Weight loss and gain

Question 1

when dealing with a weight loss case, what is the first thing you ask about?

Answer 1

appetite!! is it polyphagia or anorexia? this leads your differentials in different directions

Question 2

what are causes for weight loss with polyphagia?

Answer 2

• insufficient quantity
• poor quality?
• increased exercise
• growing animal
• pregnancy?

Question 3

if a patient is being fed enough but still has weight loss with polyphagia, what are you suspecting is going on?

Answer 3

• hypermetabolism
• nutrient loss

Question 4

what are causes of hypermetabolism?

Answer 4

• hyperthyroidism
• fever
• neoplasia
• pregnancy
• lactation

Question 5

what are causes of nutrient loss leading to polyphagia with weight loss?

Answer 5

loss of glucose, protein, fats: energy sources

Question 6

how could protein be lost?

Answer 6

• GI Tract
• kidney
• skin (burn victims)
• 3rd space (protein dumped into abdomen)

Question 6

how could glucose be lost?

Answer 6

kidney!! spill-over from DM, or can’t reabsorb like fanconi’s

Question 7

how can fats be lost?

Answer 7

GI!

Question 8

what are the 4 locations of anorexia?

Answer 8

1. brain: primary anorexia (hunger center)
2. mouth: pseudoanorexia
3. tube/GI: primary GI
4. not the tube: secondary GI

Question 9

4 types of anorexia-caused weight loss

Answer 9

1. hunger center - CNS disorders - tumor?
2. pseudoanorexia
3. primary GI
4. secondary GI

Question 10

what can cause pseudoanorexia?

Answer 10

problems associated with teeth, mucosa, bone, joint, muscle, nerves

Question 11

what are causes of primary GI anorexia?

Answer 11

intolerance, inflammation, infection, obstruction, GI neoplasia

Question 12

what are causes of secondary GI anorexia?

Answer 12

organ system disease (liver, IMHA, pancreatitis, Addisons), metabolic

Question 13

what should your first-wave diagnostics for anorexia be?

Answer 13

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

Question 14

what does a minimum database include?

Answer 14

CBC, biochemistry panel and urinalysis

Question 15

what are your second wave diagnostics with anorexia?

Answer 15

• total T4 and FeLV/FIV in a cat
• texas GI panel
• chest and abdominal films

Question 16

if both first and second wave anorexia diagnostics are unremarkable, what do you investigate next?

Answer 16

GI tract: barium series (rarely done now), US, endoscopy, abdominal exploratory

Question 17

what is your last rule-out for anorexia diagnostics?

Answer 17

rule out central disease: CT or MRI scan

Question 18

how do you decide if a patient has actually gained weight?

Answer 18

• different breeds
• calculate intake
• BCS
• lean body mass
  different shapes, compare to RER. scale 1-5 or 1-9

Question 19

what is the RER?

Answer 19

RER = 70 * BW (kg)^0.75
or
RER = (30 * kg) + 70

Question 20

what are the main categories of weight gain?

Answer 20

. increased intake + increased appetite : behavioral
- increased intake + increased appetite : true polyphagia
- normal or decreased intake

Question 21

what are your main thoughts regarding increased intake and increased appetite?

Answer 21

too many groceries! taking in more than you burn. treats, exercise, new animal
client communication!

Question 22

what could be causing increased intake and true polyphagia?

Answer 22

• hyperadrenocorticism
• insulinoma
• growth hormone
• pregnancy
• drugs: steroids, anti-seizure meds

Question 23

what species can have acromegaly with growth hormone?

Answer 23

cats!!

Question 24

what can cause weight gain with normal or decreased appetite/intake?

Answer 24

• hypothyroidism in dogs
• central disease
• other factors like age, neutering, breeds, owner related

Question 25

are males or females more likely to gain weight?

Answer 25

females: 1.5x more
neutering increases by 2x

Question 26

when seeing an overweight patient but they have normal or decreased appetite/intake, what do you need to make sure about their physical exam?

Answer 26

make sure it’s actual fat and not:
- edema
- ascites
- intra-abdominal masses
- organomegaly
normal intake but perceived as weight gain

Question 27

what should your first-wave diagnostics be for a patient with weight gain?

Answer 27

• history: appetite!
• PE
• calculate intake
• minimum database!

Question 28

what are your second-wave diagnostics for a patient with weight gain?

Answer 28

• thyroid panel
• adrenal testing for cushing’s

Question 29

kidney failure, diabetes, hyperthyroidism, addison’s are primary/secondary GI?

Answer 29

secondary

Question 29

what are your third wave diagnostics for weight gain?

Answer 29

rule out central disease: CT or MRI

Question 30

allergies, IBD, obstruction, GI neoplasia, adenocarcinoma are primary/secondary GI?

Answer 30

primary