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GIR Test 2 > B5.035 Involuntary Weight Loss > Flashcards

B5.035 Involuntary Weight Loss Flashcards

1
Q

what is temporal wasting

A

atrophy of muscles on the side of a person’s head associated with rapid weight loss

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2
Q

describe the concept of weight homeostasis

A

the body reacts to changes in weight to return to its usual body weight
primarily mediated by leptin and ghrelin

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3
Q

response of the body to increased weight

A

increased energy expenditure and/or decreased intake

mediated by: increased leptin from fat cells > hypothalamus > decreased feeding

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4
Q

response of the body to decreased weight

A

decreased energy expenditure and/or increased intake
mediated by: decreased leptin from fat cells, increased ghrelin and other GI/fat signals > hypothalamus > increased feeding

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5
Q

normal weight fluctuations

A

day to day weight fluctuates up to 5 lbs

  • changes in intake and output
  • changes in day of measurement
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6
Q

what amount of weight loss is pathologic

A

4% weight loss has about a 75% sensitivity and 61% specificity for increased mortality risk

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7
Q

possible mechanisms for involuntary weight loss

A 
inflammatory cytokines (TNF, IL-6)
increased energy expenditure
decreased appetite
social factors
psychiatric illness
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8
Q

pathogenesis of involuntary weight loss

A

stimulus as described previously
muscle and fat breakdown
usual regulatory mechanisms in defense of body fat mass not functioning or not effective

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9
Q

definition of involuntary weight loss

A

weight loss that is not intended by the patient, and is not a consequence of the expected treatment of a known condition
>5% weight loss within 6-12 months
weight loss measured or by objective clinical criteria

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10
Q

definition of unexplained weight loss

A

weight loss that is not intended, and of which the cause is not found after a workup
the exact amount of workup and time is not precisely defined

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11
Q

definition of sarcopenia

A

geriatric syndrome consisting of low muscle mass (2 SDs below reference) and poor physical performance

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12
Q

definition of cachexia

A

metabolic syndrome: loss of muscle mass caused by an underlying illness
weight loss of 5% or greater over 12 mo or less and:
-decreased muscle strength
-fatigue
-anorexia
-low fat-free mass index
-abnormal laboratory tests (increased inflammatory markers, anemia)

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13
Q

how often is a cause of involuntary weight loss found

A

33-60% of the time etiology identified
94% of those with initial negative workup found to have a diagnosis
10-25% still without a primary diagnosis after extended follow up

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14
Q

what are the 3 primary etiologies of involuntary weight loss

A

38% malignancy
23% psychiatric
10% GI diseases

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15
Q

MEALS ON WHEELS

A 
M: medication
E: emotional problems
A; anorexia nervosa, alcoholism
L: late life paranoia
S: swallowing disorders
O: oral factors
N: no money
W: wandering and dementia like behaviors
H: hyper- hypo- thyroidism
E: enteric problems
E: eating problems
L: low salt, low cholesterol diet
S: stones, social problems
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16
Q

what markers might indicate and increased risk of malignancy as an etiology of weight loss

A 
age > 60
WBC > 12,000
alk phos > 300
LDH > 500
hemoglobin < 10
ESR > 29
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17
Q

factors associated with decreased risk of malignancy

A

smoking < 20 years

no decrease in physical activity

18
Q

initial testing for involuntary weight loss

A 
CBC
liver enzymes
albumin
creatinine level
calcium
TSH
HIV
ESR
CRP
LDH
chest x-ray
19
Q

symptoms that may be associated with involuntary weight loss

A

fever, fatigue
dysphagia, oral/gum problems
dyspnea, exertional fatigue
indigestion, abdominal pain, change in stool pattern, early satiety

20
Q

involuntary weight loss associated with cardiovascular disease

A

independent marker of increased mortality in context of cardiac disease
mediated
presents with loss of muscle mass and fat
heart failure diagnosis established prior to development of cachexia

21
Q

involuntary weight loss associated with renal disease

A

protein energy malnutrition
inflammatory cytokines and neuropeptide signaling to hypothalamus
at times hard to distinguish from medication causes (diuretics)

22
Q

involuntary weight loss associated with neurological conditions

A

dementia- cognitive decline causing decreased intake
MS and neuromuscular disorders- physical function of chewing and swallowing
Parkinson’s- reduced swallowing, reduced GI function

23
Q

involuntary weight loss associated with endocrinopathies

A

hyperthyroidism- weight loss in 50% affected
adrenal insufficiency
DM - 50% present with weight loss

24
Q

involuntary weight loss associated with infectious disease

A

HIV

TB

25
Q

prescription drugs that can lead to weight loss

A 
topiramate
SSRIs
buproprion
metformin
GLP-1 agonists
laxatives
diuretics
26
Q

types of substance abuse that can lead to weight loss

A

cocaine (fat dysregulation, appetite suppression)
EtOH
heroin
meth

27
Q

what are some adverse effects associated with prescriptions that can lead to weight loss

A 
altered taste or smell
anorexia
dry mouth
dysphagia
nausea and vomiting
28
Q

involuntary weight loss associated with psych/social factors

A

depression
anxiety
meds used in psychiatric illnesses
poverty = inadequate intake of calories

29
Q

involuntary weight loss associated with pulmonary disease

A

advanced COPD, rheumatologic disease, malignancy, TB, interstitials lung disease
low muscle mass = higher mortality
etiology: increased work of breathing, neuro-hormonal changes

30
Q

involuntary weight loss associated with GI diseases

A 
pancreatic insufficiency
celiac
diarrheal illnesses
IBD
peptic ulcer disease
mesenteric ischemia
protein losing enteropathy
dental disease
31
Q

3rd most common cancer related death

A

colon cancer

32
Q

which cancers cause weight loss?

A

pancreatic cancer
GI cancer
head and neck cancer
lung cancer

33
Q

direct effect of tumor on cancer cachexia

A

release cytokines
release proteolysis inducing factor
release lipid mobilizing factor

34
Q

secondary hormonal effects of tumor on cancer cachexia

A

acts on adrenal and pancreatic B cells to release insulin, cortisol, and glucagon

35
Q

effect of tumor cytokines

A

stimulate hypothalamus to encourage anorexia and increased energy expenditure
stimulate liver to release acute phase proteins

36
Q

effect of lipid mobilizing factor

A

fat breakdown

37
Q

effect of proteolysis inducing factor

A

protein breakdown

38
Q

tumor derived catabolic factors

A 
activins
myostatin
TGFB
serotonin
parathyroid hormone related protein
39
Q

important pro-inflammatory mediators arising from tumor immune system crosstalk

A

IL-1
TNF
IL-6

40
Q

what is futile cycling?

A

the browning of adipose to increase energy expenditure

41
Q

mechanism of tumor induced muscle atrophy

A

upregulated pathways that produce E3 ubiquitin ligase and autophagy proteins leading to myofibrillar protein breakdown
Ca2+ mishandling leads to contractile dysfunction

GIR Test 2 (20 decks)

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