Ministry of health protection of ukraine
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| MINISTRY OF HEALTH PROTECTION OF UKRAINE
Vynnitsa national medical university named after M.I.Pyrogov
METHODOLOGICAL RECOМMENDATIONS for independent work of students by preparation for practical classes
Vynnitsa – 2012 METHODOLOGICAL RECOМMENDATIONS for the students of 4-th course of medical faculty for preparation to the practical classes from endocrinology 1.Тopic №19: Obesity. Clinics, diagnostics, differential diagnosis, treatment, prophylactics. Methabolic syndrome. 2. Relevance of topic: In 1997 WHO declared obesity as a global epidemy, which is a serious threat to the population’s health in the world because of the development of concomitant diseases - arterial hypertension, coronary heart disease, type 2 diabetes mellitus. Mortality risk increases much when BMI is more than 30 kg/m2. Medium spreading of obesity in the world is about 30 %, and in high developed countries (USA, Germany, UK) - 45-50 % of all population. According to the prognosis for 2010 year the number of people with obesity supposed to be increasing up to 50-60 % in these countries. Therefore, obesity is an important medical-social problem now and a factor which deteriorates the life quality of patients. It has considerable economic consequences. Obesity adversely affects morbidity and mortality, primarily through cardiovascular complications. The death rate from many diseases, from accidents, and from surgery, is significantly higher among the obese, increasing with the magnitude of the obesity. Sudden death is also common. 3. Aim of lesson:
Student must know:
Student must be able:
4. References 4.1. Main literature
4.2. Additional literature
Basic Level. Students must know:
Students should be able to:
Students’ Independent Study Program. You should prepare for the practical class using the existing text books and lectures. Special attention should be paid to the following:
Short content of theme OBESITY. Obesity is characterized by excessive accumulation of body fat. Obesity in not a condition for which a precise definition is particularly useful. Unlike many “real” diseases, obesity represents one arm of distribution curve of body fat or body weight, with no sharp cut-off point. Its importance lies in the many, often serious, complications to which obese people are subject. In these complications that warrant undertaking a treatment that is so often unsuccessful.
The cause of obesity is simple – consuming more calories than are expended as energy. However, we usually do not know why persons consume more calories than they expend. Predisposing factors.
Classification by Egorov.
Classification due to stages of obesity.
Classifcation of overweight in adults by BMI (WHO, 1997)
Classification due to deposition of fat tissue.
Classifcation of Obesity (Dedov I.I., Melnichenko G.A., Fadeev V.V., 2000) Primary obesity I. Alimentary constitutive obesity 1. Android (upper type, abdominal, visceral):
Secondary (symptomatic) obesity I. With determined genetic defect. II. Cerebral
III. Endocrine
Diseases and syndromes, accompanied with obesity
Clinical manifestations. Obese people come to the doctor not only complain about their fitness but also with complications (cardiovascular, pulmonary, orthopedic and others). Clinical particularities of hypothalamic obesity.
Differential diagnosishave to be made between different types of obesity. Alimentary obesity.
Pickwickian syndrome. It can occur in the massively obese persons. Pressure on the thorax from the encompassing sheath of the fatty tissue combined with pressure on the diaphragm from below by large intra-abdominal accumulations may lead to reducing of the respiratory capacity, hypoventilation, retention of CO2 leading to decreased effects of CO2 as respiratory stimulant and resultant hypoxia and somnolence. Hypothalamic-pituitary disorders. Barrakcer – Simmons’s disease (progressing lipodystrophia).
Dercum’s disease (generalized painful lipomatosis).
Babinsky-Frelych’s disease (adipose-genital dystrophy).
Endocrine pathology. Laurence – Moon – Biedl syndrome.
Morganyi – Stuart – Morel’s syndrome.
Postnatal neuroendocrine syndrome (PNES).
Differential diagnosis of alimentary constitutive and hypothalamic-pituitary obesity
Comment: “+” – the sign is present; “-” – the sign is absent; “+/-” – the sign may be. Treatment. The prognosis for obesity is poor, particularly for obese children, and the course tends to progress throughout the life. Obesity is a chronic condition resistant to treatment and prone to relapse. Most obese persons will not participate in outpatient treatment, and those who do will not lose a significant amount of weight. Most of those who do lose weight will regain it. These results are poor, not because of failure to implement any therapy of known effectiveness, but because no simple or generally effective therapy exists. The numerous people who try to reduce without medical assistance, on diets and advice from magazines, may have more success. The basis of weight reduction in all treatment regimens is to establish a caloric deficit by reducing intake below output. Diet. The simplest way to reduce caloric intake is with a low-calorie diet. Optimal long-term effects are achieved with a balanced diet containing readily available foods. For most people, the best reducing diet consists of their usual foods in amounts limited with the aid of standard tables of food values. Such a diet gives the best chance of long-term maintenance of the weight loss, although it is the most difficult diet to follow during weight reduction. Consequently, many people turn to novel or even bizarre diets, of which there are many. The effectiveness of these diets, if any, results, in large part, from monotony - nearly everyone will tire of almost any food if that is all they get to eat. Consequently, when they stop the diet and return to their usual fare, the incentives to overeat are increased. Fasting has had considerable vogue as a treatment for obesity, but it is now rarely used. Most patients promptly regain most of the weight they lose. Since fasting is not without complications, it should be carried out in a hospital. Several recommendations. Patient has to:
Physical activity. It is frequently recommended in weight reduction regimens and its usefulness has probably been underestimated even by its proponents. Since caloric expenditure in most forms of physical activity is directly proportional to body weight, with the same amount of activity obese persons expend more calories than do those of normal weight. Physical activity has to be: 1) regular; 2) bring only positive emotions; 3) it is better to work in a group of the patients. Medications. Many preparations (amphetamines, fenfluramine, others) are used as anorectic drugs. Their efficacy and side effects seem comparable and their potential to abuse limited. However, to an even greater degree than after other conservative treatment, weight is regained after drug treatment and the use of appetite suppressants is currently out of favor. We have to use medications in patients with endocrine and cerebral pathology: anti-inflammatory drugs (to treat encephalitis, arachnoiditis), bromcreptin, peritol (to treat hypothalamic and pituitary disorders) and others. Physiotherapy. Massage, automassage, circulating shower-massage are very effective in the treatment of the patients. Surgery. Radical surgical treatment may offer some hope to persons with morbid obesity (100 % overweight) in whom all others treatments have failed. Tests and Assignments for Self-assessment. Multiple Choice. Choose the correct answer/statement:
What is the provisional diagnosis?
