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Body weight loss

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Systemic weight loss refers to the body's weight loss due to disease or certain factors, and is less than 10% of the standard weight is weight loss (the author believes that those who are 10% lower than the standard weight are lean, less than 20% Known as weight loss).

Cause

Cause

Etiology classification

First, physical weight loss

Second, nerve-endocrine and metabolic diseases caused by weight loss

(a) Hypothalamic syndrome.

(B) pituitary dysfunction.

1. Anterior pituitary dysfunction (Simmonds disease and Sheehan syndrome).

2. Diabetes insipidus weight loss.

(3) Hyperthyroidism.

(D) chronic adrenal insufficiency (Addison disease).

(5) Diabetes.

(6) Pheochromocytoma.

Third, malignant tumor

Fourth, chronic infection

1. Tuberculosis.

2. Chronic suppurative infection.

3. Schistosomiasis.

4. Parasitic diseases.

5. AIDS.

Five, digestive tract diseases

1. Oral and pharyngeal diseases.

2. Chronic gastrointestinal diseases.

3. Chronic liver and gallbladder disease.

4. Chronic pancreatic disease.

6. Mental anorexia (neuro anorexia)

Seven, severe trauma and burn caused by weight loss

Eight, drug-induced weight loss

mechanism

First, insufficient caloric intake

(1) Insufficient calorie-protein intake

Under normal circumstances, eating is the only way to capture energy. The lack of nutrition and the loss of weight are caused by the lack of calories and protein. When the heat is not enough, the energy is first provided by the adipose tissue, and the protein provides the amino acid as a substrate for gluconeogenesis. In poverty-stricken areas such as famine, war and backward production, those with insufficient calories are called Marimus. People are extremely thin and edema. Kwshior-kor disease is often found in patients with insufficient protein intake, often with edema.

(2) Hypothalamic syndrome

A variety of factors cause hypothalamic injury, ventral lateral nuclear prey center (the feeding center) damage, the ventromedial nucleus fullness center (anorexia center) is relatively excited and refuses to eat, anorexia, leading to weight loss.

(3) Difficulty in swallowing caused by oral, pharyngeal, larynx, esophageal and cardiac diseases, affecting eating and losing weight

1. Oral inflammation, ulcers, and injuries: such as riboflavin deficiency, oral ulcers caused by Behcet's disease, inflammation, glossitis caused by niacinamide deficiency, tooth and gum lesions.

2. pharyngeal, laryngeal inflammation, tuberculosis, cancer.

3. Esophageal inflammation or stenosis, esophageal cardia cancer, achalasia or stenosis.

4. Cranial nerve palsy, ball paralysis.

5. Myasthenia gravis, polymyositis, systemic sclerosis and other esophageal muscle damage.

(4) Gastrointestinal diseases

Such as chronic gastritis, peptic ulcer, stomach cancer, pyloric stenosis. Incomplete intestinal obstruction, postoperative gastrectomy, etc., often cause insufficient nutrients to cause weight loss.

(5) malignant tumor

Weight loss is often one of the main manifestations of malignant tumors. The causes of weight loss may be: 1 The lack of appetite is the main factor, especially due to anxiety and treatment response, which increases the loss of appetite. 2 The rapid growth of tumor consumes energy; 3 malignant tumor may produce a metabolic toxin, which reduces the glucose utilization rate of patients, increases the oxidative metabolism of free fatty acids, increases the amino acid and lactate to gluconeogenesis, and increases the inefficient consumption of ATP. . 4 secondary tumor infection, bleeding, exudation, etc., make patients with advanced malignant tumors more weight loss.

(6) Chronic infection

Such as tuberculosis, schistosomiasis, typhoid fever, chronic suppurative infection and other patients caused by a lack of appetite, fever increased energy consumption. The first symptoms of AIDS patients are weight loss, fatigue, and fever.

