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The Nutrition-Focused History and Physical Examination (NFPE) in Malnutrition
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Peripheral edema occurs for a number of reasons, most commonly because of a cardiovascular etiology. Anasarca may be caused by hepatic and renal failure, as well as by nephrotic syndrome. Lymphedema can occur after surgery, injury and other causes. Myxedema is a manifestation of hypothyroidism.
Assessment – Nutrition-Focused Physical Exam to Detect Macronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Edema resulting from malnutrition should not be confused with that caused by chronic diseases. Hence, caution should be exercised when utilizing edema as a criterion for diagnosing malnutrition using the Academy/ASPEN characteristics. Clinicians should investigate the causes of peripheral edema thoroughly. In the absence of any diseases that can cause edema and in the presence of severe protein-calorie malnutrition, peripheral edema can be attributed to malnutrition.
Left thoracic subtotal esophagectomy
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Since the predominant symptom of esophageal carcinoma is difficulty in swallowing, most patients are nutritionally depleted. The nutritional status of the patients is important in predicting the outcome. A poor nutritional status decreases host resistance to infection and affects healing of an anastomosis. Physical examination should look for peripheral edema, specifically in the feet and flanks which, if present, gives an initial clue for very poor nutritional status of the patient. Measurement of the serum albumin is a more objective estimate of the status of the patient. A low value of serum albumin (<34 g/L) increases the risk of surgical complications, including anastomotic leakage. A positive nitrogen balance is important for the patient’s safe passage through the rigors of this major operation and postoperative stress. Hyperalimentation may be necessary for patients with poor nutritional status before surgery. Albumin or blood plasma can be given to supplement nutrition in patients with hypoproteinemia.
The clinical associations with cardiomegaly in patients undergoing evaluation for pulmonary hypertension
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Benjamin Daines, Sanjana Rao, Omid Hosseini, Sofia Prieto, John Abdelmalek, Mohamed Elmassry, Pooja Sethi, Victor Test, Kenneth Nugent
This study included 102 patients presenting for evaluation for possible pulmonary hypertension who underwent comprehensive evaluations, including right heart catheterization. The mean age was 62.3 ± 15.0 years, 63.7% of patients were female, and 24.5% were Hispanic. Sixty-four patients (62.7%) had cardiomegaly based on chest radiographs. There were no statistically significant differences in age, gender, or ethnicity between patients with or without cardiomegaly. Ninety-one patients (89.2%) presented with shortness of breath. There was no statistically significant difference between the frequency of shortness of breath in patients with cardiomegaly compared to those without cardiomegaly. Forty-eight patients (47.1%) presented with edema peripheral edema during their initial evaluation. There was no statistically significant difference in the frequency of edema in patients with cardiomegaly compared to those without cardiomegaly. Common comorbidities included hypertension (73.5%), diabetes (38.2%), and obstructive sleep apnea (38.2%). There was no statistically significant association between cardiomegaly and any comorbidity. There were no statistically significant differences in systolic or diastolic blood pressures in these two groups.
The importance of right ventricular function in patients with pulmonary arterial hypertension
Published in Expert Review of Respiratory Medicine, 2018
Roberto Badagliacca, Silvia Papa, Roberto Poscia, Beatrice Pezzuto, Giovanna Manzi, Roberto Torre, Francesco Fedele, Carmine Dario Vizza
A 61-year-old man with hypercholesterolemia presented with dyspnea on exertion and asthenia. The patient was NYHA/WHO functional class III. In November 2012, the patient had an estimated systolic pulmonary artery pressure of 75 mmHg and was referred to our center (Pulmonary Hypertension Unit, La Sapienza University of Rome). Physical examination revealed mild peripheral edema. The distance covered in the 6-minute walk test (6MWT) was 380 m. The pulmonary function test was normal. High-resolution computed tomography (HRCT) did not reveal parenchymal disease, but did show slight ground glass opacity and RV enlargement (Figure 1(a)). The CT angiography did not show thrombotic apposition in pulmonary artery bifurcation, segmentary, and sub-segmentary branches, and the lung perfusion scan did not show segmental defects (Figure 1(b,c)).
Understanding the impact of commonly utilized, non-insulin, glucose-lowering drugs on body weight in patients with type 2 diabetes
Published in Expert Opinion on Pharmacotherapy, 2018
Kathryn M. Hurren, Marissa W. Dunham
Weight gain resulting from TZDs is likely multifactorial and primarily includes fat accumulation through fat cell proliferation as well as fluid retention [39–41]. Agonism at the PPARγ receptor, which is expressed more on subcutaneous fat than visceral fat, is proposed as the mechanism of favorable fat redistribution from visceral to subcutaneous sites; however, decrease in visceral fat is not consistently seen [41,42]. No changes in resting metabolic rate, thermogenic responses to meals, or hunger/satiety have been seen with pioglitazone [43]. The mechanism for peripheral edema is unclear and has been studied minimally in the intended treatment population. Proposed mechanisms include stimulation of renal tubular sodium reabsorption, increased sympathetic nervous system activity, altered interstitial ion transport, and changes in vascular endothelial permeability [41].