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BVM3 Alimentary > Weight Loss - Logical Diagnostic Approach > Flashcards

Weight Loss - Logical Diagnostic Approach Flashcards

1
Q

Remind yourself - What are the 4 “Define” steps in logical problem solving?

A

Define the problem
Define the system (how may it be involved)
Define the location (within the system)
Define the lesion

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2
Q

What do you need to consider when you are refining the problem in weight loss?

A

Refine the problem:
- Weight loss associated with decreased appetite
- Weight loss associated with normal or increased appetite

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3
Q

How do you refine the problem of weight loss due to decreased appetite? What do you need to distinguish about what is happening with the patient?

A

Can’t eat or Wont’ eat?

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4
Q

What are the top issues associated with “can’t eat”? What is the proper term for it?

A

Can’t eat = dysphagia
Defined as difficulties in prehension, mastication and/or swallowing

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5
Q

Prehension and mastication difficulties are most often associated with disorders of what structures?

A

Mouth and pharynx

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6
Q

What is happening in this photo? What must be examined with every single physical exam?

A
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7
Q

How do you define the problem further in terms of patients who “won’t eat”? What questions do you need to answer about the patient?

A

Loss of smell? Just picky?
Another animal getting the food?
True anorexia (actually not eating)?

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8
Q

What is the difference between anorexia and hyporexia?

A

Anorexia is defined as a lack of appetite for food. Hyporexia means a reduction in appetite.

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9
Q

What is pseudo-anorexia?

A

Animal who truly wants to eat, but cannot eat due to issues with mastication, prehension, etc.

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10
Q

Where in the brain are feeding-satiety centers located?

A

Hypothalamus

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11
Q

What is the control of appetite (feeding-satiety center) influenced by?

A

Blood glucose levels
Body temperature
Metabolic products
Neural input from GI tract
Substances released by neoplasia
Psychic factors

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12
Q

What body system can sometimes only manifest as anorexia +/- lethargy/depression in early stages of disease? What do you need to make sure you distinguish?

A

Can be only (early) manifestation of CNS disease
Need to differentiate between primary and secondary CNS causes of anorexia

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13
Q

Are primary or secondary CNS causes of anorexia more common?

A

Secondary

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14
Q

What is a main cause of anorexia in horses? What about this disease can mask significant weight loss?

A

PPID - pituitary pars intermedia dysfunction
Hypertrichosis (excessive hair growth) can mask significant weight loss

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15
Q

What kinds of stressors can lead to weight loss in veterinary patients?

A

Separation anxiety
New baby/pet
Change in environment or routine
Loss of an owner or companion

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16
Q

List some causes of anorexia

A

Endogenous toxins, Exogenous toxins
Pyrexia
Electrolyte disturbance
Hepatic disease
Neoplasia
Psychic factors
Primary CNS disease

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17
Q

What are the 4 steps of food processing?

A

Ingestion
Digestion
Absorption
Utilization

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18
Q

What is maldigestion of nutrients?

A

Normal digestion is impaired

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19
Q

What is malabsorption?

A

Nutrients are digested normally but cannot be absorbed appropriately

20
Q

What is malutilization?

A

Nutrients are digested and absorbed normally, but are utilized abnormally by the body or lost

21
Q

What are the top reasons (in terms of food processing) for weight loss with a normal or increased appetite?

A

Malassimilation
- Maldigestion/Malabsorption
Malutilization

22
Q

List the reasons for maldigestion. Which animal is this usually most common in?

A

Exocrine pancreatic insufficiency
Secondary enzyme deficiency
Deficiency of bile acid
Loss of brush border enzymes

23
Q

Why is maldigestion less important in the horse?

A

Herbivorous diet (low fat) - bile acid abnormality not a huge deal
Pancreatic dysfunction extremely rare

24
Q

What pathogen causes brush border enzyme insufficiency in foals?

A

Rotavirus

25
Q

Where in the intestines is malabsorption (not) occurring?

A

Small intestinal absorption of nutrients impaired

26
Q

What are the 2 options for defining the system regarding malabsorption?

A

Primary GI (structural) vs. Secondary GI (metabolic) disease

27
Q

Why is malabsorption so important in the horse?

A

Can be due to structural disease of both large and small intestine
Can be due to intestinal dysmotility

28
Q

T/F - Secondary GI disease causing malabsorption is very common in the horse

A

False - Secondary GI disease rare

29
Q

What are primary GI infiltrative diseases of the small intestine wall in the dog/cat?

A
30
Q

What are the primary GI infiltrative diseases of the small and large intestine wall in the horse? What is a common cause of intestinal dysmotility?

A
31
Q

What is “malassimilation”?

A

Maldigestion/Malabsorption - paired together as they often present together

32
Q

What are the clinical signs of malabsorption in dogs and cats?

A

Weight loss
Diarrhea
+/- Coprophagia

33
Q

What type of diarrhea is associated with malabsorption in dogs and cats? (where in the bowel)

A

small bowel diarrhea

34
Q

What are the clinical signs of malabsorption in the horse?

A

Weight loss
Diarrhea
+/- Dependent edema due to PLE
Recurrent colic

35
Q

List some secondary GI causes of malabsorption?

A

Hepatic disease
Right sided cardiac disease
Hyperthyroidism

36
Q

How does hepatic disease cause malabsorption?

A

Affects the production of bile acids, which are important for assisting in digestion and absorption of fats

37
Q

How does RCHF cause malabsorption?

A

Increase in edema in SI (ascites) which leads to a decrease in absorptive capability

38
Q

How does hyperthyroidism cause malabsorption?

A

Speed of transit of food through gut increased - less time for absorption
Weight loss also due to increase in metabolic rate

39
Q

What is malutilization?

A

Failure to utilize nutrients appropriately that have been digested and absorbed normally
OR
Loss of nutrients after absorption

40
Q

T/F - Diarrhea is usually NOT a significant feature of malutilization in dogs and cats?

A

True! Except sometimes in hyperthyroidism and hepatic disease (metabolic issues)

41
Q

What is the most common cause of malutilization in the horse?

A

Loss of nutrients most common - PLE (protein losing enteropathy)

42
Q

In the horse, what part of the intestine is usually diseased, which causes a loss of nutrients?

A

More commonly associated with large intestinal disease due to larger surface area of equine large intestine

43
Q

T/F - chronic diarrhea is NOT usually a significant feature of malutilization in the horse?

A

False! Chronic diarrhea goes hand in hand with chronic weight loss in the horse due to large surface area of LI

44
Q

What are the underlying causes of malutilization of nutrients with either a normal or increased appetite in dogs and cats?

A

Dieabetes mellitus
CHF
Dirofilariasis
Neoplasia
Hyperthyroidism
Liver disease (sometimes)
Renal disease (protein losing nephropathies - damaged glomerulus)

45
Q

What are the underlying causes of malutilization of nutrients with either a normal or increased appetite in the horse?

A

PLE
PPID
Liver disease
Chronic asthma
Neoplasia
Protein losing nephropathies

46
Q

What are the conditions that cause malutilization that are ALWAYS associated with increased appetite?

A

Diabetes mellitus
Hyperthyroidism

Occasionally:
Neoplasia
Liver disease

BVM3 Alimentary (24 decks)

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