Weight loss Flashcards
How should the problem of weight loss be defined? 3
Muscle atrophy?
Caloric intake?
Palatability?
What is temporal myositis?
Muscle atrophy in head, i.e. not weight loss due to fat. Means dog can’t open mouth to eat –> weight loss
How do you REFINE the problem of weight loss? 2
Weight loss associated with DECREASED appetite? (i.e. can’t eat or won’t eat?)
Weight loss associated with NORMAL OR INCREASED appetite?
How do you identify the problem of weight loss further?
CAN’T EAT: prehension difficulties? paniful mouth? dysphagia?
WON’T EAT: loss of smell? ‘true’ anorexia?
What controls appetite?
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
How to define the system for anorexia…
Primary CNS vs secondary CNS (more common) cause of anorexia. But anorexia (with lethargy/depression) can be the only (early) manifestation of CNS disease.
What are important aspects to consider during the anorexia PE?
Does the animal have:
pyrexia, masses, severe constipation, severe heart disease, anaemia, icterus?
List some causes of anorexia.
endogenous toxins, exogenous toxins, pyrexia, electrolyte disturbances (esp Ca, Na, K), hepatic disease, neoplasia, physic factors, primary CNS disease.
How do you approach the weight loss with normal or increased appetite case?
Think pathophysiologically. The problem is likely to be due to:
MALDIGESTION
MALABSORPTION
MALUTILISATION
What is malassimilation?
Maldigestion, malabsorption or both
What are the causes of maldigestion?
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.
2 broad causes of malabsorption.
Primary GI disease (most common) or secondary GI disease.
Causes of malabsorption - primary GI disease. 6
Infiltrative diseases of the gut wall: IBD Lymphagiectasia GIT lymphoma Severe SIBO Dry FIP
Clinical signs of malabsorption - primary GI disease. 3
Weight loss (usually normal or increased, can be decrease or capricious)
Diarrhoea (slight-severe)
Coprophagia (sometimes)
Causes of malabsorption - secondary GI disease 3
Hepatic disease (since bile acids important)
Right sided cardiac disease
Hyperthyroidism (gut transit time increased, less time for absorption, increased metabolic rate)
What is malutilisation? 2
Failure to utilise appropriately nutrients that have been digested and absorbed normally OR loss of nutrients after absorption
Is diarrhoea usually a significant feature of malutilisatioN?
No, except perhaps hyperthyroidism
Causes of malutilisation - normal or increased appetite.
DM
CHF
Dirofilariasis
Neoplasia
Hyperthyroidism
Liver disease (but appetite usually decreased)
Renal disease (protein losing nephropathy, tubular disease with only subtle decrease in appetite)
Most common causes of mautilisation - INCREASED appetetite
DM and hyperthyroidism. Others too but less common
What does BAR mean on a physical exam?
Bright, alert and responsive
What should you always consider if there is weight loss with a reduced appetite?
Is the reduction in appetite sufficient to explain the degree of weight loss?
What should you consider if there is inappetance?
If due to inappetance, are there other clinical signs that might assist identification of the system involved?
What is the first step when an animal is presented for weight loss? 2
to ensure that the caloric intake and palatability of the diet are adequate for the animal’s needs (esp large and giant dog breeds)
How can the normal caloric requirement of a normally active dog or cat be calculated?
[(30weight in kg)+70]1.2
double answer for growing dog, very active animal or one that is pregnant/lactating