(7) Chronic lesions or functional failure caused by weight loss in important organs

Such as heart failure caused by liver and gastrointestinal congestion, edema, chronic pulmonary heart disease caused by tissue ischemia, hypoxia, severe liver disease such as cirrhosis portal hypertension caused by gastrointestinal congestion, edema caused by liver function damage , nausea, even vomiting, hypoproteinemia, nausea, vomiting, loss of appetite caused by uremia due to renal failure, etc., all of which are caused by lack of appetite affecting the intake of nutrients leading to weight loss.

(8) The use of certain drugs often leads to loss of appetite and weight loss

For long-term use of various antibiotics, sulfa drugs for the treatment of various infectious diseases, long-term application of aminophylline, ammonia salicylic acid. Amine chloride, estrogen, etc. can cause upper abdominal fullness, loss of appetite, thyroxine, amphetamine, etc. can significantly increase the metabolic rate, long-term application of laxatives affect intestinal absorption function can cause weight loss.

(9) Mental anorexia

The patient is in an antifeedant state due to an emotional disorder, and the weight can be drastically reduced.

Second, the increase in nutrient loss

1. Chronic inflammatory bowel disease caused by diarrhea, a large amount of nutrients are discharged from the digestive tract and cause weight loss, such as chronic enteritis, chronic bacillary dysentery, ulcerative colitis, Crohn's disease of intestinal tuberculosis.

2. Small intestine resection, intestinal disease, blind floor syndrome Small intestine is the main place for food digestion and absorption, small intestinal lesions cause nutrient absorption disorder and weight loss.

3. Hepatobiliary and pancreatic system diseases due to insufficient secretion or lack of pancreatic exocrine and bile secretion, so that food digestion and absorption disorders.

4. Diabetes is lost due to the large amount of grapes in the urine. In patients with chronic nephritis, a large amount of proteinuria causes hypoproteinemia, and its weight loss is often masked by edema. Large area burns, exfoliative dermatitis, large areas of skin erosion, wounds with a large amount of plasma exudation, resulting in energy loss.

Third, the increase in metabolic rate leads to increased consumption

Hyperthyroidism or excessive thyroxine consumption, a large number of catecholamines release human blood circulation in pheochromocytoma, both increase the metabolic rate, and increase the oxidative metabolism of the three major nutrients. Although there are more foods, the body weight is significantly reduced. In addition to diarrhea and malabsorption in patients with carcinoid syndrome, increased metabolic rate is also one of the factors. Others have long-term fever, excessive exercise, long-term insomnia, etc., which can be lost due to excessive energy consumption.

Examine

an examination

Related inspection

Maximum gastric acid secretion measurement (MAO) plasma thyroid stimulating hormone releasing hormone (TRH) triiodothyronine inhibition test pepsin determination thyroxine binding globulin

Maximum gastric acid secretion measurement (MAO) --

After stimulation with pentagastrin gastrin, the parietal cells fully exert their secretory function within 1 hour, and the amount of gastric acid that can be secreted is called MAO.

Free triiodothyronine (FT3) --

T3 is a hormone synthesized and secreted by thyroid follicular cells. FT3 accounts for about 0.3% of T3. It can enter the tissue cells through the cell membrane and exert physiological effects. Its concentration is consistent with the concentration of triiodothyronine in the tissue, and it is also consistent with the metabolic state of the body. It also has diagnostic value for non-thyroid diseases. Clinically, the RIA method is commonly used.

Plasma thyroid stimulating hormone releasing hormone (TRH) --

Plasma thyroid stimulating hormone releasing hormone (TRH) is an indicator of hypothalamic function.

Determination of gastric free hydrochloric acid --

The free acid is hydrochloric acid, and the combined acid refers to hydrochloric acid which is loosely bound to protein.

Determination of gastric basic gastric acid secretion (BAO) --

The amount of basal gastric acid secretion (BAO) refers to the amount of gastric acid secretion that is continuous with each other in the absence of food or drug stimulation.

Pepsin assay --

The precursor of pepsin is pepsinogen, which is secreted by the main cells of the fundus gland and converted to gastric protease in gastric acid. Determination of pepsin can help diagnose stomach diseases.

