Anorexia and Cachexia

Question 1

Why might anorexia be hard to identify?

Answer 1

It may not be noticed if they’re eating to satiety

may be reported as something else if they’re trying to eat regular amounts: N’V abdominal pain

Question 2

What’s the difference between primary and secondary anorexia?

Answer 2

primary - hypothalamus fialus to respond to orexigenic signals (often secondary to inflammatory process)
secondary - due to something else, like pain, shortness of breath, fatigue, etc

Question 3

What’s the most frequent reason patients will have anorexia?

Answer 3

early satiety - there’s something just making them not hungry

Question 4

What are some physical exams of sarcopenia?

Answer 4

temporal and mandibular wasting
thenar wasting
supraclavicular wasting
decreased grip strength

Question 5

What’s malnutrition?

Answer 5

It’s not just anorexia -
it’s an imbalance of energy or specific nutrients that leads to adverse effects on body function - can be too little in or too little out

Question 6

What’s the most common lacking nutrient

Answer 6

protein

Question 7

What are the two basic arms of cachexia?

Answer 7

metabolic change and reduced food intake

Question 8

True or false: the body weight lost in cachexia can typically be explained by the increased metabolic demands of the patient’s underlying disease

Answer 8

false - it’s more than what the disease would take - so it’s somethin gon top of it

Question 9

What are the stages or anorexia/cachexia syndrome?

Answer 9

pre-cachexia (fatigue, weakness, less than 5% weight loss, may be reversible)
cachexia (worse - over 5% weight loss, clinically evidenct and significant)
refractory cachexia (over 10% loss, irreversible)

Question 10

What’s the survival rate with refractory cachexia?

Answer 10

less than 3 montsh

Question 11

Under what situations should you intervene for anorexia/cachexia?

Answer 11

1. early in pre-cachexia
2. when cure is a pssibility
3. when patient enjoys eating
4. when the patient doesn’t insist on returning to previous level of function

Question 12

Does invasive medical means of feeding help?

Answer 12

nope - fails to improve function, heal, prevent aspiration

no change in survival - maybe actually decreases survival

Question 13

What are some pharmaceutical options for treating ACS?

Answer 13

methylphenidate - as an antidepressant
dronabinol - gives them the munchies
megestrol acetate - stimulates hypothalamus as a progestin analogue (makes the body think its pregnant)

Question 14

Should you use perc tubes in dementia patients?

Answer 14

nope - use oral assisted feedings

Question 15

What’s involved for oral assisted feeding?

Answer 15

personal assistance - support, not cheerleading
accommodating changing tastes
adaptive utensils
aromatherapy
liberalizing diets