Differential diagnosis of obesity:

Differential diagnosis of obesity:
A simple obesity



(A) of the constitution of obesity (early-onset obesity)



Adult obesity at an early age until there is a family history of obesity appetite good body fat distribution of fat proliferation of mast cells were restricted diet and exercise to strengthen the efficacy of the poor are less sensitive to insulin without cause obesity available



(B) Acquired obesity (adult-onset obesity) more than 20 to 25-year-old due to the onset of excessive nutrition activities and to reduce the amount of genetic factors in obesity and non-proliferation of mast cells in fat diet and exercise to lose weight after weight loss better Insulin sensitivity to resume



Second secondary obesity



(A) of the hypothalamus and obesity



1. Hypothalamus syndrome involving a variety of causes of diseases caused by the hypothalamus



(1) cause: ① tumor up to 70 cases of domestic see this disease in 53 cases in which the tumor attached to a maximum of craniopharyngioma (25 cases) followed by the pineal gland tumors (11 cases), 6 cases of hypothalamic tumors of the third ventricle tumor 4 Cases of ependymoma 2 olfactory groove meningioma tumor nodules gray saddle ectopic pineal tumor astrocytoma tumor on the reported 1 case of leukemia still metastatic cancer tumor blood vessels and environmental hamartoma tumor teratoma Plasmacytoma neurofibromatosis by the middle section of tumor medulloblastoma sarcoma malignant skin tumors, such as vascular endothelial ② infection and inflammation: tuberculosis or purulent meningitis and viral encephalitis epidemic cerebrospinal meningitis encephalitis measles, chicken pox smallpox rabies Vaccination histoplasmosis, and other domestic 70 cases of the disease in 6 cases of inflammation; ③ traumatic brain surgery and radiation therapy ④ cerebral vascular diseases such as tumors and cerebrovascular atherosclerosis in systemic lupus erythematosus and other reasons caused by TAO; ⑤ granulation Swelling and degeneration as tuberculoma sarcoidosis reticuloendothelial cells hyperplasia multiple chronic eosinophilic granuloma yellow tuberous sclerosis brain tumor softened by the middle gliosis ⑥ such as Gap acute attack of blood carbon dioxide narcotic oral disease Ye Lin Chloro-Propionibacterium contraceptives reserpine-induced amenorrhea syndrome ⑦ galactorrhea a trauma-induced environmental changes, such as functional barriers



(2) clinical features: the hypothalamus due to the small and functional damage to a number of complex diseases often involving nuclear groups and a number of physical conditioning for the central performance of the complex clinical syndrome: ① more food due to obesity and disease involving ventral medial hypothalamus or nuclear Nodules in the vicinity of the Department of often caused by genital dysplasia (obesity, said that reproductive incompetence dystrophy syndrome frohlich performance of the majority of the people of drowsiness or lethargy strong fresh attack disease (Kleine-tevlll syndrome in patients who can not control the performance of paroxysmal Hours of sleep for several days to wake up after overeating due to obesity ② endocrine dysfunction due to one or more of the hypothalamic-releasing hormone anterior pituitary hormone secretion, or endocrine disorder caused by hyperthyroidism or decreased as precocious puberty or sexual dysfunction Amenorrhea male obese women of reproductive incompetence of the loss of the sense of smell and hypoplasia syndrome; galactorrhea amenorrhea a Hypercortisolism hypothyroidism acromegaly gigantism diabetes insipidus, such as fever or hypothermia ③ ④ mental disorders such as disorientation and volatile Kuxiao Pina and hallucinations Dengzheng ⑤ hypothalamus epilepsy headache pain or hyperhidrosis Khan, hand-foot-fat group closed sphincter dysfunction visually impaired vision 'Pianmang defect and blood pressure fluctuations (fluctuated people mydriasis or both sides of the narrow range) based on the diagnosis ① in the history of how eating a variety of fat drowsiness endocrine dysfunction abnormal regulation of body temperature abnormal secretion of sweat ② head CTMRIJ ray angiography, and so on in order to check showed intracranial lesion and the nature of the anterior pituitary hormone ③ ④ determination of adrenal function and Gonadal function of the thyroid function tests ⑤ islet function test ③ hypothalamic-pituitary dysfunction may be given to patients' IRHLRH excited to observe the examination of cerebrospinal fluid test ① intracranial pressure and interleukin (inflammation increased when people leukocyte ③ EEG



