Disorders of Appetite

Question 1

What is water intake?

Answer 1

thirst

Question 2

What is food intake?

Answer 2

appetite

Question 3

What is polydypsia?

Answer 3

excessive thirst or excess drinking

Question 4

What is adipsia?

Answer 4

inappropriate lack of thirst

- with consequent failure to drink in order to correct hyperosmolality

Question 5

What is anorexia?

Answer 5

lack or loss of appetite for food

Question 6

What is obesity?

Answer 6

abnormal or excessive fat accumulation that presents a risk to health

Question 7

What are two types of poydypsia?

Answer 7

1. Primary

2. Secondary

Question 8

What is secondary polydypsia?

Answer 8

• More common

* Medical issues that disrupt any step in osmoregulation or alter ADH can cause secondary polydipsia

Question 9

Where is ADH stored?

Answer 9

posterior pituitary

Question 10

What is ADH?

Answer 10

• Antidiuretic hormone (ADH) or vasopressin
• Acts on the kidneys to regulate the volume & osmolality of urine
• Collecting duct - Aquaporin 2 channel

Question 11

What happen when plasma ADH is low?

Answer 11

large volume of urine is excreted (water diuresis)

Question 12

What happens when plasma ADH is high?

Answer 12

small volume of urine is excreted (anti diuresis

Question 13

What are causes of secondary polydipsia?

Answer 13

• Chronic medical conditions
• Medications
• Dehydration

Question 14

What are the chronic medical conditions that cause secondary polydipsia?

Answer 14

• Diabetes insipidus & mellitus
• Kidney failure
• Conn’s syndrome
• Addison’s disease
• Sickle cell anaemia

Question 15

What are the medications that cause secondary polydipsia?

Answer 15

• Diuretics
• Laxatives
• Both result in dehydration
• Antidepressants

Question 16

What are the dehyration that cause secondary polydipsia?

Answer 16

• Acute illness
• Sweating
• Fevers
• Vomiting
• Diarrhoea
• Underhydration

Question 17

What diabetes insipidus (DI)?

Answer 17

•General population - uncommon
•Related to pituitary problems
•Impaired ADH production
Treatment with desmopressin

Question 18

What is diabetes mellitus (DM)?

Answer 18

• General population - common
• Related to high blood sugar
• Treatment of high blood sugar

Question 19

What are other medical conditions leading to polydipsia?

Answer 19

1. Acute kidney failure
2. Conn’s syndrome
   - Primary aldosteronism
3. Addison’s disease
   - Hypoadrenocorticism

Question 20

What are the causes of primary polydipsia?

Answer 20

• Mental illness
• Brain injuries
• Organic brain damage

Question 21

What are the mental health reasons for primary polydipsia?

Answer 21

• psychogenic polydipsia (or acquired)
• Schizophrenia
• Mood disorders - depressionandanxiety
• Anorexia
• drug use

Question 22

What is polydypsia a problem?

Answer 22

1. Kidney and bone damage
2. Headache
3. Nausea
4. Cramps
5. Slow reflexes
6. Slurred speech
7. Low energy
8. Confusion
9. Seizures

Question 23

What are the different types of adipsia?

Answer 23

• Type A – most common
• Type B
• Type C
• Type D

Question 24

What happens in adipsia?

Answer 24

1. Increased osmolarity of urine
2. Stimulates secretion of ADH
3. Water retention
4. Sensation of thirst decreases

Question 25

What is an eating disorder?

Answer 25

Mental disorder defined by abnormal eating habits, includes: •Binge eating disorder •Anorexia nervosa •Bulimia nervosa •Pica •Rumination syndrome •Avoidant/restrictive food intake disorder

Question 26

How common are eating disorders?

Answer 26

* Global eating disorder prevalence ↑ed from 3.4% to 7.8% between 2000 and 2018. * 70 million people live with eating disorder

Question 27

What are the signs of anorexia?

Answer 27

Low BMI, continuous weight loss, amenorrhea, halitosis, mood swings, dry hair, skin & hair thinning

Question 28

What are the causes of anorexia?

Answer 28

Genetic, environmental, psychological,  sociological

Question 29

What is the mechanism of anorexia?

Answer 29

seretonin

Question 30

What are the classification of anorexia?

Answer 30

1. Mild: BMI > 17 2. Moderate: BMI of 16–16.99 3. Severe: BMI of 15–15.99 4. Extreme: BMI < 15

Question 31

Why is obesity increasing?

Answer 31

cheap, calorie rich/ nutrient. poor beverages, sweets and fast food

Question 32

What is involved in the screening of obesity?

Answer 32

1. Height, weight and abdominal girth 2. Medical history: - Dietary and physical activity patterns, psychosocial factors, weight-gaining medications,  familial traits 3. BMI = kg/m2 4. BMI of ≥30 or ≥25 + comorbidity or risk factor

Question 33

What is the treatment of obesity?

Answer 33

diet + exercise

Question 34

When do people get surgical treatment of obesity?

Answer 34

* People with a > BMI 40 or 35+ comorbidities | * Various procedures

Question 35

What is the most common type of surgical treatment of obesity?

Answer 35

* Most common Roux-en-Y gastric bypass & sleeve gastrectomy * WL 5 yrs after BS: 30% - 35% * Remission of comorbidities * Diabetes (80%) * OSA (80%-85%

Question 36

What is GLP1 and GLP2 used for?

Answer 36

* Stimulate insulin release | * Inhibit glucagon release

Question 37

What is ghrelin used for?

Answer 37

* Hunger hormone | * NPY activation – initiate appetite

Question 38

What is PYY used for?

Answer 38

* Satiety | * anorexogenic

Question 39

What are the hormonal changes after bariatric surgery?

Answer 39

1. Chrelin reduces | 2. GLP1 + GLP2 and PYY elevated