Weight loss and gain Flashcards
when dealing with a weight loss case, what is the first thing you ask about?
appetite!! is it polyphagia or anorexia? this leads your differentials in different directions
what are causes for weight loss with polyphagia?
- insufficient quantity
- poor quality?
- increased exercise
- growing animal
- pregnancy?
if a patient is being fed enough but still has weight loss with polyphagia, what are you suspecting is going on?
- hypermetabolism
- nutrient loss
what are causes of hypermetabolism?
- hyperthyroidism
- fever
- neoplasia
- pregnancy
- lactation
what are causes of nutrient loss leading to polyphagia with weight loss?
loss of glucose, protein, fats: energy sources
how could protein be lost?
- GI Tract
- kidney
- skin (burn victims)
- 3rd space (protein dumped into abdomen)
how could glucose be lost?
kidney!! spill-over from DM, or can’t reabsorb like fanconi’s
how can fats be lost?
GI!
what are the 4 locations of anorexia?
- brain: primary anorexia (hunger center)
- mouth: pseudoanorexia
- tube/GI: primary GI
- not the tube: secondary GI
4 types of anorexia-caused weight loss
- hunger center - CNS disorders - tumor?
- pseudoanorexia
- primary GI
- secondary GI
what can cause pseudoanorexia?
problems associated with teeth, mucosa, bone, joint, muscle, nerves
what are causes of primary GI anorexia?
intolerance, inflammation, infection, obstruction, GI neoplasia
what are causes of secondary GI anorexia?
organ system disease (liver, IMHA, pancreatitis, Addisons), metabolic
what should your first-wave diagnostics for anorexia be?
as non-invasive, minimum database as possible
1. history: appetite!
2. physical exam
3. estimate intake relative to weight
4. minimum database: rule out organ disease
5. fecal
what does a minimum database include?
CBC, biochemistry panel and urinalysis
what are your second wave diagnostics with anorexia?
- total T4 and FeLV/FIV in a cat
- texas GI panel
- chest and abdominal films
if both first and second wave anorexia diagnostics are unremarkable, what do you investigate next?
GI tract: barium series (rarely done now), US, endoscopy, abdominal exploratory
what is your last rule-out for anorexia diagnostics?
rule out central disease: CT or MRI scan
how do you decide if a patient has actually gained weight?
- different breeds
- calculate intake
- BCS
- lean body mass
different shapes, compare to RER. scale 1-5 or 1-9
what is the RER?
RER = 70 * BW (kg)^0.75
or
RER = (30 * kg) + 70
what are the main categories of weight gain?
. increased intake + increased appetite : behavioral
- increased intake + increased appetite : true polyphagia
- normal or decreased intake
what are your main thoughts regarding increased intake and increased appetite?
too many groceries! taking in more than you burn. treats, exercise, new animal
client communication!
what could be causing increased intake and true polyphagia?
- hyperadrenocorticism
- insulinoma
- growth hormone
- pregnancy
- drugs: steroids, anti-seizure meds
what species can have acromegaly with growth hormone?
cats!!
what can cause weight gain with normal or decreased appetite/intake?
- hypothyroidism in dogs
- central disease
- other factors like age, neutering, breeds, owner related
are males or females more likely to gain weight?
females: 1.5x more
neutering increases by 2x
when seeing an overweight patient but they have normal or decreased appetite/intake, what do you need to make sure about their physical exam?
make sure it’s actual fat and not:
- edema
- ascites
- intra-abdominal masses
- organomegaly
normal intake but perceived as weight gain
what should your first-wave diagnostics be for a patient with weight gain?
- history: appetite!
- PE
- calculate intake
- minimum database!
what are your second-wave diagnostics for a patient with weight gain?
- thyroid panel
- adrenal testing for cushing’s
kidney failure, diabetes, hyperthyroidism, addison’s are primary/secondary GI?
secondary
what are your third wave diagnostics for weight gain?
rule out central disease: CT or MRI
allergies, IBD, obstruction, GI neoplasia, adenocarcinoma are primary/secondary GI?
primary
