STUDY - Technical - New Dacian's Medicine
Weight
Gain and Loss
Translation Draft
In normal people, the weight is stable for long periods of time, due to the fact that food intake is in balance with energy consumption through nerve activity in the hypothalamus, which provides signals to eat or to stop eating. Because the system is usually effective, either gaining weight or losing weight can bring considerations of abnormality and, consequently, be sought medical help.
In this case, no anamnesis is complete without determining whether the weight has increased or decreased and, if this has happened, by what value. In general, a change of 5% of body weight or 5 kg is considered significant. However, a weight loss of 5 kg may not be important in a person weighing 130 kg who is trying to lose weight, while a decrease of 2 kg may be worrying in a person weighing 40 kg.
Weight gain (weight gain) is less likely to have a pathological cause than weight loss. In most cases, it is the consequence of overeating and inappropriate (physical or not) activity and the diagnosis is usually simple obesity. Sometimes obesity can be the consequence of hypothyroidism, Cushing syndrome or a hypothalamic disease such as craniopharyngeal disease.
The search for pathological causes of weight gain is rarely indicated if the associated signs do not suggest an underlying cause. Sometimes weight gain is not of a fat nature, but liquid, in which case the main problems to consider are congestive heart failure, renal failure or cirrhosis with ascites.
Lately there has been a real epidemic of obesity, especially in developed countries. This epidemic is almost certainly due to access to attractive, tasty and low-cost foods. Despite multiple studies suggesting altered metabolism and altered satiety as predisposing factors, a person does not gain weight without overeating. All obese patients have, at rest, absolute high metabolic rates, not low.
But, it cannot be said that pathological mechanisms cannot play a certain role. A particular interest has been directed at the supposed satiety signal, leptin, synthesized in and released from fat tissue, as a product of the ob gene. Leptin is believed to work in the hypothalamus, blocking the synthesis or release of neuropeptide Z, which appears to be a strong signal for food. Although leptin deficiency is "quite" considered to be the cause of obesity, there is still no clear evidence of this, as leptin resistance may be important in human obesity. However, at this time, it is not clear whether defects in the synthesis and action of leptin play any significant role in the state of obesity.
Although rarely caused by a disease, obesity predisposes to the disease, especially diabetes mellitus, but also biliary lithiasis, degenerative joint disease, hyperlipidemia, atherosclerosis, hypertension, sleep apnea and probably cancer.
In the case of weight loss, in all studies there are patients who lose weight without a decable cause, but significant and involuntary weight loss is usually a sign of a serious illness. Even if no disease is found at the initial assessment, weight loss should not be considered to be idiopathic. The patient should be followed at regular intervals, with repeated examination, because the occult disease that caused the weight loss may not manifest for long.
There are three general mechanisms of weight loss, but in the same patient can be operative several mechanisms: 1. increase in energy consumption, 2. increase energy loss in stool or urine and 3. low food intake. Low intake is by far the most common mechanism, generally due to decreased appetite, but may also result from obstruction of the esophagus or stomach, secondary to a stricture, compressive mass or infiltrating malignant disease.
The only common causes of increased metabolism are hyperthyroidism, pheochromocytoma and intense exercise programs. The loss of ingested energy is generally due to either diabetes mellitus with glycosuria or intestinal malabsorption with steatorrhea. Chronic pancreatitis in alcoholics is the most common cause of steatorea. Malabsorption can occur in intestinal lymphoma, celiac sprue, tumors of insular cells (such as somatostatinoma or gastrinoma), irradiation disease, obstruction of the biliary tract, inflammatory bowel disease and a variety of other diseases.
If weight loss occurs under conditions of increased food intake, the diagnosis is usually diabetes mellitus, hyperthyroidism or malabsorption syndrome. Sometimes leukaemias and lymphomas may present with weight loss in the absence of anorexia or even with increased dietary intake. Large prospective studies on the causes of weight loss are not available and existing ones are conducted on a small number of cases, making all conclusions suspicious.
In young people, the most likely diagnoses are diabetes mellitus, hyperthyroidism, anorexia nervosa or infection, especially with HIV. In older people, cancer is the most likely cause of significant weight loss, the secondary, remote cause being psychiatric illness such as Alzheimer's disease and depression. In most circumstances, diagnosing the cause of weight loss is not difficult and is revealed by historical, physical examination and routine laboratory tests. The most common occult condition is cancer.
Gastrointestinal, pancreatic and liver malignancies particularly predispose to weight loss. Infectious disease can sometimes be symptomatically silent. Weight loss can occur in HIV infection before defined AIDS disease, and tuberculosis, fungal disease, bacterial endocarditis or hepatitis can manifest itself through weight loss in the absence of defining symptoms.