(B) of the pituitary obesity



Empty sella syndrome as a result of saddle or saddle next to the tumor by radiation therapy after surgery or for secondary non-empty sella syndrome after surgery or radiation therapy for primary empty sella syndrome of unknown etiology Internal report to the saddle area are mostly caused by arachnoid adhesion (about 50% of the saddle area of the local people so that the adhesion of cerebrospinal fluid drainage impeded the normal pulsatile cerebrospinal fluid pressure under the impact of its settlement thinning saddle every other open (defect) arachnoid Under the chamber and the third ventricle of the lower part of the former can saddle people with defects caused by the expansion of pituitary sella pressure arising from a series of clinical pregnancy several times during pregnancy were pituitary physiological hypertrophy (which can increase the number of times the human pituitary after pregnancy-induced increases Saddle and every hole is greater than birth pituitary fossa up gradually after the pituitary saddle back so that every hole and the pituitary fossa left more room for the saddle people with spinal defects in pituitary damage caused by pituitary tumors or cystic change occurred craniopharyngioma Subarachnoid space capsule with the traffic caused by the breakdown of empty sella or spontaneous pituitary tumor necrosis can be caused by empty sella * Women are often found in the bed headache vision loss increased intracranial pressure and visual field defect with some of the fat patients were light Sex and degree of hypothyroidism but pituitrin normal diagnosis based on multi-functional: the skull X-ray film showing the expansion of sella spherical or oval have Sella bone absorption; head CT shows the expansion of pituitary fossa shrink pituitary fossa The brain is full of low-density fluid; MRI showed pituitary organizations close to flatten under pressure in the saddle at the end of saddle-like signal in the water is full of material under the saddle depression



2. Pituitary adenoma or hyperplasia growth hormone secretion of growth hormone (GH) caused by excessive body bone and soft tissue hypertrophy and hyperplasia of the internal organs associated with endocrine metabolic disorder clinic in order to face crudely hand-foot skin mast crassa sella headache dizziness before the onset of puberty, such as the expansion of For gigantism after the onset of puberty for plastic side hypertrophy before the onset of puberty and lasting until puberty Buyu after the performance of acromegaly as the tremendous weight of non-treatment of this disease lipomatosis



3. Pituitary adrenocorticotropic hormone (ACTH) for most of the micro-cell adenoma adenoma adenoma excessive secretion of ACTH to promote bilateral adrenal hyperplasia excessive secretion of cortisol lead to fat protein metabolism of sugar to the clinical manifestations of heart fat full moon face buffalo skin back the Philippines Bo Wen Zi Jing acne high blood pressure urine disease osteoporosis, and other groups



4. Prolactin pituitary tumor in the pituitary tumor to see more of a mostly female adenoma due to excessive secretion of prolactin (PRL) due to hyperprolactinemia clinical performance galactorrhea amenorrhea, or menstrual disorder infertility obesity edema vision Decline, and so on; male patients with a rare performance of the anti-impotence headache vision loss or vision impairment based on the diagnosis; ① history; ② PRL determination of the continued general than 4.55 nmol / L and normal female 0.046 ~ 1.14 Nmol / L for men 0.046-0.97 0.97nmol / L such as the PRL> 0.046 ~ 1.14nmol / L contribute to the diagnosis of the disease; ③ exciting test: TRHO.5mg intravenous or oral metoclopramide (metoclopramide) 10mg Perphenazine 8 mg chlorpromazine 25 mg spray after the peak response to the PRL are <2 times the value of the base; ④ skull X-ray film CTMRI help diagnosis



(C) Cushing syndrome (also known as Cushing's syndrome)



1. Etiology



(1) bilateral adrenal hyperplasia (Cushing's disease): this accounts for 70% of the total number of disease due to pituitary tumor, or ACTH hypothalamic-pituitary dysfunction excessive secretion of ACTH stimulation of bilateral adrenal hyperplasia and secretion cortex Zuiguo Multi-induced



