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Y2 - BRS - GI > Disorders of Appetite > Flashcards

Disorders of Appetite Flashcards

1
Q

What is water intake VS food intake regulated?

A

Water intake = thirst

Food intake = appetite

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2
Q

Define the terms:

Polydipsia
Adipsia
Anorexia
Obesity

A

Polydipsia = excessive thirst or excess drinking

Adipsia = inappropriate lack of thirst with consequent failure to drink in order to correct hyperosmolality

Anorexia = lack or loss of appetite for food

Obesity = abnormal or excessive fat accumulation that presents a risk to health

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3
Q

What is the difference between Anorexia VS Anorexia Nervosa?

A

Anorexia = medical symptoms for lack / loss of appetite for food

Anorexia nervosa = psychological eating disorder

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4
Q

What are the 2 types of thirst disorders?

A

Polydipsic = drinking too much
OR
Adipsic = drinking too little

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5
Q

What are the 2 types of polydipsic disorders?

A

Primary

Secondary - more common

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6
Q

What are the 2 types of adipsic disorders?

A

Primary

Secondary

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7
Q

What is secondary polydipsia?

A

Secondary = result of anotehr ongoing condition

e.g. medical issues / medications that disrupt any step in osmoregulation or alter ADH production / release

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8
Q

What are the possible causes of secondary polydipsia?

A 
Chronic medical conditions = 
Diabetes insipidus & mellitus 
Kidney failure
Conn’s syndrome (primary aldosteronism)
Addison's disease (hypoadrenocorticsm)
Sickle cell anaemia

Medications =
Diuretics
Laxatives
Antidepressants

Dehydration = 
Acute illness
Sweating
Fevers
Vomiting
Diarrhoea
Underhydration
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9
Q

What does insipid mean?

What does mellitus mean?

A

Tasteless

Sweet tasting / ‘honeyed’ (sweet urine)

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10
Q

How do diabetes mellitus (DM) and diabetes insipidus (DI) differ?

A

Both lead to large volumes of urine

DM =
General population - common

Related to high blood sugar - high BGL filtered in the kidneys = draws more water out of the nephrons along with it = higher volume of sugary urine

High BGL induces this diuresis

Treatment of high blood sugar = control of blood sugar to stop patients passing high volumes of sweet urine

DI =
General population - uncommon

Related to pituitary problems = lack of ADH release from posterior pituitary (condition may be called cranial diabetes)

Impaired ADH production means kidneys cannot concentrate the urine

Treatment with desmopressin - synthetic long acting form of ADH

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11
Q

48M - Mr Smith

Unhealed wound on shin
Lost some weight
Frequently goes to the toilet (interrupts his meetings)
Relationhip w/ wife is not what it used to be

What is wrong with Mr Smith

A

Diabetes Mellitus

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12
Q

What are the key signs and symptoms of diabetes mellitus?

A 
Always being tired
Frequent urination
Sudden weightloss
Unhealed wounds
Sexual problems
Always hungry
Blurry vision
Numb or tingling hands / feet
Always thirsty
Opportunistic infections e.g. vaginal infections
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13
Q

What are some other medical conditions that can lead to polydipsia?

A

Acute kidney failure - toxins, trauma, systemic infections, cancer, urinary obstruction, heatstroke

Conn’s syndrome - primary aldosteronism (overproduction of aldosterone = increased Na+ and K+ in the blood)

Addison’s disease - hypoadrenocorticism (adrenal cortical insufficiency) = inability to concentrate urine despite normal renal function

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14
Q

What causes primary polydipsia?

A

Psychogenic polydipsia (or acquired)

Schizophrenia (20% with chornic SZ = psychogenic polydipsia)

Mood disorders e.g. depression and anxiety

Anorexia

Drug use

Brain injuries -

Organic brain damage - e.g. myelination syndromes, motor neuron disease etc.

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15
Q

84F -
Multiple coronary angioplasties
Used to enjoy walks - now severe shortness of breath walking around the house
Dr prescribed some medications for this
Forgetful, finds it difficult to answer granddaughters texts
Polydipsia
Dry lips

Why does Mrs Smith drink do much water and why are her lips dry?

A

Accumulation of water secondary to her heart failure

This is treated by thiazides - prescribed by her doctor (this is a diuretic)

So the diuretics are causing her symptoms

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16
Q

Why is polydipsia a problem?

A 
Upset electrolyte balance in the body = diluted blood = hypernatremia = swelling 
Kidney and bone damage
Headache
Nausea
Cramps
Slow reflexes
Slurred speech
Low energy
Confusion
Seizures
17
Q

What are the 4 types of adipsia?

