Weight gain & loss Flashcards
amount of food intake is determined by:
1) availability
2) attractiveness
3) emotional factors
4) physical factors
energy expenditure is determined by:
Basal metabolism -- ~50% total normal energy intake --remains fairly constant in health Physical activity --easily fluctuated --major impact on body weight
weight gain of excess caloric intake
Family obesity
–genetics/ “learn” to overeat
Emotional hyperphagia
–stress, anxiety, depression
weight gain of fluid retention
Edema from known disorder --nephrotic syndrome --congestive heart fail --cirrhosis of liver Premenstrual edema --transient & benign Salt retaining medications --Steroids --NSAIDS --Lithium
weight gain of pregnancy
- -considered a physiological weight gain
- -postpartum weight loss is often difficult
weight of endocrinology disorder
- -cushing syndrome
- -hypothyroidism
Cushingism
[Dexamethason suppression test]
- -low dose at 12PM fails to suppress 8am cortisol
- -high dose at 12PM suppresses ACTH producing pituitary adenoma only
Cushingism S&S
- -insomnia
- -hunger
- -muscle wasting
- -thinning skin
- -gastric ulcer
- -hypokalemia
- -acne
- -bruisability
- -immunosuppression
Hypothyroidism
- -slow mind & body
- -weak heartbeat
- -constipation
- -myxedema
- -slow reflexes
- -hair thinning
- -depression “schizophrenia” irritability
- -big tongue
- -croaky voice
- -dry & cold skin
weight gain in children
- -consider endocrine & genetic disorders
- -familial obesity
- -genetic predisposition
- -a learned disorder
physical findings in the obese patient
Obesity of increased caloric intake = distributed evenly
–EXCEPT: ab fat, *asian
Endocrinology obesity usually displays patterned fat
–truncal = cushing
–obesity + dry hair + coarse skin + hoarse voice + “hung up” muscle stretch reflexes = hypothyroidism
weight loss
–non-deliberate = serious finding = serious disease
weight loss mechanism
- -decreased caloric intake
- -accelerated metabolism
- -loss of calories in urine or stool
weight loss most any disease
- -decreased appetite
- -tissue wasting
endocrinology weight loss
- -diabetes mellitus (type 1*)
- -thyrotoxicosis (hyperthyroidism)
- -addison disease
diabetes mellitus (type 1*)
=polyuria, polydipsia (thirst), polyphagia (hunger)
1st = osmotic diuresis
later = loss of tissue
thyrotoxicosis
hyperthyroidism
--weight loss due to increased metabolic rate & increase motor activity. =graves, hot adenoma, factitious --fine tremor --neurotic anxiety (atrial fib) --lid lag --brisk reflexes --low LDL diarrhea
Addison disease
weight loss due to decreased appetite resulting from decreased cortisol secretion
= hyper pigment, mental illness, sudden death, no ACTH stimulation test
gastrointestinal weight loss
Fat malabsorption --sprue --chronic pancreatitis --cystic fibrosis Inflammatory bowel disease
infection associated weight loss
Usually occult infection --TB --systemic mycoses --parasitic infestations HIV disease
renal disease associated weight loss
–early manifestation of uremia is anorexia
malignancy associated weight loss
–MC cause of weight loss in the absence of major S&S
–any malignancy results in eventual weight loss
–mechanism of malignancy induced weight loss
Anorexia
Increase metabolic demand
Side-effects of cancer
psychological associated weight loss
- -anorexia nervosa
- -conversion disorders
- -schizophrenia
- -depression
diagnostic tests
- -the big 4 (CBC, UA, chem profile, ESR)
- -fasting plasma glucose
- -thyroid function test
- -amylase & lipase
- -stool analysis
