Gastro - Disorders of Appetite

Question 1

What is polydipsia?

Answer 1

excessive thirst or excess drinking

Question 2

What is adipsia?

Answer 2

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

Question 3

What is the clinical definition of anorexia as a symptom?

Answer 3

lack or loss of appetite for food

Question 4

What is obesity?

Answer 4

abnormal or excessive fat accumulation that presents a risk to health

Question 5

What are the 2 different types of polydipsic or adipsic?

Answer 5

primary or secondary

Question 6

What is secondary polydipsia?

Answer 6

Medical issues that disrupt any step in osmoregulation or alter ADH

Question 7

Which type of polydipsia is more common?

Answer 7

secondary

Question 8

What are the 3 main categories of causes of secondary polydipsia?

Answer 8

→ chronic medical conditions
→ medications
→ dehydration

Question 9

What are the chronic medical conditions that causes secondary polydipsia?

Answer 9

→ Diabetes insipidus & mellitus
→ Kidney failure
→ Conn’s syndrome
→ Addison’s disease
→ Sickle cell anaemia

Question 10

What medications can cause secondary polydipsia?

Answer 10

→ Diuretics
→ Laxatives
(Both result in dehydration)
→ Antidepressants

Question 11

What can cause dehydration generally, which can go to cause polydipsia?

Answer 11

→ Acute illness
→ Sweating
→ Fevers
→ Vomiting
→ Diarrhoea
→ Underhydration

Question 12

What are the key differences between diabetes mellitus and diabetes insipidus?

Answer 12

Question 13

What are the common symptoms of diabetes?

Answer 13

→ always tired
→ always hungry
→ frequent urination
→ blurry vision
→ numb or tingling hands + feet
→ always thirsty
→ sudden weight loss
→ wounds that won’t heal
→ sexual problems
→ vaginal infections

Question 14

How does acute kidney failure lead to polydipsia?

Answer 14

→ the failing kidneys lose the capacity to concentrate the urine maximally
→ which means that they must excrete more water to eliminate the solutes acquired in the diet
→ As a consequence, patients are forced by thirst to drink more water to cover the loss linked to solute excretion

Question 15

How does Conn’s syndrome cause polydipsia?

Answer 15

v

Question 16

How does Addison’s disease cause polydipsia?

Answer 16

v

Question 17

What can cause primary polydipsia?

Answer 17

→ Mental illnesses - psychogenic polydipsia
→ Brain injuries
→ Organic brain damage

Question 18

What other mental illnesses can cause primary polydipsia?

Answer 18

→ schizophrenia
→ mood disorders (depression + anxiety)
→ anorexia
→ drug use

Question 19

What are the consequences of polydipsia?

Answer 19

→ Kidney and bone damage
→ Headache
→ Nausea
→ Cramps
→ Slow reflexes
→ Slurred speech
→ Low energy
→ Confusion
→ Seizures

Question 20

What are the different types of polydipsia? What is most common?

Answer 20

→ Type A – most common
→ Type B
→ Type C
→ Type D

Question 21

What is the mechanism of adipsia?

Answer 21

→ increased osmolality of urine
→ stimulates secretion of ADH
→ water retention
→ sensation of thirst decreases

Question 22

What is an eating disorder?

Answer 22

mental illness defined by abnormal eating habits

Question 23

What are some examples of eating disorders?

Answer 23

→ Binge eating disorder
→ Anorexia nervosa
→ Bulimia nervosa
→ Pica (eating or craving of things that are not food)
→ Rumination syndrome (rare behavioral disorder in which food is brought back up from the stomach. It is either rechewed, reswallowed, or spit out)
→ Avoidant/restrictive food intake disorder (restricted to eating 1 or 2 types of food, to necessarily to do with body image)

Question 24

What is the prevalence of eating disorders?

Answer 24

→ Global eating disorder prevalence increased from 3.4% to 7.8% between 2000 and 2018
→ 70 million people live with eating disorder

Question 25

What are the signs of anorexia?

Answer 25

→ low BMI
→ continuous weight loss
→ amenorrhea
→ halitosis
→ mood swings
→ dry hair + skin
→ hair thinning

Question 26

What are the causes of anorexia?

Answer 26

→ genetics
→ environmental
→ psychological
→ sociological

Question 27

What is the main mechanism of anorexia?

Answer 27

→ something to do with serotonin
→ mainly unsure

Question 28

What BMI signifies mild anorexia?

Answer 28

BMI > 17

Question 29

What BMI signifies moderate anorexia?

Answer 29

BMI of 16-16.99

Question 30

What BMI signifies severe anorexia?

Answer 30

BMI of 15-15.99

Question 31

What BMI signifies extreme anorexia?

Answer 31

BMI < 15

Question 32

Why is obesity increasing?

Answer 32

→ not down to lack of exercise (physical activity started to decline prior to obesity epidemic)
→ cheap calorie-rich / nutrient poor beverages, sweets + fast food

Question 33

How do you screen for obesity?

Answer 33

→ Height, weight and abdominal girth
→ Medical history: Dietary and physical activity patterns, psychosocial factors, weight-gaining medications, familial traits
→ BMI of ≥30 or ≥25 + comorbidity or risk factor

Question 34

What life-style modification is best in treatment of obesity?

Answer 34

→ diet = 8.5%
→ exercise = 2.4%
→ diet + exercise = 10.8%
therefore both work best

Question 35

When are people referred to surgical treatment of obesity?

Answer 35

people with > BMI 40 or
people with > BMI 35 and have co-morbidities

Question 36

What are the different surgical treatments for obesity?

Answer 36

→ bariatric surgery = weight-loss surgery
→ various procedures
→ most common = Roux-en-Y gastric bypass & sleeve gastrectomy

Question 37

What are the effects of bariatric surgery?

Answer 37

→ WL 5 yrs after BS: 30% - 35%
→ Remission of comorbidities:
→ Diabetes (80%)
→ OSA (80%-85%)
→ reduction of mortality and morbidity after BS

Question 38

What are the effects of GLP-1 and GLP-2?

Answer 38

→ stimulate insulin release
→ inhibit glucagon release

Question 39

What are the hormonal changes after BS?

Answer 39

→ reduction of ghrelin
→ elevation of GLP-1 + GLP-2 + PYY