(2) of the adrenal adenoma cancer or its secretion cortisol secretion of a large number of mostly functional autonomy from the pituitary tumors secrete ACTH regulation of a large number of cortisol feedback inhibition caused by the release of ACTH in tumor tissue than the same side or opposite often adrenal atrophy



2. Cortisol rise to a large number of clinical manifestations of fat and protein metabolism of sugar multiple organ dysfunction mainly how the quality of blood face the full moon face buffalo back concentric pattern of fat purple skin acne hairy high blood pressure diabetes mellitus groups, such as osteoporosis



3. Diagnosis based on the



(1) clinical presentation: a typical clinical course of disease but often Yiwangerzhi early often do not rely typical laboratory



(2) laboratory: ① 24 h urinary 17-hydroxy corticosteroids (17-hydroxy corticosteroids (17-OH CS)> 55.2 mol/24 h,> 69mol/24h a greater significance when the diagnosis (13.8 to 41.9 of the normal male mol/24h that is 5 ~ 15 mg of women 11 ~ 27.6mol/24h 24 h urine of a 17-corticosteroids (17, a 17-to-one)> 69.4 mol/24h, such as Japan 20mg significantly higher cancer may prompt regular ② 24h urine Free cortisol> 3036nmol/24h, the normal 28 ~ 276nmol/24 (10 ~ 100mg/24h) ③ plasma cortisol and normal adults as early as 8:00 for the average 442 ± 276 (16 ± μg / dl), 16:00 average for the 221 ± 166 nmol / L (8 ± 6μg/dl), the lowest midnight this morning when the disease increased plasma concentration of midnight, when no significant circadian rhythm to reduce the disappearance ④ low-dose dexamethasone suppression test (2mg / d) will not be simple obese suppression ⑤ midnight inhibition can be a single dose dexamethasone suppression test: Night at 23:30 am service lmg dexamethasone in the previous month after the morning service 8:00 measured blood plasma cortisol simple obesity and normal plasma cortisol suppression was to control the value of More than 50% of the disease and those who are not inhibited ⑥ determination of plasma ACTH normal as early as 8:00 for the average 1.1-11pmol / (5 ~ 50 pg / mL), pituitary tumor or hypothalamic-pituitary disorders are caused by adrenal hyperplasia Slightly higher concentrations of plasma ACTH adrenal tumor while reducing ectopic ACTH syndrome was significantly higher when



(3) inspection equipment: B-mode X-ray film scanning, and so on CTMRI adrenal Cushing's syndrome diagnosis help



(D) disease of obesity Islet



1. Insulinoma B, also known as islet cell tumor because of a large number of tumors secrete insulin-induced hypoglycemia repeated attack as a result of eating more fat and more than hypoglycemia morning attack on an empty stomach or after exercise when blood sugar attack <2.76mmol / L for the alleviating of sugar quickly after diagnosis See Section IV of this chapter based on the "hypoglycemia"



2. Diabetes mellitus (NIDDM) diabetes is obesity early symptoms of hypertrophy of fat cells to insulin sensitivity in patients with non-fasting and postprandial increase in fasting insulin levels when up to 30 min / L up to 200 ~ 300 Mu / L caused by eating more fat and Fasting blood glucose to normal after meal blood sugar can often ≥ 11.1mmol / L (200mg/dl), or reduce the tolerance in accordance with the clinical diagnosis of diabetes: Diabetes: any time blood glucose ≥ 11.1mmol / L and fasting plasma glucose ≥ 7.8mmol / L or 2 h after meal Blood sugar) ≥ 11.1mmol / L or 75g glucose tolerance test (OGTT): fasting blood glucose ≥ 7.8 mmol/L2 h ≥ 11.1mmol / L / impaired glucose tolerance: 2h postprandial blood glucose> 7.8 ~ <11.1mmol / L



3. Functional spontaneous hypoglycemia due to eating more and more common in obese middle-aged women based on the diagnosis of hypoglycemia see a



