Last updated on 21 Oct 2014 at 4:10 PM (Abdo16)

Obesity
A 42 year old NZ European woman comes for a follow-up GP visit because she recently had blood tests that have shown abnormal liver function. She is obese and complains of irregular periods and fatigue for a few months. She feels her mood is low. Her blood pressure is 156/94 mmHg and there is glucose in her urine.

 

Applied Science for Medicine
Anatomy and physiology of the liver, pancreas, adrenal glands and upper airway
Physiology and distribution of adipose tissue
Glucose and cholesterol homeostasis
Definition and pathophysiology of 'metabolic syndrome'; role in the development of atherosclerosis
Pathophysiology of hypertension
Physiology of the hypothalamic-pituitary-gonadal axis, including the menstrual cycle
Pathophysiology of polycystic ovarian syndrome (PCOS); recognise the relationship between metabolic syndrome and PCOS
Understand the steroidogenesis pathway; pathophysiology of androgen excess; pathophysiology of steroid excess
Pharmacology of metformin, antihypertensives

Clinical and Communication Skills
History from a patient with obesity including use of the Epworth Sleepiness Scale
Perform a general examination; recognise the signs of cortisol excess and of androgen excess
Differential diagnosis of obesity
Indications for ultrasound abdomen, transvaginal ultrasound (recognise the implications of obesity as a risk factor for endometrial hyperplasia/cancer), sleep studies
Interpret investigations for causes of obesity (overnight dexamethasone suppression test, 24 hour urinary cortisol, thyroid function tests); interpret investigations for complications of obesity (liver function tests, HbA1c, urine albumin:creatinine ratio, lipid profile, serum testosterone)
Use of appropriate communication skills for discussing obesity with patient; screening for depression
Management of obesity, non-alcoholic fatty liver disease, metabolic syndrome, PCOS including life-style factors and role of the dietitian
Role of bariatric surgery for treatment of obesity
Outline the management of obesity-related sleep disorders
Outline the management of Cushing's syndrome
Complications and prognosis of obesity

Personal and Professional Skills
Provide advice regarding weight loss and lifestyle modification
Reflect on personal attitudes to obesity

Hauora Māori
Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in NZ presenting with abnormal liver function tests
Understanding of inequities in access to health services and quality of medical care for Māori, and application of this to clinical decision making and management
Awareness of disproportionate impact of socioeconomic deprivation on Māori, particularly for health-related behaviours, and appropriate response

Population Health
Obesity epidemic, obesigenic environment and relationship to broader determinants of health
Describe the global burden of obesity, risk factors and lifestyle associated with obesity
Strategies to reduce obesity and strategies to reduce impact of obesity
Epidemiology of non-alcoholic fatty liver disease, metabolic syndrome, PCOS
Screening for diabetes, hypertension, dyslipidaemia

 

Conditions to be considered relating to this scenario

Common

non-alcoholic fatty liver disease, metabolic syndrome, obstructive sleep apnoea, diabetes mellitus, impaired glucose tolerance, dyslipidaemia, essential hypertension, PCOS

Uncommon

ectopic ACTH from malignancy, Cushing's syndrome