Triiodothyronine inhibition test--

After taking exogenous T3 in normal people, the T3 concentration in the blood is increased. Negative feedback can inhibit the secretion of TSH in the anterior pituitary, and the 131I rate of thyroid is significantly reduced. Diffuse goiter with hyperthyroidism, due to the presence of long acting thyroid stimulator (LATS) and long-acting thyroid stimulant protectants in the blood, can stimulate the thyroid to cause an increase in 131I rate, and is not affected T3 inhibition. The thyroid absorbing 131 iodine function test sometimes overlaps with the values of normal people and hyperthyroidism, which affects the diagnosis of the disease.

Triiodothyronine inhibition test method: for differential diagnosis of patients with high iodine intake rate. The method was as follows: 60-100 g of sodium triiodothyronine was orally administered on the 1st, and it was taken in 3 times for 6 days, and the radioactive isotope iodine iodine test was repeated.

Glucose Corrosion Tolerance Test --

Diabetes family members with subclinical diabetes should use this test.

Serum insulin (SI) --

Insulin can lower blood sugar, and when blood glucose or amino acid concentration is high, it can promote insulin secretion.

Serum glucagon (PG) --

Glucagon is synthesized and secreted by islet cells, which raises blood glucose concentration and antagonizes insulin action. This test can reflect the function of islet alpha cells.

Serum cortisol (FC) --

Cortisol is produced and secreted by the adrenal cortex and belongs to the corpus callosum glucocorticoids. Its secretion is controlled by the anterior pituitary adrenocorticotropic hormone. The determination of serum cortisol directly reflects the secretory function of the adrenal cortex.

Total protein (TP) --

Serum protein is the most abundant substance in serum solids.

Diagnosis

Differential diagnosis

Differential diagnosis of systemic wasting:

First, the body is thin and thin: non-progressive, often family history, no cause can be investigated.

Second, organic disease isting

(a) hypothalamic syndrome

The patient presented with weight loss, anorexia, anorexia, mental disorders, decreased sexual function, abnormal temperature regulation, and symptoms associated with the cause (see section Hypothalamic Syndrome).

(two) hypopituitarism

1. Diabetes insipidus: refers to the syndrome caused by insufficient secretion of vasopressin (ADH) (pituitary diabetes insipidus) or kidney deficiency of diuretic hormone response (renal diabetes insipidus). In the pituitary diabetes insipidus, the cause of unexplained (also known as primary) accounted for 1/3 to 1/2, hereditary (familial) diabetes insipidus is rare (accounting for 1%) secondary to more common diseases because of tumors, such as Craniopharyngioma, pituitary tumor, pineal tumor.

Glioma and meningioma. Traumatic brain injury, followed by surgery, other such as inflammation, granulomatosis, blood disease (leukemia), sarcoidosis. Yellow tumors, etc. The clinical manifestations are polyuria, polydipsia, polydipsia, low urine relative density <1.006, partial diabetes insipidus can reach 1.010 in severe dehydration, and urine osmotic pressure mostly <200min/kg. Heavier patients have anxiety, weight loss, lack of sleep, lack of appetite, weakness and so on. The diagnosis is based on the section on abnormal urine output.

2. The anterior pituitary function reduction (Simmonds disease) is called Sheehan syndrome due to postpartum hemorrhage, which is the most common type. Other causes of pituitary tumors, traumatic brain injury and surgical injury, infection or invasive disease, after radiation therapy. Due to insufficient or lack of hormone secretion in the anterior pituitary, the target gland function is reduced, followed by the gland, thyroid, and adrenal insufficiency. Sheehan caused by postpartum hemorrhage. The syndrome is characterized by postpartum lactation, amenorrhea, hair loss, genital atrophy, etc., followed by hypothyroidism and adrenal insufficiency. Patients have loss of appetite, weight loss, cold, fatigue, low blood pressure, slow pulse rate and thin skin. Pale, severe cases of hypoglycemia, shock, coma. Called pituitary crisis. May have mental symptoms. Pituitary tumors caused by headache, hemianopia, X-ray cranial slices can have a saddle enlargement, CT and MRI showed the presence of tumors. Laboratory tests showed that hormone levels in the anterior pituitary were decreased, and thyroid function tests, adrenal function tests, and gonadal function tests were all below normal.

