Logical Approach to Weightloss

Question 1

When given a weightloss case, what is the first most important question?

Answer 1

Weightloss associated with decreases appetite or weightloss associated with normal or increased appetite.

Question 2

Before looking for pathological causes, what is it important to determine about weightloss?

Answer 2

Is it true weightloss (loss of fat) or is it muscle atrophy? Is the caloric intake of the patient big enough? Palatability etc. of the diet?

Question 3

If the weightloss is associated with decreased appetite, what is the next important step?

Answer 3

Is it that the animal can’t eat (dental issues, dysphagia etc.), or that the animal won’t eat (anorexia)?

Question 4

What is anorexia in relation to animals?

Answer 4

A true loss of appetite controlled by the satiety centres in the hypothalamus. It is important to consider whether it is primary or secondary CNS anorexia.

Question 5

If an animal is anorexic and showing signs of lethargy/depression also, is this more likely to be a clinical manifestation of primary CNS pathology, or secondary CNS causes?

Answer 5

Primary (Direct) CNS Pathology

Question 6

If weightloss is associated with normal or increased appetite, how can this further be broken down into three categories?

Answer 6

Maldigestion, Malabsorption and Malutilisation.

Question 7

What is Maldigestion? Give a common example.

Answer 7

Normal digestion is impaired, e.g. exocrine pancreatic insufficiency.

Question 8

What is Malabsorption? How can this be further broken down (think logically)?

Answer 8

Nutrients digested by not absorbed appropriately. Can be either Primary GI disease (e.g. IBD, Lymphoma), or secondary GI disease (e.g. Hepatic disease, hyperthyroidism).

Question 9

What is Malutilisation? Give some common examples.

Answer 9

Nutrients digested and absorbed, but not utilised properly or are lost. e.g. Hyperthyroidism, Neoplasia, Diabetes Mellitus.

Question 10

If a patient is presenting with severe diarrhoea, is it more likely to be maldigestion/malabsorption or malutilisation? Why?

Answer 10

Maldigestion/Malabsorption, because diarrhoea is usually not a significant feature of malutilisation.

Question 11

If a patient has malutilisation, and an INCREASED appetite, out of this list, which could it possibly be: Neoplasia, Diabetes Mellitus, Dirofilariasis, Liver Disease, Hyperthyroidism

Answer 11

Diabetes Mellitus, Hyperthyroidism