Page 1138 - Small Animal Clinical Nutrition 5th Edition

1184 Small Animal Clinical Nutrition

VetBooks.ir CASE 68-2

Vomiting in a Miniature Poodle
Philip Roudebush, DVM, Dipl. ACVIM (Small Animal Internal Medicine)
Hill’s Scientific Affairs
Topeka, Kansas, USA

Patient Assessment
A seven-year-old male miniature poodle was examined for lethargy, excessive panting, elevated liver enzyme activity and intermit-
tent vomiting of six weeks’ duration. The vomitus was usually yellow foam or partially digested food. Elevated liver enzyme activ-
ity was noted on laboratory work obtained by the referring veterinarian (Table 1, Days 0 and 12). A two-week course of oral amox-
a
icillin failed to improve the patient’s problems. The dog received a single 2-mg intramuscular injection of triamcinolone for gen-
eralized pruritus. The lethargy, panting and vomiting were first noted shortly thereafter.
Physical examination revealed a bright, alert dog that weighed 5 kg, appeared slightly overweight (body condition score [BCS]
4/5) and panted continuously. Other findings included a few subcutaneous lipomas, mild periodontal disease, hepatomegaly, bilat-
eral lenticular sclerosis, right patellar luxation and no evidence of testicles in the scrotum.The owners were given the dog as a young
puppy and denied that it had been castrated.
Evaluation of these problems included a complete blood count (mild leukocytosis), heartworm check (negative), serum biochem-
istry profile (normal except for elevated liver enzyme activity [Table 1, Day 19]), urinalysis (normal), fecal flotation (hookworms)
and abdominal radiographs. Survey abdominal radiographs revealed an extremely enlarged liver that displaced the axis of the stom-
ach dorsocaudally and displaced the small bowel caudally. Ultrasound demonstrated a segment of terminal jejunum or ileum with
a thickened bowel wall. Retained testicles were also identified. Prothrombin and activated partial thromboplastin times were nor-
mal. Examination of an ultrasound-guided fine-needle aspirate of the liver revealed vacuolar changes in hepatocytes consistent with
steroid hepatopathy. An anthelmintic was administered for the hookworm infection.
The dog was reexamined one week later for an ACTH response test with determination of resting and post-ACTH plasma cor-
tisol concentrations. An exploratory celiotomy was also planned to obtain liver and intestinal biopsy specimens and remove the
retained testicles.
The resting cortisol concentration was subnormal and failed to increase after intramuscular administration of ACTH gel (Table
1, Day 19). During surgery, a diffusely enlarged, pale liver with rounded margins was noted; biopsy specimens were obtained from
the liver, distal small intestine and colon; the retained testicles were identified and removed. Histopathologic examination of these
specimens revealed diffuse testicular atrophy, normal intestinal structure except for mild dilatation of lacteals and multifocal hepat-
ic vacuolar change consistent with steroid hepatopathy.
The tentative diagnosis was secondary hypoadrenocorticism and hepatopathy associated with parenteral administration of corti-
costeroids.
Assess the Food and Feeding Method
The dog was normally fed a combination of commercial grocery brand moist food mixed with broiled chicken and cottage cheese.
The commercial food and table food were mixed in approximately a 50:50 ratio. An unspecified amount of this mixture was offered
twice daily. The dog preferred to drink either ice water or iced tea.

Questions
1. What are the key nutritional factors to consider for this patient?
2. Outline a feeding plan for this dog including food and feeding method.
3. What other therapy should be considered?
4. How should this dog be monitored for response to therapy?

Answers and Discussion
1. The key nutritional factors for patients with mild to moderate hepatic disease that is expected to be self-limiting are listed in
Table 68-8. The food should contain appropriate amounts of these key nutrients and other essential nutrients based on the
patient’s current lifestage. Dramatic changes are not necessary in the nutrient levels of food for patients with mild to moderate
hepatic disease and no evidence of hepatic failure, portosystemic vascular shunts, ascites or hepatic encephalopathy.
2. A commercial dog food formulated for older dogs (i.e., senior or geriatric food) would be appropriate for this patient. Such a food
would be more balanced and avoid the probable excess protein and fat provided by the current diet of 50% moist commercial gro-
cery brand food and 50% chicken and cottage cheese.The daily energy requirement (DER) should be calculated to maintain cur-
rent body weight until the liver disease has resolved. The food and water should be offered in multiple small meals throughout