(E) hypothyroidism and obesity



As the metabolic rate to reduce energy consumption caused by lower part of the majority of obese patients with weight gain from the effect of swelling caused by fluid performance of the virtual face swollen skin dry and rough skin pale and cold lack of appetite, constipation, heart rate slow down, and so on the basis of diagnosis: ① In the history of primary hypothyroidism often from chronic lymphocytic thyroiditis may have caused part of the history of goiter patients with history of thyroid surgery or radiation therapy ② signs in support of the history of hypothyroidism ③ T3T4 increased serum thyroid 131I prostate and most of the second rate increase FT3FT4 forward a few high peaks, and so on



(F) gland dysfunction and obesity



1. Polycystic ovary syndrome may have a fat hairy irregular menstruation or amenorrhea sterile body temperature was the basis of single-phase long-term bilateral ovarian increase ovulation does not feasible B-mode local CT laparoscopy confirmed plasma LH levels increased a lower level of hH LH / ThH ratio> 3



2. Postmenopausal obesity because of ovarian failure on lower levels of estrogen in the hypothalamus and pituitary feedback inhibition caused by weakening and autonomic dysfunction and obesity at the same time more food with fat metabolism disorders



3. No male testis or testis disease-free type of sexual dysfunction often have fat removed or gonadal radiation injury after sex workers are often fat loss gonad function of the autonomic dysfunction caused by obesity is occurring at the same time as a result of the basis of sex with disease Make it easier to identify



(G) Other
1. Salt and water retention of obesity is associated with idiopathic edema simple obesity syndrome occurs in middle-aged women standing edema and more activities and the rest Lateral Horizontal increase in the early morning before the menstrual period and sooner or later to reduce body weight difference of 1 ~ 1.5 kg (the normal average of 0.5 kg) over the rapid weight gain often menstruation or amenorrhea less thirsty and easy Niaoshao emotional instability headache drowsiness face and extremities vasomotor dysfunction, orthostatic hypotension, such as water tests Li position Show a clear water can help to stay sodium Lu diagnosis



2. The pain of obesity was particularly prevalent in post-menopausal women to reduce their pain threshold of pain is characterized by obesity subcutaneous fat nodules found in neck axilla in patients with nodular sustainable for many years often been stopped as early as premature sexual function



3.Prader-Willi syndrome, also known as the three low-fat obesity syndrome mainly low muscle tone with mental retardation gonadal function in the lower infancy to childhood obesity have significantly more than feeding the body and the short trunk and legs were fat and more fat tubby Due to a high degree of body fat and respiratory function to the impact of post-adolescent diabetes or impaired glucose tolerance are often based on the diagnosis: In addition to the history and clinical performance of low-tension muscle biopsy so that myogenic or neurogenic atrophy



4. Skull plate with hyperplasia (Morgagni-Stewart-Morel syndrome) disease is rare, almost all more common in women after menopause, about half of the obese patients to the main trunk and proximal extremities are often severe mental disorders, headaches and more hair on after Amenorrhea or less basal metabolic rate of glucose metabolism and reduce barriers to the skull X-ray film show and other frontal skull plate with hyperplasia



5. Childish one of retinitis pigmentosa refers to more than 1 (toe) malformation syndrome (Laurence-Moom-Biedl syndrome) of this rare disease is commonly found in the same family in the male members of the main means there are more obese (toe) and abnormal pigment Retinal degeneration short hair and long eyelashes long eyebrows genital development, such as poor mental retardation



(H) drug-induced obesity



And certain mental disorders in patients with long-term use of chlorpromazine call to promote protein synthesis of insulin preparations glucocorticoid Astemizole making drugs such as loss of appetite in patients with hyperthyroidism and eating more fat.

