消化系統(tǒng)疾病-30胃腸道中英文1校the anorectic cat unterer

MedizinischeLudwig-ilians-Universit?tTheAnorecticDr.StefanUntererDiplomateOverview概DefinitiondecreasedorlossofappetitedecreasedappetitebettertermforpatientswithdecreasedfoodCauseslookforunderlyingcauseanorexiaisacommoncauseforbringingcatstotheVet厭食是主人帶貓咪就診的常見原因anorexiaisseenincombinationwithavarietyofdiseases很多疾病都會表現(xiàn)出厭食癥狀Causescatsstopeating,iftheyfeel?notwell‘oralwayslookformorespecificproblems,thatoccurwithanorexia,e.g.fever,painfulabdomen,…Causesfirst首先判anorexiaasonly/sole厭食是唯一的異

morespecificproblempresent厭食是繼發(fā)的，存在其的異Causesfirstinterestedin

notinterestedCausesnotabletoeatpainwithin orwhenopeningthemechanicalfoodaversionstress/psychogenicinfluences應(yīng)激/CausesspecifichistoryWhatdotheyfeedChanges?StressorsNewanimal?Changesintheenvironmentaskforsubtlesymptomse.g.weightloss–typicalandsometimesonlysymptomofsmallboweldisease體重減輕—小腸Causesspecifichistorycatsdevelopfoodaversionveryquickly,especiallyiffood/feedingisconnectedwithunpleasentevents(e.g.pilling/treatmentwhilefeeding)check (gingiva,teeth,larynx/pharynx,tongue,（牙齦，牙齒，喉/咽，舌，舌系帶Gingivitis牙齦Neoplasiatongue舌基部/舌系膜腫Ulcerationdueto杯 導(dǎo)致的潰Foreignbody(string)舌系帶處的異物（線Causesnotinterestedinsenseof

senseofCauses+senseofsmellDrugs藥painsystemicdiseaseinflammatory(Interleukine1)炎癥（白介素neoplastictumornecrosisfactor)腫瘤(腫瘤壞死因子DiagnosticWork-up診step-by-stepapproach診fromnon-invasivetoinvasive(31ststepnorestraint)第一步（無需保定貓checkskull/nose,checkforretrobulbarpressure(pressureoncheck (Frenulum!)檢查口腔（舌系帶checktemporomandibularjoint/swallowing檢查顳下頜關(guān)節(jié)/吞checkspecificallyforpain特別要檢查有無疼neurologicexam神經(jīng)學(xué)檢DiagnosticWork-up診adcheckspecificallyforpainpainincatsisnotalwaysdetectedclinically在 不容易發(fā)forexample,inonly25%ofcatswithpancreatitisapainfulabdomenisapparentduringphysical僅有25%的胰腺炎貓在體格檢查中發(fā)現(xiàn)有腹痛癥DiagnosticWork-up診 stepwithrestraint)第二步（需要保定貓bloodworkCBC,BCspecifictestsfPLi(felinepancreaticlipasebileacidsDiagnosticWork-up診 stepwithrestraint)第二步（需要保定貓diagnosticimagingradiographs(thoracic,abdominal)X光片（胸片、腹片ultrasound(abdominalcardiac)超聲（腹部、心超bloodpressuremeasurementDiagnosticWork-up診fromnon-invasivetoinvasive(3steps)ifafterbloodworkandimagingnocauseforanorexiaisfound,checkgastrointestinaltractCNS中樞神經(jīng)系DiagnosticWork-up診anorexiawithlackofothersymptoms胃部疾病，DiagnosticWork-up診ifcauseofanorexiaisnotfoundinstep1to checkstomachandalwaystakesmallbowelbiopsies,ifweightlossDiagnosticWork-up診pancreatitiscommoninacutepancreatitisreadilyidentifiedbyfPLiandultrasound(sensitivityfPLi:80–100%*)FormanMA,MarksSL,DeCockHE,etal.JVetInternMed.FormanMA,ShiromaJ,ArmstrongPJ,etal.JVetInternMed.Pancreatitis胰腺炎診DiagnosticWork-up診chronicpancreatitismuchmorecommonthanacutechronicpancreatitisnotreadilyidentifiedbyandfPLi(sensitivityfPLi:54FormanMA,MarksSL,DeCockHE,etal.JVetInternMed.DiagnosticWork-up診simultaneousoccurenceofchronicpancreatitischronicenteritischroniccholangitis慢性膽管炎discussedin DiagnosticWork-up診diagnosticlaparotomywithifcauseofanorexiaisnotfoundinsteps1anddiagnosisofchronicinflammationindifferentorgans(Triaditis)onlyhistologicallypossible! distinctivefeaturesincatsdailyobligatneedsofaminoacidsandprotein,astheyarenotabletodownregulateKrebscycleduringfastingperiods每日必catsuseproteinsasenergysourceevenifcarbohydrateshighproteinrequirements(cat29dog12%,human8%)（貓29%，犬12%，人requirementsfortaurin,arginine,methionine,cysteine,andpossiblycarnitinehigherthanfordogs和犬相比，貓對牛磺酸、distinctivefeaturesincatsarachidonicacidsisanessentielfattyacidforcats;itisconsumedviaanimalfat花生四烯酸對貓是必須氨基酸，通catscannotsynthesizeVitaminDandA貓不能合成VDcatshavehighVitaminBrequirements高VBcatscanusecarbohydratesonlypoorlyastheyproduceonlylittleamylaseandlessdisaccharidasesarepresentwithintheintestines貓利用碳水化合物的能力有限，因為腸metabolicderailmenthepaticlipidosis)代謝異常（脂肪肝energyrequirementsnotmetdelayedhealing intestinalintegrityandincreasedintestinalpermeabilityforbacteriaandtoxines progressiveliverfailureduetomassivelipiddepositionwithinhepatocytes肝細(xì)胞內(nèi)脂肪大量沉著releaseofperipherallipidreservesunderexactpathophysiologicmechanismsunkonwn(mostlikelymultifactorial)確切的病理生理機制尚不清楚（最 earlyrecognitionandappropriatetherapyobesecatssuddenonsetofanorexiapredisposingfactorscatsofanybreedandagecanbe(mostlymiddle-agedtooldercats)任何品種 confirmationofdiagnosis?hepaticsearchforincitinghepaticlipidosisdiagnosis脂肪肝-ALPusuallyincreasedALPALTand notoronlymildlybilirubinusuallyelevatedcoagulationoftenabnormal*partiallyduetoVitaminK

