Weight loss

Question 1

How should the problem of weight loss be defined? 3

Answer 1

Muscle atrophy?
Caloric intake?
Palatability?

Question 2

What is temporal myositis?

Answer 2

Muscle atrophy in head, i.e. not weight loss due to fat. Means dog can’t open mouth to eat –> weight loss

Question 3

How do you REFINE the problem of weight loss? 2

Answer 3

Weight loss associated with DECREASED appetite? (i.e. can’t eat or won’t eat?)
Weight loss associated with NORMAL OR INCREASED appetite?

Question 4

How do you identify the problem of weight loss further?

Answer 4

CAN’T EAT: prehension difficulties? paniful mouth? dysphagia?
WON’T EAT: loss of smell? ‘true’ anorexia?

Question 5

What controls appetite?

Answer 5

Feeding satiety centres in the hypothalamus which are influenced by:
blood glucose levels
body temperature
metabolic products
neural input from the GIT
substances released by neoplasia
physic factors
DIRECT CNS PATHOLOGY

Question 6

How to define the system for anorexia…

Answer 6

Primary CNS vs secondary CNS (more common) cause of anorexia. But anorexia (with lethargy/depression) can be the only (early) manifestation of CNS disease.

Question 7

What are important aspects to consider during the anorexia PE?

Answer 7

Does the animal have:

pyrexia, masses, severe constipation, severe heart disease, anaemia, icterus?

Question 8

List some causes of anorexia.

Answer 8

endogenous toxins, exogenous toxins, pyrexia, electrolyte disturbances (esp Ca, Na, K), hepatic disease, neoplasia, physic factors, primary CNS disease.

Question 9

How do you approach the weight loss with normal or increased appetite case?

Answer 9

Think pathophysiologically. The problem is likely to be due to:
MALDIGESTION
MALABSORPTION
MALUTILISATION

Question 10

What is malassimilation?

Answer 10

Maldigestion, malabsorption or both

Question 11

What are the causes of maldigestion?

Answer 11

EPI (most common, due to pancreatic acinar atrophy)
Secondary enzyme deficiency (lumenal conditions not optimal for enzyme function)
Deficiency of bile acid
Loss of brush border enzymes

Perhaps the most common diagnosis when there is weight loss with increased appetite.

Question 12

2 broad causes of malabsorption.

Answer 12

Primary GI disease (most common) or secondary GI disease.

Question 13

Causes of malabsorption - primary GI disease. 6

Answer 13

Infiltrative diseases of the gut wall:
IBD
Lymphagiectasia
GIT lymphoma
Severe SIBO
Dry FIP

Question 14

Clinical signs of malabsorption - primary GI disease. 3

Answer 14

Weight loss (usually normal or increased, can be decrease or capricious)
Diarrhoea (slight-severe)
Coprophagia (sometimes)

Question 15

Causes of malabsorption - secondary GI disease 3

Answer 15

Hepatic disease (since bile acids important)
Right sided cardiac disease
Hyperthyroidism (gut transit time increased, less time for absorption, increased metabolic rate)

Question 16

What is malutilisation? 2

Answer 16

Failure to utilise appropriately nutrients that have been digested and absorbed normally OR loss of nutrients after absorption

Question 17

Is diarrhoea usually a significant feature of malutilisatioN?

Answer 17

No, except perhaps hyperthyroidism

Question 18

Causes of malutilisation - normal or increased appetite.

Answer 18

DM
CHF
Dirofilariasis
Neoplasia
Hyperthyroidism
Liver disease (but appetite usually decreased)
Renal disease (protein losing nephropathy, tubular disease with only subtle decrease in appetite)

Question 19

Most common causes of mautilisation - INCREASED appetetite

Answer 19

DM and hyperthyroidism. Others too but less common

Question 20

What does BAR mean on a physical exam?

Answer 20

Bright, alert and responsive

Question 21

What should you always consider if there is weight loss with a reduced appetite?

Answer 21

Is the reduction in appetite sufficient to explain the degree of weight loss?

Question 22

What should you consider if there is inappetance?

Answer 22

If due to inappetance, are there other clinical signs that might assist identification of the system involved?

Question 23

What is the first step when an animal is presented for weight loss? 2

Answer 23

to ensure that the caloric intake and palatability of the diet are adequate for the animal’s needs (esp large and giant dog breeds)

Question 24

How can the normal caloric requirement of a normally active dog or cat be calculated?

Answer 24

[(30weight in kg)+70]1.2

double answer for growing dog, very active animal or one that is pregnant/lactating

Question 25

As a guideline, how many kcals are in 1 cup standard dry food and 400g wet food?

Answer 25

cup of dry food = 400kcals

wet food = 360kcals

Question 26

What CN innervates the jaw?

Answer 26

5 = trigeminal

Question 27

What CN innvervates the tongue?

Answer 27

12 = hypoglossal

Question 28

What is dysphagia (difficulty in swallowing) indicated by?

Answer 28

excessive, forceful attempts to swallow or by regurgitation (into mouth or nostrils)

Question 29

What can dysphagia be due to?

Answer 29

• Local disorders of the tongue or pharynx such as inflammation, FBs, trauma or neoplasia.
• Palatine abnormalities
• Rarely, neurological disorders involving CN9 (glossopharygeal), CN 10 (vagus) or CN 12 (hypoglossal).
• Cricopharyngeal achlasia is a rare congenital disorder of young animals in which the cricopharyngeal sphincter fails to relax when the animal swallows. Unknown aetiology but surgical correction possible by cricopharyngeal myotomy

Question 30

What systemic disorders may cause inflammation (lips, gums, tongue, gingival or oropharyngeal structures)?

Answer 30

Uraemia due to renal failure
Viral infections in cats (tongue)
Autoimmune disorders (pemphigus)
Neutropenia (drug dyscrasias, bone marrow failure)

Question 31

What might cause drug dyscrasias? 2

Answer 31

Phenylbutazone and phenobarbitone

Question 32

What might cause BM failure?

Answer 32

FeLV

Question 33

What local disorders may cause inflammation (lips, gums, tongue, gingival or oropharyngeal structures)?

Answer 33

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