Causes of obesity:

Causes of obesity:
Cause of classification



Divided into simple obesity and secondary two major categories of obesity



(A) simple obesity



No obvious cause of endocrine and metabolic diseases are to be found



1. Physique, also known as juvenile-onset obesity and obesity -



2. Acquired obesity, also known as adult-onset obesity



(B) secondary obesity



There are obvious causes of endocrine and metabolic diseases, such as available



1. Hypothalamic disease



(1) of the hypothalamus syndrome: a variety of causes of traumatic after-effects such as inflammation can lead to cancer, such as granuloma hypothalamus syndrome of obesity



(2) inability to reproductive disorders and obesity: Frohlich, also known as syndrome



2. Pituitary disease



(1) ACTH pituitary tumor cells: also known as Cushing's disease



(2) pituitary growth hormone (GH) cell tumor: also known as acromegaly



(3) pituitary prolactin (PRL) cell tumor



3. Hypothyroidism



(1) primary (and thyroid) hypothyroidism



(2) of the hypothalamus - pituitary hypothyroidism



4. Islet disease



(1) non-insulin-dependent (NIDDM2 type) diabetes early



(2) Insulinoma: B, also known as islet cell tumor



(3) functional spontaneous hypoglycemia



5. Adrenocortical hyperthyroidism, also known as Cushing's disease Cushing's syndrome



6. Gonadal Hypothyroidism



(1) female menopause obesity



(2), polycystic ovary syndrome



(3) No male testis or testis-type disease-free



7. Other



(1) the pain of obesity (Dercum's disease)



(2,) of salt and water retention of obesity



(3) inside the skull plate hyperplasia (Morgagni-Stewart-Morel syndrome)



(4) and naive - retinitis pigmentosa - means more (toe) malformation syndrome (Laurence-Moon-Biedl syndrome)



8. Obesity drug-induced psychosis in patients with long-term use of certain diseases chlorpromazine to promote long-term use of insulin protein synthesis preparation of sugar, and other quality-Astemizole appetite in patients with hyperthyroidism and can lead to obesity.

Yuechi Yue lost the 15 food

Yuechi Yue lost the 15 food
1. Laver

In addition to the rich in vitamins A, B1 and B2, the most important thing is that it contains abundant minerals and cellulose, can help take the row in the body of waste and the accumulation of water, land Shoutui thereby effect.

2. Sesame

It's "Linseed oleic acid," can be attached to the removal of cholesterol in blood vessels, so that a better metabolism, weight loss Tuijiu received much more easily.

3. Bananas

Although the high calorie, low fat and rich in potassium, low-fat Baodu also reduce the accumulation of fat in the lower part of the body, is the ideal time to lose weight food.

4. Apple

Apple's unique with malic acid, can speed up the metabolism and reduce lower body fat, and with it's rich in calcium than other fruits can reduce the salt content is lower body edema.

5. Red

Contained in the red stone base of the acid can increase the large ingredients of peristalsis, the promotion of urination and constipation to reduce in order to clear the lower body fat.

6. Papaya

It has a unique protein enzymes break down, you can clear the Meat and as a result of the accumulation of fat in the lower part of the body, and papaya contain meat is good pectate colon hydrotherapy agent can reduce the accumulation of waste in the lower part of the body.

7. Watermelon

It is the fruit of diuretic experts, eating can be reduced to remain in the body of excess water, and sugar does not own, will not be addressed to eat more fat.

8. Eggs

Eggs inside the vitamin B2 help to remove fat, in addition, it contains niacin and vitamin B1 can remove the lower body fat.

9. Grapefruit

We glance early grapefruit very low calorie, and will not eat more fat, but that it also contains potassium-rich quality, help reduce lower body fat and water accumulation.

10. Tacca

Completely free of fat and delicious, in the final analysis will also lose weight eating thing, it was the fiber-rich plants can also make the lower part of the body's lymphatic flow to the leg to prevent the swollen bubble song.

11. Spinach

Because it can promote blood circulation, so you can make the farthest away from the heart of one of the legs, are sufficient to absorb nutrients, balance the metabolism, detoxification Shoutui.

12. Celery

On the one hand, celery contains a lot of calcium, you can make up the "foot power" and it contains potassium, the lower body to reduce the accumulation of water.

13. Peanuts

Contain a great deal of vitamin B2 and niacin, on the one hand, bring high-quality protein, long-fat meat is not long, followed by the consumer can also lower body fat fat.

