Abnormal appetite

Introduction Food intake is regulated by two central organs of the hypothalamus, the ventral lateral "feeding center" and the ventral medial "satisfaction center", which produces a feeling of fullness after eating, which inhibits the activity of the former. The brain gut peptide cholecystokinin (CCK) appears to have a satiety effect and may be involved in the regulation of feeding behavior. Abnormal appetite, including loss of appetite, excessive appetite, abnormal appetite, can be caused by digestive diseases, or by other systemic diseases other than the digestive system or eating disorders.

Cause

First, lack of appetite

1, digestive diseases: such as acute hepatitis, loss of appetite can occur before the onset of jaundice, appetite deficiency may be a prominent symptom. Acute and chronic gastritis, especially chronic atrophic gastritis, can cause severe loss of appetite, intestinal diseases such as intestinal tuberculosis, enteric typhoid, chronic dysentery and colon cancer can cause loss of appetite.

2, parenteral disease: chronic pain in any part can cause loss of appetite. Fever caused by various causes, low blood sodium, low blood chlorine and acidosis, digestive system congestion caused by right heart failure can cause loss of appetite. Anorexia can be the main symptom of uremia, respiratory failure and various endocrine diseases, such as hypothyroidism, adrenal insufficiency, and hypopituitarism. In addition, some drugs such as antihypertensive drugs, diuretics, ephedra, aspirin, tetracycline, chloramphenicol and anesthetic analgesics can cause anorexia.

3, neuropsychiatric factors: Depression often accompanied by lack of appetite, emotional upset, bored or unpleasant scenes, vision, smell, taste, etc. can affect appetite, mental patients can refuse to eat.

Second, the appetite

More common in endocrine and metabolic diseases such as diabetes, hyperthyroidism, insulinoma, hypercortisolism, pheochromocytoma, giant disease and acromegaly, hypothalamic syndrome.

Third, the appetite is abnormal

Mostly caused by neuropsychiatric factors:

1. Anorexia nervosa: It is a chronic eating disorder. Its main features are special psychotic abnormalities, physical impression disorder, self-induced eating, severe malnutrition and weight loss, and amenorrhea.

2, paroxysmal bulimia: seen in some patients with neurosis, especially in some young women with hysterical personality. The patient repeatedly has unstoppable binge eating behavior, and quickly eats a large amount of food in a short period of time as a compensatory act of dissatisfaction.

an examination

Related inspection

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First, lack of appetite

1. History: The urgency, duration and progress of the loss of appetite, whether there are other accompanying manifestations such as fever, nausea, vomiting, difficulty in swallowing, diarrhea, constipation, abdominal pain, history of taking drugs and history of drinking, Whether there is no history of tuberculosis, gastritis, hepatitis, kidney disease, diabetes, whether there is a history of trauma and a clear cause, whether the weight has changed.

2, physical examination: pay attention to nutritional status and mental state.

Whether the skin has yellow staining, dehydration, edema, hyperpigmentation, whether there is heart enlargement, whether there is liver congestion, whether the liver jugular vein reflux sign is positive; whether there is cirrhosis, splenomegaly and ascites sign, whether there is tenderness or rebound Pain and lumps.

3, laboratory tests, routine blood, urine and stool examination, targeted liver function, kidney function, blood sodium, potassium, chlorine and carbon dioxide binding, blood sugar, erythrocyte sedimentation rate.

4, device examination: gastroscopy can solve the differential diagnosis of stomach disorders out of the ultra-examination can make a diagnosis of heart and kidney lesions.

Second, the appetite

1. History: Whether there is polydipsia, polyphagia, polyuria and weight loss, whether there is neurological or mental change, whether the occurrence of polyphagia occurs slowly or has a more exact date of occurrence. No change in sleep, the number of bowel movements increased.

2, physical examination: whether blood pressure is increased, with or without exophthalmos and thyroid enlargement, vascular murmur, with or without neuropsychiatric symptoms, high metabolic rate syndrome, heart rate, heart sounds, speak Lan and so on. Excessive growth and development, with or without acromosis.

3, laboratory tests: including blood sugar, urine sugar, basal metabolic rate T3, T4.TSH old, blood sodium, blood potassium, blood cortisol, urine a 17OHCS, 12-KS, etc., blood catecholamine determination, urine 24.h Determination of catecholamines, urine 24h VMA determination, multiple measurements of blood growth hormone, determination of cerebrospinal fluid growth hormone.

4, device examination: B-mode ultrasound can check for the presence of insulinoma, pheochromocytoma, adrenal hyperplasia and other J-line film. CT examination, gas angiography, angiography, brain ultrawave, etc. can show whether there is space-occupying lesion in the hypothalamus and pathological calcification, whether the saddle is increased, skull, long bone and vertebrae change, pheochromocytoma localization .

Differential diagnosis

The diagnosis should be differentiated from the following symptoms:

1. Newborns eat less: eat less, cry less, is a special manifestation of neonatal illness. Eat less, cry less, commonly known as "sleeping up", there are many reasons for non-infection and infection.

2. Overeating: It is a bad habit. According to the frequency and psychological effects, it will develop into bulimia. Excessive appetite: Excessive appetite may be very appetizing, but not fat. Where the appetite is over, a large amount of food will be swept away, and empty bags and bottles and cans will be found in their rooms. Some patients with excessive appetite eat foods that are easy to spit. Processing cereals, liquid sauces, milk drinks, or ice cream is usually easier to spit out than solid foods such as meat or bread. Patients with excessive appetite after eating usually go to the bathroom, although many people think they are brushing their teeth, but there is a vomiting smell in the bathroom and in their mouths.

3. Decreased appetite: may be caused by digestive diseases, or by other system diseases other than the digestive system or dietary central diseases. Pay attention to nutritional status and mental state. Whether the skin has yellow staining, dehydration, edema, hyperpigmentation, whether there is heart enlargement, whether there is liver congestion, whether the liver jugular vein reflux sign is positive; whether there is cirrhosis, splenomegaly and ascites sign, whether there is tenderness or rebound Pain and lumps.

4. Loss of appetite: refers to a significant reduction in unwanted food intake or food intake caused by multiple functional or organic diseases. Digestive diseases are the most common cause of loss of appetite.

5. Loss of appetite: refers to the desire for lack of food. A severe loss of appetite is called anorexia.

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