intake dimin-
Clinical Presentation
Epidemiology DISEASE FORMS/SUBTYPES ishes immune cell response and production,
protein turnover, tissue synthesis, and wound
SPECIES, AGE, SEX • Inadequate calorie and nutrient intake healing.
Animals of any species, age, life stage, or lifestyle (underfeeding) • Protein or calorie malnutrition may alter
• Adequate caloric intake but inadequate or drug metabolism.
RISK FACTORS excessive nutrient intake (unbalanced diet) • Although not well documented among
• Animals fed home-prepared diets, vegetarian/ hospitalized veterinary patients, malnutri-
vegan diets (commercial or home-cooked HISTORY, CHIEF COMPLAINT tion is thought to increase morbidity and
food), or commercial diets labeled “for Calorie- and nutrient-deprived animals present mortality.
intermittent or supplemental feeding only” with a history of weight loss, muscle loss, • In the case of specific deficient or excess
are at increased risk. orthopedic pain or lameness, inappetence or nutrients, perturbations in the pathways
• Chronic vomiting or diarrhea can alter diges- anorexia, or signs related to specific nutrient associated with those nutrients are seen.
tion and absorption, resulting in decreased deficiencies (e.g., neurologic signs in a cat with
nutrient and calorie assimilation. thiamin deficiency). DIAGNOSIS
• Glucocorticoids, cancer chemotherapeutic
agents, antibiotics, or diuretics may adversely PHYSICAL EXAM FINDINGS Diagnostic Overview
affect nutritional homeostasis. • Calorie and protein deficiency: often poor Calorie and nutrient malnutrition is diagnosed
• Oral disease, regurgitation, or mobility issues physical appearance; thin body condition; from a thorough diet history and the physical
can lead to decreased food intake. pallor; dry, coarse haircoat; flaky skin; hyper- exam findings. Specific laboratory testing for
keratosis; muscle wasting; dental disease; concentrations of nutrients of concern or
GEOGRAPHY AND SEASONALITY skeletal abnormalities; chronic wounds, imaging may also be necessary (e.g., for calcium,
Animals kept outdoors in cold climates require weakness thiamin, or taurine status).
additional calories to maintain body weight. • Specific nutrient deficiencies: signs refer-
Animals kept outdoors may not consume able to the nutrient affected (e.g., dilated Differential Diagnosis
adequate food or water during intense heat cardiomyopathy and retinal lesions for • Gastrointestinal (GI) disease: protein-losing
conditions. taurine deficiency, neurologic signs for enteropathy, exocrine pancreatic insufficiency,

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