Có 80+ tài liệu thuộc chủ đề "harrison interal medicine"
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Biology of Obesity (Part 4). For many years obesity in rodents has been known to be caused by a number of distinct mutations distributed through the genome. Most of these single- gene mutations cause both hyperphagia and diminished energy expenditure, suggesting a physiologic link between these two parameters of energy homeostasis. Identification of the ob gene mutation in genetically obese...
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Biology of Obesity (Part 5). α-MSH acts as an agonist on melanocortin-4 receptors to inhibit appetite, and. the neuropeptide AgRp (Agouti-related peptide) acts as an antagonist of this receptor. Mutations that cause obesity in humans are indicated by the solid green arrows.. In addition to these human obesity genes, studies in rodents reveal several other molecular candidates for hypothalamic mediators...
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Biology of Obesity (Part 6). OTHER SPECIFIC SYNDROMES ASSOCIATED WITH OBESITY. Cushing's Syndrome. Although obese patients commonly have central obesity, hypertension, and glucose intolerance, they lack other specific stigmata of Cushing's syndrome (Chap. Nonetheless, a potential diagnosis of Cushing's syndrome is often entertained. Cortisol production and urinary metabolites (17OH steroids) may be increased in simple obesity. Unlike in Cushing's syndrome,...
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Biology of Obesity (Part 7). WHAT IS THE STATE OF ENERGY EXPENDITURE IN OBESITY?. The average total daily energy expenditure is higher in obese than lean individuals when measured at stable weight. However, energy expenditure falls as weight is lost, due in part to loss of lean body mass and to decreased sympathetic nerve activity. When reduced to near-normal weight...
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What factors contribute to the patient's obesity?. How is the obesity affecting the patient's health?. What is the patient's level of risk from obesity?. What are the patient's goals and expectations?. Is the patient motivated to begin a weight management program?
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Evaluation and Management of Obesity. Excess abdominal fat, assessed by measurement of waist circumference or waist-to-hip ratio, is independently associated with higher risk for diabetes mellitus and cardiovascular disease. Measurement of the waist circumference is a surrogate for visceral adipose tissue and should be performed in the horizontal plane above the iliac crest. Cut points that define higher risk for...
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Evaluation and Management of Obesity. Assessing the Patient's Readiness to Change. An attempt to initiate lifestyle changes when the patient is not ready usually leads to frustration and may hamper future weight-loss efforts. Readiness can be viewed as the balance of two opposing forces: (1) motivation, or the patient's desire to change. and (2) resistance, or the patient's resistance to...
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5 kg) weight loss compared to no treatment or usual care.. weight loss.. A current area of controversy is the use of low-carbohydrate, high-protein diets for weight loss. Several randomized, controlled trials of these low-carbohydrate diets have demonstrated greater weight loss at 6 months with improvement in coronary heart disease risk factors, including an increase in HDL cholesterol and a...
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Physical Activity Therapy. Appetite-suppressing drugs, or anorexiants, affect satiety—the absence of hunger after eating—and hunger—a biologic sensation that initiates eating. discontinuation of the medication
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Orlistat (Xenical) is a synthetic hydrogenated derivative of a naturally occurring lipase inhibitor, lipostatin, produced by the mold Streptomyces toxytricini. Orlistat is a potent, slowly reversible inhibitor of pancreatic, gastric, and carboxylester lipases and phospholipase A2, which are required for the hydrolysis of dietary fat into fatty acids and monoacylglycerols. The drug acts in the lumen of the stomach and...
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Evaluation and Management of Obesity. The three restrictive-malabsorptive bypass procedures combine the elements of gastric restriction and selective malabsorption. These procedures include Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion (BPD), and biliopancreatic diversion with duodenal switch (BPDDS) (Fig. RYGB is the most commonly performed and accepted bypass procedure. Although no recent randomized controlled trials compare weight loss after surgical and nonsurgical...
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Many patients with BN have past histories of anorexia nervosa, and many patients with AN engage in binge eating and purging behavior. BN depends on body weight: patients with AN are, by definition, significantly underweight, whereas patients with BN have body weights in the normal range or above.. Patients with BED are typically middle-aged men or women with significant obesity....
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Table 76-1 Common Characteristics of Anorexia Nervosa and Bulimia Nervosa. Anorexia Nervosa a Bulimia Nervosa. Binge eating 25–50% Required for. Physical and Laboratory Findings a. Gastrointestinal Salivary gland enlargement. Salivary gland enlargement. a Patients with the binge-eating/purging subtype of anorexia nervosa may also exhibit the physical and laboratory findings associated with bulimia nervosa.. FSH, follicle stimulating hormone. TSH, thyroid stimulating...
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Patients with AN typically have few physical complaints but may note cold intolerance. Some women who develop AN after menarche report that their menses ceased before significant weight loss occurred. Soft, downy hair growth (lanugo) sometimes occurs, and alopecia may be seen. Salivary gland enlargement, which is associated with starvation as well as with binge eating and vomiting, may make...
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Table 76-2 Diagnostic Features of Anorexia Nervosa. Refusal to maintain body weight at or above a minimally normal weight for age and height. (This includes a failure to achieve weight gain expected during a period of growth leading to an abnormally low body weight.). Intense fear of weight gain or becoming fat.. Distortion of body image (e.g., feeling fat despite...
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An algorithm for basic treatment decisions regarding patients with anorexia nervosa or bulimia nervosa. Based on the American Psychiatric Association's practice guidelines for the treatment of patients with eating disorders. *Although outpatient management may be considered for patients with anorexia nervosa weighing more than 75% of expected, there should be a low threshold for using more intensive interventions if the...
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Eating Disorders (Part 6). Table 76-3 Diagnostic Features of Bulimia Nervosa. Recurrent episodes of binge eating, which is characterized by the consumption of a large amount of food in a short period of time and a feeling that the eating is out of control.. Recurrent inappropriate behavior to compensate for the binge eating, such as self-induced vomiting.. The occurrence of...
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Approach to the Patient with Cancer. Approach to the Patient with Cancer: Introduction. The application of current treatment techniques (surgery, radiation therapy, chemotherapy, and biological therapy) results in the cure of nearly two of three patients diagnosed with cancer. Nevertheless, patients experience the diagnosis of cancer as one of the most traumatic and revolutionary events that has ever happened to...
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Approach to the Patient with Cancer. Cancer Around the World. When broken down by region of the world, ~45% of cases were in Asia, 26% in Europe, 14.5% in North America, 7.1% in Central/South America, 6% in Africa, and 1% in Australia/New Zealand (Fig. Lung cancer is the most common cancer and the most common cause of cancer death in...
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However, most patients with cancer present with symptoms related to the cancer, caused either by mass effects of the tumor or by alterations associated with the production of cytokines or hormones by the tumor.. Surgical staging may occur in a separate procedure or may be done at the time of definitive surgical resection of the primary tumor.. Knowledge of the...