Evaluación del Paciente con Pérdida de Peso dra. Maureira pamela dra. Corrado rosina

1. Evaluación del Paciente con Pérdida de Pesodra.Maureirapameladra.Corradorosina

2. La pérdida de más del 5 % del peso corporal inicial durante un período de 6 a 12 meses. Es el resultado de la disminución en la ingesta energética, el aumento del gasto, o la pérdida por orina o heces. Definición

3. Clasificación INVOLUNTARIA VOLUNTARIA

4. Involuntaria: con disminución o aumento del apetito, es casi siempre un signo de una grave enfermedad, psiquiátrica o médica Voluntaria: paciente con sobrepeso, o puede ser una manifestación de enfermedad psiquiátrica Clasificación

5. Historia Clínica Examen Físico importante

6. Es la pérdida de peso voluntaria o involuntaria? • El apetito se encuentra aumentado o disminuido? • Cuál es la magnitud de la pérdida de peso, en números absolutos y en porcentaje? • En qué medida el paciente ha cambiado de peso durante la vida adulta? • En cuánto tiempo el paciente ha ido perdiendo peso?

7. Pérdida de Peso Voluntaria Involuntaria Con apetito Sin apetito

8. Obesidad • Anorexia nerviosa – bulimia • Drogas anorexígenas • Profesiones Voluntario

9. Con aumento de apetito • Hipertiroidisimo • Diabetes mellitus no contolada • Malabsorción • Feocromocitoma • Aumento de la actividad física involuntaria

10. 61% perdieron de peso 42% aumento de apetito 16% disminución del peso Ancianos hipertiroidismo To determine if aging modifies the clinical presentation of hyperthyroidism and the signs of thyrotoxicosis in older people. DESIGN: Prospective cohort study. SETTING: A French university hospital. SUBJECTS: Eighty-four new patients with overt hyperthyroidism confirmed chemically between January 1992 and January 1993. Controls were 68 older euthyroid patients matched to the older hyperthyroid patients. MEASUREMENTS: Comparison of 19 classical signs of hyperthyroidism between 34 older patients (> or = 70 years; mean age 80.2) and 50 younger patients (< or = 50 years; mean age 37.4). Older patients were also compared with controls (mean age 81.3). RESULTS: Three signs were found in more than 50% of older patients: tachycardia, fatigue, and weight loss. Seven signs were found significantly less frequently in older patients (P < .001): hyperactive reflexes, increased sweating, heat intolerance, tremor, nervousness, polydipsia, and increased appetite. Only anorexia (32% vs 4%) and atrial fibrillation (35% vs 2%) were more found frequently in older people (P < .001). A goiter was present in 94% of the younger and in 50% of the older patients (P < .001). The mean number of clinical signs found in the older subjects was significantly smaller than the number found in younger patients (6 vs 10.8; P < .001). Comparison with older controls showed three signs that were highly associated with thyrotoxicosis in older people: apathy (Odd ratio (OR): 14.8), tachycardia (OR: 11.2), and weight loss (OR: 8.7). CONCLUSION: This study confirms the paucity of clinical signs of hyperthyroidism in older adults. These results suggest the necessity of routine screening for thyroid disease in this age group (Arch Intern Med 1988 Mar;148(3):626-31.)

11. Causa más común Diabetes tipo 1 + trastornos de la alimentación Diabetes mellitus Eating disorders and IDDM. A problematic association. IDDM and eating disorders are common conditions in young women. Whether a specific association exists between these two disorders remains controversial. Some studies have suggested an increased incidence of eating disorders in young women with IDDM, whereas others have not detected such an increase. These differences may be attributable, at least in part, to methodological issues in study design, measurement tools, and relatively small sample sizes. Whether the prevalence of eating disorders in IDDM is increased will be resolved only by larger studies that use standardized diagnostic interviews. We suspect that certain aspects of IDDM and its management may trigger the expression of an eating disorder in susceptible individuals. Required dietary restraint and weight gain related to diabetes management are the factors most likely to be implicated. Eating disorders are relatively common in young women with IDDM and may contribute to impaired metabolic control with hypoglycemia and DKA, and to long-term microvascular complications of diabetes. Omission or reduction of required insulin, an extremely common means of weight control in these young women, is likely an important factor in this regard. Further research is required to determine more precisely the relationship between IDDM and eating disorders, and the effects of eating disorders on metabolic control and chronic complications of IDDM ( Diabetes Care 1992 Oct;15(10):1402-12.)

12. Con pérdida de apetito • Cáncer • Infección por HIV • Endocrinopatías • Enfermedad Cardiopulmonar • Enfermedad Crónica • Alteraciones Psiquiátricas • Abuso de sustancias y medicación involuntaria

13. Pérdida gradual: enfermedad intestinal Pérdida rápida: enfermedad secundaria Infección por HIV

14. Insuficiencia suprarrenal Hipercalcemia Hipertiroidismo Diabetes Mellitus endocrinopatías

15. 36% pérdida de peso + frec tracto digestivo Cáncer UnintentionalWeightLoss A Retrospective Analysis of 154 Cases Unintentional weight loss (UWL) was documented in 154 patients(2.8%)admitted to an internal medicine department during atwo-year period. A retrospective analysis of the clinical chartsshowed that more than one third 36.3% were found to have aneoplasm, involving preponderantly the gastrointestinal tract.Patients with neoplasia were older and more frequently Had abnormalphysical findings and significantly lower values of serum albuminas well as higher values of alkaline phosphatase than otherpatients. Despite extensive investigations, in 36 patients 23.3% UWL remained unexplained even after Prolonged follow-up periods.The remaining 62 patients had a variety of disorders, preponderantlygastrointestinal tract (26 patients) and psychiatric (16 patients)diseases. Endocrinologic disorders such as diabetes mellitusand hyperthyroidism were relatively uncommon 3.8%). Unintentionalweight loss is a relatively common problem in clinical practice.Familiarity with the spectrum of disorders associated with UWLas well as Selected clinical and laboratory values may helpin the initial examination of these patients. (ArchInternMed 1986;146:186-187)

16. Paciente de 65 años Pérdida de peso involuntaria con pérdida de apetito Pérdida de peso - hiporexia Infección HIV Cáncer anemia ldh Enfermedad Cardiopulmonar Laparotomía Exploradora albúmina DBT controlada Enfermedad Crónica Alt. psiquiátricas Linfoma Intestinal Abuso de sustancias Endócrinopatías

17. Gracias