Anorexia is a common manifestation of many illnesses including upper respiratory tract disease, oral disease, renal disease, pancreatitis, liver disease, GI disease, cardiac disease, anaemia and neoplasia. Acute or chronic pain, nausea associated with systemic disease, delayed gastric emptying and medication are also important causes of inappetence.
Nutrient intake is an important consideration in any hospitalised patient, and can easily be overlooked in a busy practice setting. Adequate nutrition is necessary to provide energy for cellular function, substrates for protein synthesis and vitamins and minerals for daily metabolic processes and maintenance of homeostasis. Failure to meet nutritional requirements will result in reduced immune system function, increased risk of sepsis, reduced tissue repair and delayed healing, muscle weakness, reduced gastrointestinal function and altered drug metabolism.
Cats can also be very susceptible to development of hepatic lipidosis following even short periods of anorexia. Hospitalised patients are often in a hypermetabolic state which when combined with starvation quickly leads to protein depletion and protein energy malnutrition, which can be a major contributing factor in multiple organ failure.
Inadequate food intake may result from inability to eat, inability to digest or absorb food, reluctance to eat as a result of stress, anorexia associated with illness or not being offered adequate palatable food. Food aversion is a particularly important component of anorexia in hospitalised cats, for example offering food or force feeding whilst a cat is feeling nauseous will often result in persistent refusal to eat that food.
Finally, in many feline patients the change in environment and stress of hospitalisation alone will result in significant inappetence. Appropriate housing and nursing care is an essential part of managing any anorexic cat, and for those that have been inappetent for less than a couple of days, are capable of ingesting food, and have no evidence of systemic illness then the following may be enough to restore a normal appetite before more invasive assisted feeding techniques need to be considered:
• Reduce environmental stressors e.g. dogs, noise
• Make sure the cats food bowl is as far away from its litter tray as possible
• Offer food that the cat is used to as cats are strongly influenced by habit in their selection of foods
• Increase palatability e.g. adding flavours, increasing fat/protein content, warming to improve aroma, changing texture and consistency
• Tempting – smearing a small amount of food on the paws or face usually stimulates a licking response that may result in continued ingestion of food
• Wide shallow feed bowls should be used to avoid the cats’ whiskers touching the sides
• Offer small frequent meals, removing the food bowl in-between
• Gentle stroking will often stimulate eating
• Draping a towel over the cage, or placing the food in a cardboard box or similar, where the cat can hide can be useful
• Some cats like a lot of TLC and hand-feeding, whereas others prefer to be left alone and undisturbed in a quiet place.
The overall aim of hospitalisation is to keep the cat in a safe, clean and quiet environment conducive to recovery and where it can be handled with minimum stress to the cat or staff. Nurses can play a vital part in ensuring that the feline patients are well nourished during their hospital stay!
