Introduction
Most species of animal can go many
days without eating. This is not true for cats, especially when they
are sick. Several days of not eating (anorexia) can have serious
consequences in cats and lead to failure of important organs like the
liver.
Causes of
Lack of appetite
Internal organ diseases like liver
disease hepatic
lipidosis, infections,
FeLV,
and fevers, along with anatomical problems like a broken
jaw can all prevent a cat
from taking in adequate nutrition. In addition, all of these diseases
increase caloric needs, so a lack of appetite in a diseased cat is an
important problem to address.
The
yellow discoloration to this cats gums is called icterus,
commonly know as jaundice. In this specific case the icterus
is caused by liver disease because this cat has hepatic
lipidosis. Feeding tubes are commonly used in these cats
because they have stopped eating.
Short Term
Treatment Options
Several options are available to give adequate
nutrition to cats that are not eating. Many times they begin eating
after we rehydrate them with intravenous
fluids, especially if they have
kidney
disease. Sometimes we also need to assist
feed them with special foods that are easy to administer and digest.
Some cats will even start eating after we give them valium
intravenously. Cats that have sugar
diabetes (diabetes mellitus) might begin
eating after we control their blood sugar level with insulin. Cats
that are in pain from serious injury like a broken
jaw might start eating when we give them
pain
medication.
This
liquid diet called Clinicare is often used to provide both
fluid and nutrition on a short term basis. It can be given
orally or through a tube.
Another food used to provide short term nutrition is
called A/D. A/D is also used for long term nutritional support in some
cases. It can also be given orally by just putting it in your pets mouth.
It can also be given through a tube when some water is added to it.
Medium Term
Treatment Options
A nasogastric tube is an option that sometimes
works well for several days. This tube is passed through the nostrils and into
the esophagus. It is taped and sutured in place. It has the advantage of easy
placement and maintenance. The main problem is that the small diameter of the
tube that is used only allows a liquid diet (CliniCare). To give an adequate
amount of calories on a long term basis with this liquid diet would mean giving
a volume of liquid that is far too much for the digestive system to handle,
and the cat will usually vomit.
nother medium term treatment option
is tube feeding. In this technique we fill a syringe with A/D and attach a small
rubber feeding tube to the end. We gently pass this tube into your pets esophagus
and give it the full amount of food that is in the tube. It has the advantage
of using a food source (A/D) that is more solid than a liquid diet (CliniCare),
so your pet receives more of its needed calories. It also has the advantage
of minimal discomfort since no tube is left in for long periods of time. Some
cats will begin eating on their own after only 1 or 2 feedings with this techinque.
Long Term
Treatment Options
PEG Tube
A very effective solution to long term feeding
is a PEG tube. PEG stands for Percutaneous EndoGastric.
It consists of a tube that passes from the inside of the stomach, through
the abdominal body wall to the outside. It allows the long term use of food
that will give adequate nutrition. Its first disadvantage is difficult placement.
It is usually put in with a special instrument like an endoscope, or is placed
surgically during an exploratory surgery of the abdomen. Both methods require
general anesthesia.
In addition, a further disadvantage is the potential for infection in the
abdomen at the site the tube passes out of the stomach.
In
this picture you can visualize the PEG tube that is exiting
from the stomach after an exploratory surgery.
Esophagotomy TubeIn terms of ease of placement, cost, and
effectiveness, one of the best options for long term feeding is an
esophagotomy tube. It does not require specialized equipment or
exploratory surgery, and can usually be placed with sedation only.
Serious complications are rare, and usually consist of
regurgitation of food if too much is given too rapidly, especially
in the first few days of feeding.
The
esophagotomy tube passes from the left side of the neck
into the far end of the esophagus. The tube is measured
to ensure that the proper length is passed, and that the
tube does not go into the stomach. This picture shows the
measurement of the tube.
This is the
appearance of the tube immediately after insertion and
suturing to the skin.
When it is bandaged
only the tip where you will insert the food is
visible.
An x-ray reveals the path of the tube. The arrows on
top outline the tube that is outside of the neck and under the bandage
and along the back. The arrows on the bottom are the feeding tube as
it passes inside the esophagus from left to right. As planned, it goes
partway down the esophagus and does not enter the stomach.
Feeding
Technique
A food that is routinely fed through a feeding tube for long
term maintenance is called A/D. We have a handout that gives you detailed information
on this food. We will let you know how much to give and if we want any supplements
added. You usually need to add a little water to it to so that it can flow through
the feeding tube.
If a PEG tube has been put in then the food you
administer goes directly into the stomach. When food is given through
the esophagotomy tube it partially fills the esophagus temporarily
until it flows into the stomach. In both cases give
the feeding mixture slowly and usually at room temperature or
slightly warmed.
You will be feeding several times per day throughout
the day. After the feeding you need to flush the tube with a small amount of
warm water. If it becomes clogged in spite of flushing, place a small amount
of cola or papaya juice in the tube until it dissolves the clotted food.
One of our nurses will give you
detailed instruction in how to use one of these tubes before your pet
leaves the hospital. If you have any difficulty with this tube we are
here to help you, so please let us know if you need assistance after
you return home. We would like to check your pet and the tube on a
weekly basis until it is removed.
The amount of time the feeding tube stays in
varies from weeks to months. Only when your pet is eating well and putting on
weight will we remove it. An added advanatage to the esophagotomy tube over
the PEG tube is the ease of removal. On occasion the PEG tube can cause an intestinal
blockage when removed because the tip of the tub remains in the stomach after
removal and must pass through the intestines to be eliminated.
The overwhelming majority of cats respond
positively to long term tube feeding. If your pet consistently vomits
then we will put it on some medication to minimize this usually
temporary problem.
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