消化系统疾病-30胃肠道中英文1校the anorectic cat unterer

MedizinischeLudwig-ilians-UniversitätTheAnorecticDr.StefanUntererDiplomateOverview概DefinitiondecreasedorlossofappetitedecreasedappetitebettertermforpatientswithdecreasedfoodCauseslookforunderlyingcauseanorexiaisacommoncauseforbringingcatstotheVet厌食是主人带猫咪就诊的常见原因anorexiaisseenincombinationwithavarietyofdiseases很多疾病都会表现出厌食症状Causescatsstopeating,iftheyfeel‚notwell‘oralwayslookformorespecificproblems,thatoccurwithanorexia,e.g.fever,painfulabdomen,…Causesfirst首先判anorexiaasonly/sole厌食是唯一的异

morespecificproblempresent厌食是继发的，存在其的异Causesfirstinterestedin

notinterestedCausesnotabletoeatpainwithin orwhenopeningthemechanicalfoodaversionstress/psychogenicinfluences应激/CausesspecifichistoryWhatdotheyfeedChanges?StressorsNewanimal?Changesintheenvironmentaskforsubtlesymptomse.g.weightloss–typicalandsometimesonlysymptomofsmallboweldisease体重减轻—小肠Causesspecifichistorycatsdevelopfoodaversionveryquickly,especiallyiffood/feedingisconnectedwithunpleasentevents(e.g.pilling/treatmentwhilefeeding)check (gingiva,teeth,larynx/pharynx,tongue,（牙龈，牙齿，喉/咽，舌，舌系带Gingivitis牙龈Neoplasiatongue舌基部/舌系膜肿Ulcerationdueto杯 导致的溃Foreignbody(string)舌系带处的异物（线Causesnotinterestedinsenseof

senseofCauses+senseofsmellDrugs药painsystemicdiseaseinflammatory(Interleukine1)炎症（白介素neoplastictumornecrosisfactor)肿瘤(肿瘤坏死因子DiagnosticWork-up诊step-by-stepapproach诊fromnon-invasivetoinvasive(31ststepnorestraint)第一步（无需保定猫checkskull/nose,checkforretrobulbarpressure(pressureoncheck (Frenulum!)检查口腔（舌系带checktemporomandibularjoint/swallowing检查颞下颌关节/吞checkspecificallyforpain特别要检查有无疼neurologicexam神经学检DiagnosticWork-up诊adcheckspecificallyforpainpainincatsisnotalwaysdetectedclinically在 不容易发forexample,inonly25%ofcatswithpancreatitisapainfulabdomenisapparentduringphysical仅有25%的胰腺炎猫在体格检查中发现有腹痛症DiagnosticWork-up诊 stepwithrestraint)第二步（需要保定猫bloodworkCBC,BCspecifictestsfPLi(felinepancreaticlipasebileacidsDiagnosticWork-up诊 stepwithrestraint)第二步（需要保定猫diagnosticimagingradiographs(thoracic,abdominal)X光片（胸片、腹片ultrasound(abdominalcardiac)超声（腹部、心超bloodpressuremeasurementDiagnosticWork-up诊fromnon-invasivetoinvasive(3steps)ifafterbloodworkandimagingnocauseforanorexiaisfound,checkgastrointestinaltractCNS中枢神经系DiagnosticWork-up诊anorexiawithlackofothersymptoms胃部疾病，DiagnosticWork-up诊ifcauseofanorexiaisnotfoundinstep1to checkstomachandalwaystakesmallbowelbiopsies,ifweightlossDiagnosticWork-up诊pancreatitiscommoninacutepancreatitisreadilyidentifiedbyfPLiandultrasound(sensitivityfPLi:80–100%*)FormanMA,MarksSL,DeCockHE,etal.JVetInternMed.FormanMA,ShiromaJ,ArmstrongPJ,etal.JVetInternMed.Pancreatitis胰腺炎诊DiagnosticWork-up诊chronicpancreatitismuchmorecommonthanacutechronicpancreatitisnotreadilyidentifiedbyandfPLi(sensitivityfPLi:54FormanMA,MarksSL,DeCockHE,etal.JVetInternMed.DiagnosticWork-up诊simultaneousoccurenceofchronicpancreatitischronicenteritischroniccholangitis慢性胆管炎discussedin DiagnosticWork-up诊diagnosticlaparotomywithifcauseofanorexiaisnotfoundinsteps1anddiagnosisofchronicinflammationindifferentorgans(Triaditis)onlyhistologicallypossible! distinctivefeaturesincatsdailyobligatneedsofaminoacidsandprotein,astheyarenotabletodownregulateKrebscycleduringfastingperiods每日必catsuseproteinsasenergysourceevenifcarbohydrateshighproteinrequirements(cat29dog12%,human8%)（猫29%，犬12%，人requirementsfortaurin,arginine,methionine,cysteine,andpossiblycarnitinehigherthanfordogs和犬相比，猫对牛磺酸、distinctivefeaturesincatsarachidonicacidsisanessentielfattyacidforcats;itisconsumedviaanimalfat花生四烯酸对猫是必须氨基酸，通catscannotsynthesizeVitaminDandA猫不能合成VDcatshavehighVitaminBrequirements高VBcatscanusecarbohydratesonlypoorlyastheyproduceonlylittleamylaseandlessdisaccharidasesarepresentwithintheintestines猫利用碳水化合物的能力有限，因为肠metabolicderailmenthepaticlipidosis)代谢异常（脂肪肝energyrequirementsnotmetdelayedhealing intestinalintegrityandincreasedintestinalpermeabilityforbacteriaandtoxines progressiveliverfailureduetomassivelipiddepositionwithinhepatocytes肝细胞内脂肪大量沉着releaseofperipherallipidreservesunderexactpathophysiologicmechanismsunkonwn(mostlikelymultifactorial)确切的病理生理机制尚不清楚（最 earlyrecognitionandappropriatetherapyobesecatssuddenonsetofanorexiapredisposingfactorscatsofanybreedandagecanbe(mostlymiddle-agedtooldercats)任何品种 confirmationofdiagnosis‚hepaticsearchforincitinghepaticlipidosisdiagnosis脂肪肝-ALPusuallyincreasedALPALTand notoronlymildlybilirubinusuallyelevatedcoagulationoftenabnormal*partiallyduetoVitaminK