A

Adipsia may also be called hypodipsia

Type A - most common (AKA essential hyponatremia) - increased osmotic threshold = molecules cannot pass through the membranes

Type B - decreased ADH response even if there is an osmotic stimuli, likely to be due to elimination of osmoreceptors

Type C - completely eliminated osmoreceptors

Type D - ADH release occurs with normally functioning levels of osmoregulation

18
Q

What is the mechanism of the lack of thirst sensation in adipsia?

A

Increased osmolality of urine stimulates ADH secretion

Leads to water retention and sensation of thirst decreases

V. rare disorder - lack of research

19
Q

How do the osmoreceptors detect plasma osmolarity and how does it affect ADH release?

A

Cells shrink when plasma becomes more concentrated

Proportion of cation channels increase - membrane depolarises

Sends signals (increases neuronal firing frequencies) to the ADH producing cells to increase ADH production

Leads to fluid retention and invokes thirst / drinking

20
Q

What are eating disorders?

A

Thought to be low food intake previously

Definition now currently stands at range of psychological conditions caused by unhealthy eating habits e.g. obsession with body weight, binge eating, etc.

Can cause serious health issues

21
Q

What are some examples for eating disorders?

A

Binge eating disorder - high body weight

Anorexia nervosa - eat little due to fear of gaining weight

Bulimia nervosa - people eat a lot then try to get rid of it (e.g. via laxatives, throwing up)

Pica - eating non-food items (i.e. things with no nutritional value)

Rumination syndrome - regurgitate food and swallow

Avoidant/restrictive food intake disorder - reduced / selected food intake (narrow spectrum of food in the diet) but not driven by fear of gaining weight

22
Q

What is the global prevalence of eating disorders?

A

Global eating disorder prevalence increased from 3.4% to 7.8% between 2000 and 2018

70 million people live with eating disorder

23
Q

What are the signs of anorexia?

A 
Signs and symptoms are due to lack of nutrients - 
Low BMI
Continuous weight loss
Amenorrhea
Halitosis
Mood swings
Dry hair, skin and hair thin
24
Q

What are the different BMI categories for anorexia?

A

Mild: BMI > 17
Moderate: BMI of 16–16.99
Severe: BMI of 15–15.99
Extreme: BMI < 15

25
Q

What are the causes and mechanism of anorexia?

A

Genetic predisposition, environmental, psychological, sociological

Mechanism via serotonin
Normal hormonal response to challenges with serotonergic agents
Increased CSF conc of serotonin and metabolites of serotonin are found in the urine and blood

26
Q

What is halitosis?

A

Bad breath

27
Q

15F - Miss Smith
Lives with her parents
Tired and abnormally thin
Gingival bleed (bleeding in the mouth from the gums)
Wanted to see her dentist - but parents didn’t let her
Under pressure at school, but enjoys meeting her friends
Can’t wait til the end of lockdown
Often feels hungry, would like to eat more

Why has Miss Smith got gingival bleeding and why has she lost weight?

A

Child neglect - scurvy

28
Q

What percentage of the worlds population will be obese by 2030?

A

51%

29
Q

Why is obesity increasing?

A

Cheap, calorie rich, readily available food

Not lack of exercise necessarily - as physical activity declines prior to obesity epidemic

30
Q

What are the screening tools used for obesity?

A

Height, weight and abdominal girth

Medical history: dietary and physical activity patterns, psychosocial factors, weight-gaining medications, familial traits

BMI = kg/m2

BMI of ≥30 or ≥25 + comorbidity or risk factor = considered for treatment

31
Q

What are the 2 types of obesity?

A

Central obesity - strongly linked to CVD, DM, Alzheimers

General obesity

32
Q

What are the treatment options for obesity?

A

Life style modification = diet, exercise

Pharmacological treatments

Surgical treatments

33
Q

What surgical treatments are available for obesity?

A

People with a > BMI 40 or 35+ comorbidities

Various procedures: bariatric or metabolic surgery = minimally invasive, various types are absorptive (stops food being absorbed) or restrictive (stops patient from being able to put in a lot of food for it to be absorbed)

Most common Roux-en-Y gastric bypass & sleeve gastrectomy

WL 5 yrs after BS: 30% - 35%

Remission of comorbidities =
Diabetes (80%)
OSA (80%-85%)

34
Q

What are the hormones related to obesity?

A

GLP1 and GLP2:
Stimulate insulin release
Inhibit glucagon release

Ghrelin:
Hunger hormone
NPY activation – initiate appetite

PYY:
Satiety
Anorexogenic

35
Q

What hormonal changes are seen after bariatric surgery?

A

Ghrelin reduces

GLP1, GLP2 and PYY elevated

Y2 - BRS - GI (14 decks)

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