Anorexia and weight loss

Question 1

List the 3 broad causes of weight loss

Answer 1

Malnutrition
Maldigestion/ Malabsorption
Malutilisation

Question 2

List 4 reasons why an animal may not want to eat

Answer 2

Pain - e.g. dental
Stress- common in cats
Nausea
pyrexia- common cause in cats

Question 3

what is the most common cause of animal not physically be able to eat

Answer 3

Dental disease

Question 4

what is Masticatory muscle myositis

Answer 4

Immune mediated inflammatory condition
Inciting cause unknown
Immune system forms antibodies towards a specific component of myosin found only in muscles of mastication

Question 5

Describe the acute phase of Masticatory Muscle Myositis

Answer 5

inflammed masicatory muscle
hard to open jaw as painful

Question 6

describe the what the chronic phase of Masticatory Muscle Myositis

Answer 6

Fibrosis and atrophy - cannot open mouth
§ (differentiates from Trigeminal Neuritis)
No pain but anorexia and wt loss

Question 7

Describe how to diagnose Masticatory Muscle Myositis

Answer 7

Presentation
ELectromyography (EMG)- spontaneous electrical activity
biopsy histology

Question 8

describe how to treat Masticatory Muscle Myositis- in acute phase

Answer 8

best chance in acute phase
Immunosuppressive therapy (prednisolone 2mg/kg)
Dose gradually tapered over months

Question 9

describe how to treat Masticatory Muscle Myositis in chronic phase

Answer 9

Chronic- attempt to stretch jaw open under GA?
Recurrence common
PTS

Question 10

what is Cricopharyngeal atelectasis

Answer 10

Neuromuscular motility disorder causing incomplete/asynchronous relaxation of the upper oesophageal sphincter
usually congenital, rarely acquired

Question 11

Describe how to treat Cricopharyngeal atelectasis

Answer 11

Surgery
Cricopharyngeal myotomy or cricopharyngeal and thyropharyngeal myectomy
65% success (less if acquired)

Question 12

describe how to diagnose Cricopharyngeal atelectasis

Answer 12

Fluoroscopy
Cricopharyngeal muscle doesn’t relax
retention of barium in the caudal pharyn

Question 13

what is Maldigestion/ Malabsorption always associated with

Answer 13

GI disease
appetite often increased (unless nausea associated)

Question 14

where does the problem tend to be with maldigestion

Answer 14

stomach

Question 14

where does the problem tend to be with malabsorption

Answer 14

small intestine

Question 15

List 2 examples of systemic diseases that can cause maldigestion/malabsorption

Answer 15

Hyperthyroidism in cats
Hypoadrenocorticism (Addison’s disease) in dogs

Question 16

List 3 possible causes of abnormal nutrient handling in animals

Answer 16

Protein losing nephropathies
Diabetes Meletus
Liver disease

Question 17

List 5 causes of increased demand for nutrients in animals

Answer 17

Neoplasia
Hyperthyroidism
Infection
Cardiac cachexia
Parasites

Question 18

What is weight loss with increased appetite commonly associated with

Answer 18

malabsorption or malutilisation

Question 19

what is hyporexia

Answer 19

not eating enough for normal maintenance

Question 20

what is anorexia

Answer 20

not eating at all

Question 21

List 3 common causes of anorexia/ hyporexia

Answer 21

Renal/ Hepatic dx (toxin accumulation)
Any inflammatory /infectious process causing pyrexia
Neoplasia

Question 22

List 3 common causes of reluctance to eat

Answer 22

Association of food with nausea/pain/ stressful event
stressors
change to less palatable diet

Question 23

List 3 common causes of mechanical inability to eat

Answer 23

Dental disease
Gingivostomatitis
Oral/pharyngeal/oesophageal masses

Question 24

describe how to treat anorexia

Answer 24

Treat underlying condition
Tempt to eat (beware of causing food aversions)
Appetite stimulants (e.g. mirtazapine)
Antiemetics if nausea (e.g. maropitant)
Analgesia if painful conditions
Minimise stress

Question 25

when is hepatic lipidosis common in cats

Answer 25

if rapid weight loss due to absolute/relative calorie deficit
increased risk if high BCS

Question 26

List the clinical signs of hepatic lipidosis

Answer 26

Hepatomegaly
Jaundice
Lethargy
Vomiting/diarrhoea
Ileus
Hypersalivation
Pallor
Neck ventroflexion,
Coagulopathies

Question 27

Describe how to treat hepatic lipidosis

Answer 27

IVFT - 0.9% NaCl NOT hartmans
suppliment K+, phosphate and B12 according to biochem
start feeding slowly- high protein low carb diet
Consider antiemetics- maropitant

Question 28

what is the prognosis for hepatic lipidosis

Answer 28

> 80% recovery if treatment started early

Question 29

How does refeeding syndrome occur

Answer 29

If patient fed too much/too quickly after prolonged anorexia.
Starvation causes electrolyte depletion (K+)
Insulin released by pancreas when refeeding implemented- this will use K+ and will cause it to drop even further

Question 30

List the clinical signs of refeeding syndrome

Answer 30

Seen within 5 days of refeeding
- cervical ventroflexion,
- severe muscle weakness
- acute red blood cell lysis
- respiratory failure

Question 31

Describe how to treat refeeding syndrome

Answer 31

Immediately reduce feeding 50% and lower carb diet and increase slowly over 4-6 days
supplement electrolytes - monitor carefully
Monitor PCV
ECG- heart rate and rhythm

Question 32

Describe how to prevent refeeding syndrome

Answer 32

Reintroduce feeding slowly
- Max speed- 1/3rd RER on day one , 2/3rd day two, all day three
Monitor K+, Mg2+ and phosphorus at least daily and supplement as needed.

Question 33

Which of the following endocrine conditions is likely to result in weight loss?
- Hyperadrenocorticism
- Diabetes Insipidus
- Insulinoma
- Diabetes Meletus
- Hypothyroidism

Answer 33

Diabetes Mellitus

Question 34

if anorexia/hyporexia continues chronically, what can occur

Answer 34

GI disturbances (dysbiosis, intestinal hypomotility, reduced mucosal integrity)
hepatic lipidosis
refeeding syndrome