cuolesin>50%fineneedleaspirationcytologylipidosiseasilydiagnosedadditional/causingliverdiseaseispossiblyinsomecasesliverbiopsyneccessaryhepaticlipidosistherapy脂肪肝-fluidscorrectforelectrolytesKMgP)液體療法，糾正電解質(zhì)（Mg,PpatientwithsignsofHE有肝性腦病癥狀的動antibiotic,se.gAmoxicillintoreducecolonicmicrobialflora(reductionofammoniaproduction)抗生素，如：阿莫西林減少腸道Amoxicillin20mg/kgivq8h阿莫西Lactulose乳果25mlpoq12h口服2-3parts+7partsNaClasenema20ml/kgrectallyq4–6h15–203份乳果糖加7份生理鹽水配制而成的灌腸液，20ml/kg，q4-一次，一次15-20分dietproteinreducede.gHillsk/d)低蛋白飲食（Hillsk/dpatientwithoutsignsofHEenergyinputasmostimportanttherapeuticdiet(highqualityprotein,e.g.a/d,caclulateenergyrequirementsandfeedviafeedingtubesupportivemeasuresessentialaminoacidshepaticlipidosis–supportiveVitaminB1ThiaminVB1-1–2ml plexperLcristalloidVitaminB12–Cobalamin250–500mcg/cats.VitaminE–alpha-Tocopherol(Antioxidant),10-100p.hepaticlipidosis–supportiveessentialaminoacidsL-Carnitin(lipidmetabolism)250-500mg/cat/dayp.L-肉毒堿（脂肪代謝），250-500mg/貓/日，口Taurin(essentialAA,conjugationbileacids)500mg/cat/dayp.o?；撬幔ū匦璋被幔Y(jié)合膽汁酸），500mg/貓/日，口Arginin(essentialAA,Krebscycle)1,000mg/cat/dayp.精氨酸（必需氨基酸， ），1000mg/貓/日，口S-Adenosylmethionine(SAMe)30–60mg/kgq12-p.S-3060mg/kgq12-24hUrsodeoxycholicacid(UDCA)10–15mg/kg/dayp.熊去氧膽酸，1015mg/kg/Feedingmanagement飼養(yǎng)管rehydratepatientadjustelevctrolytespainmanagementCAVE:OpiatescanreducebowelFeedingmanagement飼養(yǎng)管avarietyofdrugscancausenausea/‘notfeelingwell‘(Antibiotics,NSAIDs,Chemotherapeutics,..)很多藥物可以引起不適（抗生素，NSAIDs，化療藥物…）moreisnotalwaysbetter!questioneverydrugyougiveadjustdosagee.ginrenalinsufficiencyFeedingmanagement飼養(yǎng)管useantiemeticsmetoclopramidPaspertin?)Dopamin2receptorantagonist多巴胺25-HT3antagonist3weak)5羥色胺阻斷劑（效果弱H1antagonistweak)H1阻斷劑（效果弱actsatCRTZandsmoothmuscle作用于CRTZ0.2-0.4mg/kgs.c.,p.o.Feedingmanagement飼養(yǎng)管useantiemetics使用止吐maropitantCerenia?)馬羅neurokinin1receptorantagonist神經(jīng)激肽1actsatvomitingcenter,CRTandperipheral作用 worksformotionsickness24houreffect藥效持續(xù)241mg/kgs.cp.oSID1mg/kg次Feedingmanagement飼養(yǎng)管avoidstressbequietdon‘tfeednexttothelitter feedingshouldnotbetheVet(preferred:owners,hospitalstaff)不要由獸醫(yī)進行飼喂(最好由畜主或醫(yī)院其他人員飼喂Feedingmanagement飼養(yǎng)管increasemoisturecontentdoesnotworkincatsonlyusedtodryfood!對僅吃increasefatcontentbettertastehigherenergypergramfood每gslowedgastricemtyingFeedingmanagement飼養(yǎng)管alwaysfeedfreshfoodDon‘tleavefoodout,ifnotwarmfoodworksespeciallyincatswithdecreasedsenseofsmell(catflu,oldercats)Feedingmanagement飼養(yǎng)管offerdifferentvarietiesoffoodCAVE:Ddon‘tofferveterinarydietstoin-housepatients!(acquiredfoodaversion!)在家不要飼喂和 CAVE:babyfoodcancontaingarlicpowder!causeHeinzbodyanemia) Feedingmanagement飼養(yǎng)管Mostappetitestimulantsaremetabolizedbytheliverandshouldnotbegiveninliverfailurepatients(hepaticlipidosis!).大部分的食欲刺激劑需經(jīng)肝臟代Feedingmanagement飼養(yǎng)管benzodiazepinscauseaveryshortlastingincreasedosage0.2mg/kgi.v.q12hcontraindicatedinsevereliverdamage,especiallyinpatientswithHE嚴(yán)重的肝臟損傷，