14. Kiwifruit

In addition to vitamin C is its strength, its original fiber is very rich in fat can increase the rate of decomposition, the leg to avoid the accumulation of excess fat.

15. Tomato

Eat fresh tomatoes can be removed and the diuretic tired legs and reduce swelling, if it is eaten raw, on better results.

Drug-induced obesity

Drug-induced obesity
Some drugs effective in treating the disease, can lead to obesity, these drugs are as follows:



Chlorpromazine for the treatment of schizophrenia, for the treatment of tuberculosis of the closure Remy (hydrazine derivative smoke), blood pressure drug reserpine, these drugs through



Hypothalamus of the chemical lead to the increase in appetite. Low-dose drug is almost not cause any danger (there are small doses of chlorpromazine in the treatment of



Weight loss during the anxious mood), but if the long-term, it should be avoided as much as possible.



Estrogen, and estrogen-containing contraceptives sometimes make fat women, or vulnerable to becoming obese women, estrogen is to increase appetite and help



In the water and fat retention.



Adrenocorticotropic hormone drugs, such as cortisone, hydrocortisone, dexamethasone, and so effective in the treatment of allergic diseases, rheumatism, rheumatoid



Wet disease, asthma, but also enable the formation of secondary obese patients.



In addition, as for the treatment of stomach pains, dizziness of metoclopramide, Zhuxiaohuayao-yeast tablets, protein synthesis agent Nandrolone phenylpropionate, such as insulin, are



Can lead to body fat.

Baby Crying 101

Baby Crying 101
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Communication - that's what a baby's crying is for. This sweet thing that suddenly turn into a fit of tears is just craving for your sweeter attention. All cultures in the world nod to this pattern all infants are accustomed to.

A baby cries the most during his or her first three months. Though the amount of crying steadily increase, the crying time period may vary from an hour to most of the day and this could still be considered within normal range. Like, whoah, right? Babies are also known as howling tear factories.

Some thought that a baby cries more during the afternoon accounting it to the anxiousness of the mother or the stressed mood of the father after going home from work. But the most accepted assumption now is that babies have this automatic screening ability they use to shut off all the noise that may stimulate some response from them so they could get enough rest. But in the long run, this filter weakens and totally disappears during the approximate age of six weeks. This, then, make a baby very sensitive to the external factors such as noise, movements, etc. And these generally elicit a reaction from a baby and how best could he or she respond but only through crying.

There are many reasons why a baby succumbs to crying. Deciphering these reasons is the major feat a parent must surmount. Here are some of the things your sweetsome baby is making you understand through crying.

Hunger. Yes, your attention-hungry baby is craving to let you know that his tummy is grumbling. This is the most common reason for a baby to cry, especially, during his early months. The pattern of the hunger howl could be characterized as being persistent, demanding and almost rhythmical. But that rhythm is not at any rate close to becoming musical, of course.

Boredom. What can I say? Aren't these babies just plain spoiled? Crying because of boredom, errr, I'd find that a bit more twisted or weird if it's with an adult that is. But babies are really built like this. Crying is their way of telling you, "Hey get me a life here!" Aside from attention and food, consequently, babies need a lot of stimulation. And when they don't get this, there you get your waaaaaaaaaaaaaahhhhhhhhhhh!!! The trick is to pick the baby up and play with him. This move may be frowned upon by some because of its amounting to spoiling the baby. But it is important to know that stimulation is also one of the major necessities of an infant and it won't hurt to provide him with some while in his growing age. This boredom cry is said to be also rhythmical and full of sobs and moans.

Discomfort. Pain is another precursor of the baby's crying. Who won't cry when in pain, right? Babies are not Major Paynes to endure the most excruciating discomfort they could undergo. They are little, vulnerable beings that need to be attended to when injured or when in an inconvenient situation. This cry could be more persistent, louder and more demanding. Shrieking and screaming, those are words that better describe the crying pattern roused by pain.

Another cause may be disturbance; surely, howling will proceed just when they're about to sleep or are already fast asleep and suddenly gets surprised by some noise, or movement. An illness that causes discomfort to a baby may also be the reason for a baby's bursting into fit of tears.