Primary chronic adrenal insufficiency: also known as Adison disease. Caused by adrenal atrophy (autoimmune) and tuberculosis. Mainly manifested by skin and tympanic membrane pigmentation, weight loss, fatigue, loss of appetite, nausea, low blood pressure. Diagnosis basis: 1 Characteristic performance: 2 urinary 17-OHCS and urinary 17-KS levels reduce the level of original free cortisol, plasma ACrIH level (morning normal value is 4.6~30.6pmol/L or 21~13qpg/ml) The plasma cortisol level in the ACTH stimulation test was still lower than normal (<413.85nmol/L or <15 mg/dl). Some patients with abdominal X-ray films have calcification in the adrenal gland.

(4) Hyperthyroidism

Typical hyperthyroidism has exophthalmos, thyroid enlargement with vascular murmur, polyphagia, heat, sweating, palpitations, frequent bowel movements, and severe weight loss. There is no difficulty in diagnosis, and there is no more food and nerves in apathetic hyperthyroidism. Cardiovascular excitability, only cachexia, loss of appetite, some have atrial fibrillation, heart failure, low fever, etc., need to be diagnosed by means of thyroid function test.

(5) Diabetes

Insulin-dependent diabetes mellitus (IDDM, type l) is more acute, often with obvious polydipsia, polyuria, polyphagia, and fatigue and weight loss; non-insulin-dependent diabetes mellitus (NIDDM, type 2) progresses to a large amount of diabetes when weight The decline is faster, the early three symptoms are not enough, often due to complications such as large and medium vascular atherosclerosis first. Diagnosis mainly depends on fasting blood glucose (7.8mmol/L) and postprandial 2b blood glucose11.1mmll/L (see section Diabetes)

(6) pheochromocytoma

A tumor that occurs in the adrenal medulla, sympathetic ganglia, or other parts of the pheochromocytoma, which causes paroxysmal or persistent hypertension, headache, sweating, and metabolic disorders due to its paroxysmal or persistent secretion of catecholamines. The basal metabolic rate is increased (hyperthyroidism group), weight loss, etc., but the thyroid function test is normal. The diagnosis is based on the section on hypertension.

Third, neurological (mental) anorexia

More common in young women, there are spiritual factors as incentives, showing emotional disorders, fearing that they are too obese and refuse to eat, denying hunger, denying weight loss. Long-term anti-feeding calorie-protein deficiency, rapid weight loss and even cachexia, may have amenorrhea, bradycardia, decreased body temperature, but no hair loss, may have increased hair. The second sexuality develops normally. Plasma FSH, LH, estrogen levels can be reduced, thyroid function tests and adrenal cortical function are normal. Gonadal function can return to normal after the nutritional status is restored.

Fourth, other diseases that cause weight loss

1. Chronic wasting disease: diagnosis of malignant tumors, chronic infectious diseases, chronic infectious diseases such as AIDS and schistosomiasis.

2. Digestion and absorption disorders caused by weight loss: mainly seen in the mouth and throat, esophageal cardia, gastrointestinal disease, pancreas and hepatobiliary diseases.

Five, malnutrition weight loss

More common in infants and young children, more common in the occurrence of famine and war. Lack of food and lack of energy (or) protein. Mainly manifested in weight loss, weight loss, subcutaneous fat disappearance, growth retardation, edema. Decreased organ function in each system. At the same time accompanied by the performance of vitamin deficiency, anemia, low immunity is easy to secondary infection. Laboratory tests often have anemia, decreased plasma protein (especially albumin), decreased blood lipids, and blood potassium and magnesium are often lower than normal. Thyroid function may be low. The adrenal cortex responded normally to ACTH.