cuolesin>50%fineneedleaspirationcytologylipidosiseasilydiagnosedadditional/causingliverdiseaseispossiblyinsomecasesliverbiopsyneccessaryhepaticlipidosistherapy脂肪肝-fluidscorrectforelectrolytesKMgP)液体疗法，纠正电解质（Mg,PpatientwithsignsofHE有肝性脑病症状的动antibiotic,se.gAmoxicillintoreducecolonicmicrobialflora(reductionofammoniaproduction)抗生素，如：阿莫西林减少肠道Amoxicillin20mg/kgivq8h阿莫西Lactulose乳果25mlpoq12h口服2-3parts+7partsNaClasenema20ml/kgrectallyq4–6h15–203份乳果糖加7份生理盐水配制而成的灌肠液，20ml/kg，q4-一次，一次15-20分dietproteinreducede.gHillsk/d)低蛋白饮食（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-肉毒碱（脂肪代谢），250-500mg/猫/日，口Taurin(essentialAA,conjugationbileacids)500mg/cat/dayp.o牛磺酸（必需氨基酸，结合胆汁酸），500mg/猫/日，口Arginin(essentialAA,Krebscycle)1,000mg/cat/dayp.精氨酸（必需氨基酸， ），1000mg/猫/日，口S-Adenosylmethionine(SAMe)30–60mg/kgq12-p.S-3060mg/kgq12-24hUrsodeoxycholicacid(UDCA)10–15mg/kg/dayp.熊去氧胆酸，1015mg/kg/Feedingmanagement饲养管rehydratepatientadjustelevctrolytespainmanagementCAVE:OpiatescanreducebowelFeedingmanagement饲养管avarietyofdrugscancausenausea/‘notfeelingwell‘(Antibiotics,NSAIDs,Chemotherapeutics,..)很多药物可以引起不适（抗生素，NSAIDs，化疗药物…）moreisnotalwaysbetter!questioneverydrugyougiveadjustdosagee.ginrenalinsufficiencyFeedingmanagement饲养管useantiemeticsmetoclopramidPaspertin®)Dopamin2receptorantagonist多巴胺25-HT3antagonist3weak)5羟色胺阻断剂（效果弱H1antagonistweak)H1阻断剂（效果弱actsatCRTZandsmoothmuscle作用于CRTZ0.2-0.4mg/kgs.c.,p.o.Feedingmanagement饲养管useantiemetics使用止吐maropitantCerenia®)马罗neurokinin1receptorantagonist神经激肽1actsatvomitingcenter,CRTandperipheral作用 worksformotionsickness24houreffect药效持续241mg/kgs.cp.oSID1mg/kg次Feedingmanagement饲养管avoidstressbequietdon‘tfeednexttothelitter feedingshouldnotbetheVet(preferred:owners,hospitalstaff)不要由兽医进行饲喂(最好由畜主或医院其他人员饲喂Feedingmanagement饲养管increasemoisturecontentdoesnotworkincatsonlyusedtodryfood!对仅吃increasefatcontentbettertastehigherenergypergramfood每gslowedgastricemtyingFeedingmanagement饲养管alwaysfeedfreshfoodDon‘tleavefoodout,ifnotwarmfoodworksespeciallyincatswithdecreasedsenseofsmell(catflu,oldercats)Feedingmanagement饲养管offerdifferentvarietiesoffoodCAVE:Ddon‘tofferveterinarydietstoin-housepatients!(acquiredfoodaversion!)在家不要饲喂和 CAVE:babyfoodcancontaingarlicpowder!causeHeinzbodyanemia) Feedingmanagement饲养管Mostappetitestimulantsaremetabolizedbytheliverandshouldnotbegiveninliverfailurepatients(hepaticlipidosis!).大部分的食欲刺激剂需经肝脏代Feedingmanagement饲养管benzodiazepinscauseaveryshortlastingincreasedosage0.2mg/kgi.v.q12hcontraindicatedinsevereliverdamage,especiallyinpatientswithHE严重的肝脏损伤，