Eating disorders, early Onset Alzheimer's disease and depression can cause unexplained anorexia and weight loss. Uremia and hypercalcemia may be asymptomatic, but are easily recognized by examining laboratory tests. Increased calcium levels not only produce anorexia but also also nephrogen insipid diabetes, contributing to weight loss through volume delet. Weight loss may or may not be an important feature of pheochromocytoma.
Pernicious anaemia may cause anorexia before haematological changes occur, and adrenal insufficiency at onset may cause weight loss in the absence of electrolyte changes, nausea, vomiting or hypotension. Other causes of anorexic weight loss are obstructive pulmonary disease/ emphysema, congestive heart failure, chronic liver disease and neurological diseases such as parkinsonism. For those who travel, parasitic diseases should always be taken into account.
Let's get to the diagnosis now! Weight loss is more often a diagnostic problem than a weight gain and is often a sign of a serious organic disease. Diagnosis is usually quite simple to put. In cases where no explanation is at hand, perseverance is essential. Initially, the patient should be re-examined at monthly intervals with physical and laboratory examinations. If no cause is discovered by 6 months, the return intervals may be increased. Weight gain does not require a large expense for diagnostic purposes, as long as the vast majority of cases are represented by simple obesity.
There are three scenarios that justify laboratory tests: 1. symptoms suggesting hypothyroidism (thyroid stimulating hormone - TSH), 2. central obesity, diabetes and hypotension, accompanied by weakness of the quadriceps and spontaneous bruising, raising the possibility of Cushing syndrome (nocturnal suppression test with dexamethasone, free cortisol in urine for 24 hours) and 3. obesity accompanied by headache and endocrine dysfunction suggesting craniopharyngeal or pituitary tumor that compresses or invades the hypothalamus (CT or MRI in the head).
When weight loss is the main cause or cheesexia is the major sign at physical examination, the diagnosis is already visible at the first assessment. Usually it is helpful to do a two-stage research: 1. HLG, VSH, urine analysis, multiphasic chemical tests (SMA 20), TSH, HIV test for people at risk, thoracopulmonary x-ray and occult hemorrhages in the stool and 2. abdominal CT, mammography, serum protein electrophoresis, parathyroid hormone, human PTH-related peptide, angiotensin conversion enzyme and 1,25-dihydroxyvitamin D, if hypercalcemia is present, colonoscopy if ferriprivative or melena-like anaemia is discovered or if inflammatory bowel disease is suspected, upper endoscopy for upper gastrointestinal haemorrhage or dysphagia, short ACTH test for weakness, pigmentation or hyponatremia/ hyperkalemia, hemocultures for fever of unknown origin with weight loss, bone marrow biopsy, accompanied by culture, weight loss, fever and negative hemocultures, 72-hour stool fat for weight loss with chronic diarrhea, TC or MRI in the head for weight loss with headache , neurological symptoms or endocrine failure, MRI of the spine, if examination suggests paraspinal disease, vitamin B12.
The first-phase tests are done for each patient. The multiple clinical picture will reveal diabetes mellitus, hypercalcemia, renal failure, liver disease and electrolyte abnormalities, which may suggest adrenal insufficiency or gastrointestinal disease. TSH needs to be investigated to rule out hyperthyroidism. HIV testing is indicated if risk factors are present. A thoracopulmonary X-ray must almost always be obtained. The chair must be searched for occult bleeding.
The second phase of testing is initiated if the cause of weight loss is not yet apparent and, in most cases, begins with an abdominal TC. If hypercalcemia is present, serum measurements of parathyroid hormone (PTH), human PTH-related peptide (a marker for cancer) and 1.25 dihydroxyvitamin D and angiotensin conversion enzyme (markers for sarcoidosis) should be made. mammography is indicated in women.
Weakness, pigmentation and hypoglycaemia, with or without hyponatremia/ hyperkalemia, require an ACTH test to rule out adrenal insufficiency. Feverishweight weight loss makes it necessary to obtain hemocultures and sometimes bone marrow biopsy and culture. Feriprivative anemia is an indication for colonoscopy and occasionally for upper endoscopy. Weight loss with diarrhea may also require measurement of fat content in the 72-hour stool or hormones such as gastrine, somatostatin or glucagon.
Even in the absence of anaemia or macrocytosis, a level of vitamin B12 should be measured in unexplained weight loss. New or severe headaches with or without neurological symptoms are indications for a TC examination, while back pain with fever and neurological deficiency suggests the possibility of paraspinal or epidural abscess due to tuberculosis or staphylococcus (especially in intravenous drug users).
Saturday, June 28, I'm going to address the gastrointestinal hemorrhage.
