Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ DISORDERS OF CALORIC INTAKE +++ Obesity ++ Multifactorial disease of excess body fat affecting any age group Endogenous: endocrine illness – Hypothyroid, polycystic ovarian syndrome, adrenal hyperandrogenism, imbalance of ghrelin, and leptin Exogenous: positive energy balance is stored as adipose tissue – Excess calories, sedentary lifestyle, minimal exercise Clinical manifestations Systemic – Obesity in central areas, mammary region, buttocks – Obesity in limbs, greater in upper arms and thighs; genu varum due to weight-bearing Cutaneous – Acrochordon: increases with severity of obesity, associated with Type 2 diabetes mellitus – Striae distensae: "stretch marks" – Keratosis pilaris: up to 21% of obese patients – Plantar hyperkeratosis: due to increased foot girth and weight bearing – Adiposis dolorosa (Dercum disease): rare, in postmenopausal obese women Multiple symmetric painful lipomas sparing head/neck; commonly on trunk and lower extremities Metabolic alterations – Acanthosis nigricans: insulin resistance, correlates with subsequent development of Type 2 diabetes mellitus if untreated – Polycystic ovarian syndrome (PCOS): infertility, dysmennorhea, insulin resistance, cystic ovaries on ultrasound – Hyperandrogenism secondary to metabolic dysregulation Diagnosis: obesity defined as BMI more than 30, or greater than 95% for age and gender Treatment Lifestyle and dietary modification: exercise and low-calorie diet Social support: family, friends, provider–patient contact Medications should be used with caution: phentermine, bHCG injections, orlistat Surgical: gastric bypass, or gastric outlet surgeries; necessitate monitoring for nutritional deficiencies, especially B12 +++ Anorexia Nervosa and Bulimia ++ Undernourishment due to abnormal patterns of food consumption and/or purging to achieve thinness; related to underlying psychiatric distburances Most common in adolescent females Clinical manifestations Cutaneous: xerosis, pruritus, lower limb edema, Russell sign (knuckle calluses due to chronic self-induced vomiting) Hair: thinning and increased fragility Oral: gingivitis, tooth enamel erosion, parotid gland enlargement Treatment Cognitive behavioral therapy Selective serotonin reuptake inhibitors Hospitalization with parenteral nutrition in severe circumstances +++ Protein Energy Malnutrition: Undernutrtion, Marasmus, and Kwashiorkor ++ Undernutrition: all encompassing term for nutritional and caloric deficiencies (Fig. 20-1A,B) Related to socioeconomic status and availability of nutrients in local region Favors opportunistic infections: reduced cellular immunity, phagocytic function, adaptive immunity (decreased antibody production) Secondary: from HIV, pneumonia, tuberculosis, and malaria Diagnosis: investigate possible infectious etiologies, anemia, nutritional deficiencies (metals, vitamins, etc.) – Urinalysis (UA) (infection), blood smear (malaria), PPD, fecal occult blood, parasites, or ova Marasmus: "adapted" starvation from global nutrition deficiency Occurs in developing countries: decreased intake of all macronutrients; rare in developed countries Primary causes: congenital defects (difficulty feeding, degluttition), failure to thrive (neglect, inability to nurse), alcoholism, eating disorders Secondary: lack of nutrient availability, low socioeconomic status, early and incorrect use of infant formula (not enough calories are given) Clinical manifestations – Constitutional: emaciated, growth deficiency, muscular atrophy – Systemic involvement: hypotension, hypoglycmeia, hypothermia, constipation (in infants), anemia – Cutaneous: loss of turgor, thinning of skin, xerosis, loss of elasticity Diagnosis: typically on history and physical ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessDermatologyDxRx 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessDermatologyDxRx Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options