Page 1011 - Small Animal Clinical Nutrition 5th Edition

Intro to Small Intestinal Diseases 1049

derangement is rapid intestinal transit associated with a animal species. Crypt epithelial cells produce intestinal fluid,
VetBooks.ir decreased frequency of rhythmic segmental contractions, also whereas enterocytes lining the villous tips are responsible for
absorption. Normally, absorption exceeds intestinal secretion.
termed ileus. The reduction in segmental contractions results in
Most secretagogue effects are mediated via a second messenger
a “pipe” effect with little resistance to ingesta flow. Ileus may
occur in conjunction with infiltrative diseases, severe abdominal (e.g., cyclic AMP, cyclic GMP, calmodulin). Secretagogues
pain,parvoviral enteritis or may develop postoperatively.In many include GI hormones, bacterial enterotoxins, certain pharma-
cases, iatrogenic ileus complicates the management of patients cologic agents, deconjugated bile acids and hydroxy fatty acids.
treated inappropriately with anticholinergic agents. Increased Clinical manifestations of secretory diarrhea are often extreme.
frequency of peristaltic contractions is probably not an important Patients have large volumes of fluid diarrhea and often become
cause of diarrhea in dogs and cats. However, it may play a role in dehydrated rapidly. Generally, fasting is not successful in allevi-
the irritable bowel syndrome. A reduction in peristaltic or inter- ating clinical signs.
digestive motility may result in small intestinal bacterial over-
growth. Response to dietary manipulation is variable. REFERENCE

Secretory Diarrhea The reference for Chapter 55 can be found at
Secretory diarrhea is relatively uncommon in companion ani- www.markmorris.org.
mals vs. people (cholera is the prototypical example) and food

Table 55-3. Breed-associated small intestinal disorders. Box 55-1. Small Intestinal Neoplasia.
Eosinophilic gastroenteritis German shepherd dog
Irish setter Lymphosarcoma, adenocarcinoma and mast cell tumors are the
most common intestinal tumors recognized in cats, whereas ade-
Hemorrhagic gastroenteritis Dachshund nocarcinomas and leiomyomas are more common in dogs.
Miniature poodle
Miniature schnauzer Adenocarcinomas occur most commonly in the jejunum and
ileum of cats and in the duodenum and colon of dogs.
Immunoproliferative small Basenji Lymphosarcoma arising from gut-associated lymphoid tissue is
intestinal disease Ludenhund the most common extranodal form. A number of other tumor
types occur, including plasma cell tumors, leiomyosarcomas,
Intestinal adenocarcinoma Siamese cat
hemangiosarcomas and carcinoid tumors, but are less common.
Lymphoplasmacytic enteritis German shepherd dog The diffuse nature of lymphosarcomas and mast cell tumors
Chinese Shar-Pei often results in maldigestion of carbohydrates and some proteins,
Soft-coated wheaten terrier malabsorption and subsequent malnutrition and provides the
Domestic shorthair cat
Parvoviral enteritis American pit bull terrier greatest opportunity for dietary therapy.
Doberman pinscher Nutritional support is of critical importance in managing
Rottweiler patients with intestinal neoplasia. Providing optimal nutrition helps
Labrador retriever (black) the clinician return the patient to ideal body condition, provides
some protection against the toxic side effects of antineoplastic
Small intestinal bacterial German shepherd dog
overgrowth Beagle chemotherapy and improves the patient’s quality of life (Chapter
30). As with many small bowel disorders, use of highly digestible
Lymphangiectasia* Yorkshire terrier foods is recommended with nutrient levels adjusted for each
Golden retriever patient as tolerated.
Dachshund
Basenji (IPSID) In cases of intestinal neoplasia, assisted-feeding techniques
Ludenhund (IPSID) (enteral or parenteral) may be required initially to meet nutrition-
al, fluid and electrolyte needs as the patient recovers from surgery
Wheat-sensitive enteropathy Irish setter or receives chemotherapy. In particular, early nutritional support
(i.e., parenteral or enteral) in debilitated cats is very advantageous
Key: IPSID = immunoproliferative small intestinal disease.
*Soft-coated wheaten terriers may be affected by a protein- in the initial management of gastrointestinal lymphosarcoma.
losing enteropathy that may occur in conjunction with a pro- Parenteral administration of nutrients can be added to oral intake
tein-losing nephropathy. to fully meet the patient’s requirements. Reestablishing normal
intestinal function and stimulating adaptation should begin as
soon as the patient tolerates oral food intake.
Multiple (i.e., six to eight) small meals per day are recommend-
ed in a form best tolerated by the patient. Occasionally, a liquid
form of the food may be necessary for patients undergoing vari-
ous forms of treatment.
The Bibliography for Box 55-1 can be found at
www.markmorris.org.