In normal people, the weight is stable for long periods of time, due to the fact that food intake is in balance with energy consumption through nerve activity in the hypothalamus, which provides signals to eat or to stop eating. Because the system is usually effective, either gaining weight or losing weight can bring considerations of abnormality and, consequently, be sought medical help.
In this case, no anamnesis is complete without determining whether the weight has increased or decreased and, if this has happened, by what value. In general, a change of 5% of body weight or 5 kg is considered significant. However, a weight loss of 5 kg may not be important in a person weighing 130 kg who is trying to lose weight, while a decrease of 2 kg may be worrying in a person weighing 40 kg.
Weight gain (weight gain) is less likely to have a pathological cause than weight loss. In most cases, it is the consequence of overeating and inappropriate (physical or not) activity and the diagnosis is usually simple obesity. Sometimes obesity can be the consequence of hypothyroidism, Cushing syndrome or a hypothalamic disease such as craniopharyngeal disease.
The search for pathological causes of weight gain is rarely indicated if the associated signs do not suggest an underlying cause. Sometimes weight gain is not of a fat nature, but liquid, in which case the main problems to consider are congestive heart failure, renal failure or cirrhosis with ascites.
Lately there has been a real epidemic of obesity, especially in developed countries. This epidemic is almost certainly due to access to attractive, tasty and low-cost foods. Despite multiple studies suggesting altered metabolism and altered satiety as predisposing factors, a person does not gain weight without overeating. All obese patients have, at rest, absolute high metabolic rates, not low.
But, it cannot be said that pathological mechanisms cannot play a certain role. A particular interest has been directed at the supposed satiety signal, leptin, synthesized in and released from fat tissue, as a product of the ob gene. Leptin is believed to work in the hypothalamus, blocking the synthesis or release of neuropeptide Z, which appears to be a strong signal for food. Although leptin deficiency is "quite" considered to be the cause of obesity, there is still no clear evidence of this, as leptin resistance may be important in human obesity. However, at this time, it is not clear whether defects in the synthesis and action of leptin play any significant role in the state of obesity.
Although rarely caused by a disease, obesity predisposes to the disease, especially diabetes mellitus, but also biliary lithiasis, degenerative joint disease, hyperlipidemia, atherosclerosis, hypertension, sleep apnea and probably cancer.
In the case of weight loss, in all studies there are patients who lose weight without a decable cause, but significant and involuntary weight loss is usually a sign of a serious illness. Even if no disease is found at the initial assessment, weight loss should not be considered to be idiopathic. The patient should be followed at regular intervals, with repeated examination, because the occult disease that caused the weight loss may not manifest for long.
There are three general mechanisms of weight loss, but in the same patient can be operative several mechanisms: 1. increase in energy consumption, 2. increase energy loss in stool or urine and 3. low food intake. Low intake is by far the most common mechanism, generally due to decreased appetite, but may also result from obstruction of the esophagus or stomach, secondary to a stricture, compressive mass or infiltrating malignant disease.
The only common causes of increased metabolism are hyperthyroidism, pheochromocytoma and intense exercise programs. The loss of ingested energy is generally due to either diabetes mellitus with glycosuria or intestinal malabsorption with steatorrhea. Chronic pancreatitis in alcoholics is the most common cause of steatorea. Malabsorption can occur in intestinal lymphoma, celiac sprue, tumors of insular cells (such as somatostatinoma or gastrinoma), irradiation disease, obstruction of the biliary tract, inflammatory bowel disease and a variety of other diseases.
If weight loss occurs under conditions of increased food intake, the diagnosis is usually diabetes mellitus, hyperthyroidism or malabsorption syndrome. Sometimes leukaemias and lymphomas may present with weight loss in the absence of anorexia or even with increased dietary intake. Large prospective studies on the causes of weight loss are not available and existing ones are conducted on a small number of cases, making all conclusions suspicious.
In young people, the most likely diagnoses are diabetes mellitus, hyperthyroidism, anorexia nervosa or infection, especially with HIV. In older people, cancer is the most likely cause of significant weight loss, the secondary, remote cause being psychiatric illness such as Alzheimer's disease and depression. In most circumstances, diagnosing the cause of weight loss is not difficult and is revealed by historical, physical examination and routine laboratory tests. The most common occult condition is cancer.
Gastrointestinal, pancreatic and liver malignancies particularly predispose to weight loss. Infectious disease can sometimes be symptomatically silent. Weight loss can occur in HIV infection before defined AIDS disease, and tuberculosis, fungal disease, bacterial endocarditis or hepatitis can manifest itself through weight loss in the absence of defining symptoms.
