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Anorexia 67

• Distal radial plating may result in decreased PEARLS & CONSIDERATIONS site to prevent union before radial growth is
antebrachiocarpal joint range of motion. Comments • Pes varus is a rare condition associated with
complete.
VetBooks.ir Recommended Monitoring • Stereolithographic models produced from asymmetrical distal tibial physeal closure in Diseases and Disorders
• Distraction osteogenesis may lead to flexor
tendon contracture.
dachshunds.
CT scan images may be used to preplan
surgical correction.
• Suture removal and recheck 2 weeks after • Corrective osteotomy is performed at the Technician Tips
surgery point of maximum deformity to provide Radiographs should include the elbow and
• Radiographs at 4 to 6 weeks to evaluate bone optimal realignment of the articular surfaces carpus on the same image to allow accurate
healing and appropriate limb alignment. assessment of angular changes.
○ The deformity may be localized and
PROGNOSIS & OUTCOME quantified using the center of rotation of SUGGESTED READING
angulation (CORA) method. Fox DJ. Radius and ulna. In Tobias KM, Johnston
• Guarded after ulnar ostectomy alone. Often • If there is distal radial head subluxation with SA, editors: Veterinary surgery small animal, St.
an additional surgical procedure is necessary minimal radial shortening, proximal ulnar Louis, 2012, Elsevier Saunders, pp 764-777.
at skeletal maturity to correct the angular ostectomy can shorten the ulna and restore AUTHOR: Raviv J. Balfour, DVM, DACVS
deformity. elbow congruity. EDITOR: Kathleen Linn, DVM, MS, DACVS
• Good after definitive corrective osteotomy • During ulnar ostectomy in growing dogs,
if the amount of correction is adequate. periosteum must be removed at the ostectomy

Anorexia

BASIC INFORMATION arthritis may be reluctant to jump onto neuropeptide Y/agouti–related protein)
counters to reach food; another animal and anorexigenic neurons (expressing
Definition in the home may prevent feeding by the pro-opiomelanocortic cocaine/amphet-
Anorexia is defined as lack or loss of appetite. patient). amine–related transcript).
Hyporexia is defined as a reduction of appetite • Inquire about new medications or supple- ○ Peripheral signals modulate the activity
rather than a total loss. Dysrexia is defined as ments that may affect appetite. of these neurons, including stimulation
a change in food preferences. • Inquire about other recent behavioral of orexigenic neurons (ghrelin stimula-
changes. tion) and anorexic neurons (leptin and
Synonyms insulin stimulation).
Inappetence, decreased appetite, loss of PHYSICAL EXAM FINDINGS • GI factors
appetite Findings on physical exam depend largely on ○ Gastric and intestinal distention and ileus
the underlying cause of anorexia. Examination decrease appetite.
Epidemiology may be normal, especially if reduced appetite ○ GI hormones that decrease appetite
SPECIES, AGE, SEX is due to food aversions or other psychological include cholecystokinin (CCK), pancreatic
• Dogs or cats of any age and either sex cause. polypeptide, peptide YY, glucagon-like
• Cats seem to develop food aversion more • Abdominal pain or discomfort may be peptide-1 (GLP-1), and oxyntomodulin.
often than dogs. recognized. • Other factors
• Patients with chronic anorexia or hyporexia ○ Nausea (any GI or non-GI cause)
Clinical Presentation may present with weight loss or cachexia. ○ Pain
HISTORY, CHIEF COMPLAINT • Careful oropharyngeal examination is manda- ○ Dietary changes
Anorexia/hyporexia is extremely common as a tory and may reveal severe periodontal ○ Environmental stress
part of many systemic or gastrointestinal (GI) disease, oropharyngeal foreign bodies, or oral ○ Palatability issues, including anosmia
illnesses. Occasionally, owners may report tumors that explain reluctance to eat. ○ Endocrine factors: thyroid and adrenal
reduced appetite in a seemingly healthy pet. • An orthopedic and neurologic exam is recom- dysfunction impact appetite
• Differentiate between lack of appetite versus mended. Arthritis or other painful conditions ○ Systemic disease
inability to eat due to oropharyngeal or may make animals less likely to seek food,
neurologic disease (pseudoanorexia). and central nervous system (CNS) disease
• Obtain a complete medical history, including may affect appetite. DIAGNOSIS
whether vomiting has occurred. Nausea is
a common cause of anorexia/hyporexia. Etiology and Pathophysiology Diagnostic Overview
○ For cats especially, food aversions often • Appetite is regulated by a coordinated There is a litany of causes for reduced appetite.
develop if they associate a particular food interplay of GI, metabolic, and sensory The first step is to differentiate between
with illness, nausea, or pain. systems that affect the satiety and hunger pseudoanorexia (inability to eat) and true
• Obtain a complete dietary history, including centers. anorexia. History and physical examination
recent changes in the type of diet fed. • CNS factors combined with minimal laboratory data is often
• Obtain an environmental history. Stressful ○ Control of hunger and satiety are mainly sufficient to determine the cause for anorexia.
environmental changes or warm weather regulated by the hypothalamus. Within Imaging studies are frequently helpful, and
may reduce appetite, or placement of food the hypothalamus, there is an interaction occasionally advanced diagnostics (e.g., endos-
may make eating difficult (e.g., cats with between orexigenic neurons (expressing copy, CT scan) are required.

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