4. A 36-years-old patient complains of moderate weight enlargement, breathlessness at physical exertion. He has no disease in anamnesis. His body mass is 108 kg, height is 160 cm. Body composition is normal, adipose cellular disposal is equable. What disease has the patient?
5. A 28-years-old patient complains of general weakness, which increases to the evening, dyspnea, frequent headache, thirst. She is ill for 4 years and infuenza is supposed to be the cause. Her height is 168 cm, body mass is 79 kg. Adipose disposal is dysplastic, prevalent on trunk, upper body. The face is round, red. The skin is dry. There are deep-red stria on the skin of the abdomen and hips. Pulse is 92 st/min, blood pressure is 150/90 mmHg. What is the provisional diagnosis?
6. A patient D., 17 years old, complains of overweight, increased appetite, headache, weakness, fatigue. She had frequent quinsy before. A growth of weight has begun from the age of 12 years, especially it progressed at last year. The patient doesn’t limit herself in carbohydrates and doesn’t follow any diet. Her mother is obese. Patient’s height is 161 cm, body mass is 88 kg. Adipose cellular disposal is equable. Pulse is 86 st/min, blood pressure 135/85 mmHg. What is the provisional diagnosis?
7. A patient M., 16 years old, has overweight. He was born in asphyxia at premature delivery with body mass 2600 g, length 46 cm. His weight gain has begun at the age of 10. Now his height is 169 cm, body mass is 85 kg. Female stature, gynecomastia are present. Secondary sexual charachters are bad developed - hair growth at the face is absent, pubic hair is lean. The penis is 3,5 cm length. What is the provisional diagnosis?
Answer: 1 – b. 2 – c. 3 – a. 4 – a. 5 – a. 6 – a. 7 – a. Real-life situations to be solved: As a part of a general check-up obesity and hypogonadism was found in a 16-year-old male. The patient has no complaints. What is your diagnosis? Answer: Babinsky-Frelych’s disease (adipose-genital dystrophy). A 34-year-old man S. complains of headache, increased sweating, periodical palpitation, elevation of blood pressure, severe weight gain (30 kg in 2 years), sexual failure. There are no relatives with overweight in his family. The patient considers himself to be ill for 2 years. He connects his disease with having infuenza. Physical examination. The height is 165 cm, body mass is 130 kg, adipose cellular disposal is equable. There are numerous pink thin stria on the hips and abdomen, the skin is highly wet. The left heart border is displaced to 2 cm laterally. Cardiac sounds are dull, there is an accent of the second heart sound above the aorta, blood pressure is 190/100 mmHg on the left arm and 160/90mmHg – on the right arm. Lungs are without pathology. Abdomen is enlarged because of adipose tissue, painless. Liver is near the border rib’s arc. Secondary sexual characters are retained. Thyroid gland is not enlarged. What is the clinical diagnosis? Answer: hypothalamic obesity, class III. A 30-years-old woman Z. complains of permanent headache, hard weakness, enlargement of body mass, menstrual disorders, hypertrichosis. She is ill for 2 years, but didn’t consult a doctor. At physical examination height is 160 cm, body mass 90 kg, adipose cellular disposal is not equable, prevalent at face, neck, chest, abdomen. The skin is dry, pale, has vide red stria on the chest, abdomen, hips, hypertrichosis. Blood pressure is 180/100 mmHg. Fasting glucose blood level - 7 mmol/L; urinary 17-OHCS, 17-HCS levels are increased. Glucosuria is absent. At the X-ray of the skull osteoporosis of the Turkish saddle wall is revealed.What is the clinical diagnosis? Answer: Cushing disease, obesity, class II.
1.To group the symptoms into the syndromes. 2.To find out the leading syndrome and make differential diagnosis. 3.To formulate the diagnosis. 4.To make a plan of treatment.
Methodological recommendation prepared assistant, c.m.s. Chernobrova O.I. It is discussed and confirm on endocrinology department meeting " 31 " august 2012 y. Protocol № 1. Directory: downloads downloads -> Northern England’s set-jetting locations downloads -> Dynatest 3031 lwd light Weight Deflectometer downloads -> Forth coming competitive exams downloads -> Brush High School Morning Announcements Friday, September 05, 2014 all school downloads -> Year 9 The Arts — Music downloads -> Years 7 and 8 standard elaborations — Australian Curriculum: Music draft downloads -> Chris Young sets 2016 “I’m Comin’ Over” Tour headlining dates downloads -> Slavery and Abolition: the Plymouth Connection Introduction downloads -> Summer Assignment Download 83.08 Kb. Share with your friends:
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