Eating disorders, early Onset Alzheimer's disease and depression can cause unexplained anorexia and weight loss. Uremia and hypercalcemia may be asymptomatic, but are easily recognized by examining laboratory tests. Increased calcium levels not only produce anorexia but also also nephrogen insipid diabetes, contributing to weight loss through volume delet. Weight loss may or may not be an important feature of pheochromocytoma.
Pernicious anaemia may cause anorexia before haematological changes occur, and adrenal insufficiency at onset may cause weight loss in the absence of electrolyte changes, nausea, vomiting or hypotension. Other causes of anorexic weight loss are obstructive pulmonary disease/ emphysema, congestive heart failure, chronic liver disease and neurological diseases such as parkinsonism. For those who travel, parasitic diseases should always be taken into account.
Let's get to the diagnosis now! Weight loss is more often a diagnostic problem than a weight gain and is often a sign of a serious organic disease. Diagnosis is usually quite simple to put. In cases where no explanation is at hand, perseverance is essential. Initially, the patient should be re-examined at monthly intervals with physical and laboratory examinations. If no cause is discovered by 6 months, the return intervals may be increased. Weight gain does not require a large expense for diagnostic purposes, as long as the vast majority of cases are represented by simple obesity.
There are three scenarios that justify laboratory tests: 1. symptoms suggesting hypothyroidism (thyroid stimulating hormone - TSH), 2. central obesity, diabetes and hypotension, accompanied by weakness of the quadriceps and spontaneous bruising, raising the possibility of Cushing syndrome (nocturnal suppression test with dexamethasone, free cortisol in urine for 24 hours) and 3. obesity accompanied by headache and endocrine dysfunction suggesting craniopharyngeal or pituitary tumor that compresses or invades the hypothalamus (CT or MRI in the head).
When weight loss is the main cause or cheesexia is the major sign at physical examination, the diagnosis is already visible at the first assessment. Usually it is helpful to do a two-stage research: 1. HLG, VSH, urine analysis, multiphasic chemical tests (SMA 20), TSH, HIV test for people at risk, thoracopulmonary x-ray and occult hemorrhages in the stool and 2. abdominal CT, mammography, serum protein electrophoresis, parathyroid hormone, human PTH-related peptide, angiotensin conversion enzyme and 1,25-dihydroxyvitamin D, if hypercalcemia is present, colonoscopy if ferriprivative or melena-like anaemia is discovered or if inflammatory bowel disease is suspected, upper endoscopy for upper gastrointestinal haemorrhage or dysphagia, short ACTH test for weakness, pigmentation or hyponatremia/ hyperkalemia, hemocultures for fever of unknown origin with weight loss, bone marrow biopsy, accompanied by culture, weight loss, fever and negative hemocultures, 72-hour stool fat for weight loss with chronic diarrhea, TC or MRI in the head for weight loss with headache , neurological symptoms or endocrine failure, MRI of the spine, if examination suggests paraspinal disease, vitamin B12.
The first-phase tests are done for each patient. The multiple clinical picture will reveal diabetes mellitus, hypercalcemia, renal failure, liver disease and electrolyte abnormalities, which may suggest adrenal insufficiency or gastrointestinal disease. TSH needs to be investigated to rule out hyperthyroidism. HIV testing is indicated if risk factors are present. A thoracopulmonary X-ray must almost always be obtained. The chair must be searched for occult bleeding.
The second phase of testing is initiated if the cause of weight loss is not yet apparent and, in most cases, begins with an abdominal TC. If hypercalcemia is present, serum measurements of parathyroid hormone (PTH), human PTH-related peptide (a marker for cancer) and 1.25 dihydroxyvitamin D and angiotensin conversion enzyme (markers for sarcoidosis) should be made. mammography is indicated in women.
Weakness, pigmentation and hypoglycaemia, with or without hyponatremia/ hyperkalemia, require an ACTH test to rule out adrenal insufficiency. Feverishweight weight loss makes it necessary to obtain hemocultures and sometimes bone marrow biopsy and culture. Feriprivative anemia is an indication for colonoscopy and occasionally for upper endoscopy. Weight loss with diarrhea may also require measurement of fat content in the 72-hour stool or hormones such as gastrine, somatostatin or glucagon.
Even in the absence of anaemia or macrocytosis, a level of vitamin B12 should be measured in unexplained weight loss. New or severe headaches with or without neurological symptoms are indications for a TC examination, while back pain with fever and neurological deficiency suggests the possibility of paraspinal or epidural abscess due to tuberculosis or staphylococcus (especially in intravenous drug users).
Saturday, June 28, I'm going to address the gastrointestinal hemorrhage.
Let's hear it!
P.S.
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Dorin, Merticaru