Changes

===Medical Management===

===Medical Management===

A suitable regime would incorporate the following features:

A suitable regime would incorporate the following features:

*A '''diet''' with '''protein of high quality''' and with both soluble and insoluble fibre.  Severe protein restriction is only necessary in animals showing signs of HE and it is otherwise detrimental because animals with PSS are often hypoalbuminaemic.  A protein of high quality is selected so that excess amino acids are not available to colonic bacteria and suitable sources would be cottage cheese in dogs or white fish in cats.  Soluble fibre acts in a similar manner to lactulose (below) whereas insoluble fibre decreases intestinal transit time and helps to prevent constipation.

*A '''diet''' with '''protein of high quality''' and with both soluble and insoluble fibre.  Severe protein restriction is only necessary in animals showing signs of HE and it is otherwise detrimental because animals with PSS are often hypoalbuminaemic.  A protein of high quality is selected so that excess amino acids are not available to colonic bacteria and suitable sources include cottage cheese in dogs or white fish in cats.  Soluble fibre acts in a similar manner to lactulose (below) whereas insoluble fibre decreases intestinal transit time and helps to prevent constipation.

*'''Lactulose''', a synthetic disaccharide that causes acidification of the colonic environment when it is fermented by bacteria.  This environment promotes the conversion of ammonia to ammonium and the latter ions are not easily absorbed due to their electrical charge.  The trapped ammonia is therefore excreted in faeces.  Lactulose is also an osmotic laxative that reduces the amount of time available for colonic bacteria to act on surplus amino acids.

*'''Lactulose''', a synthetic disaccharide that causes acidification of the colonic environment when it is fermented by bacteria.  This environment promotes the conversion of ammonia to ammonium and the latter ions are not easily absorbed due to their electrical charge.  The trapped ammonia is therefore excreted in faeces.  Lactulose is also a cathartic laxative that reduces the amount of time available for colonic bacteria to act on surplus amino acids.

*Administration of '''oral antibiotics''' to reduce the numbers of colonic bacteria.  Neomycin, ampicillin or metronidazole are commonly used for this purpose.

*Administration of '''oral antibiotics''' to reduce the numbers of colonic bacteria.  Neomycin, ampicillin or metronidazole are commonly used for this purpose.