Approach to weight loss Flashcards
What features on history of weight loss should prompt concern?
Any significant unintentional weight loss in a previously healthy individual.
Rapid fluctuations of weight over days ➡️ loss or gain of fluid.
Long-term changes ➡️ loss of tissue mass.
Loss of 5% of body weight over 6–12 months should prompt further evaluation.
Gradual weight loss is physiologic in persons over age 80 but high risk for malignancy or other serious illness.
How can the principle causes of weight loss be grouped?
The principal causes of involuntary weight loss can be assigned to four categories:
- Malignant neoplasms
- Chronic inflammatory or infectious diseases
- Metabolic disorders
- Psychiatric disorders
What are the common causes of weight loss in older persons vs the young?
In older persons the most common causes of weight loss are depression, cancer, and benign GI disease, with lung and GI cancers the most common malignancies in pts presenting with weight loss.
In younger individuals, diabetes mellitus, hyperthyroidism, anorexia nervosa, and
infection, especially with HIV, should be considered
What features on history can be considered? Cardiovascular and respiratory Neurology GI symptoms Past medical history Social history Psychiatric history
Ask about fever, pain, shortness of breath or
cough, palpitations
Evidence of neurologic disease.
GI symptoms including difficulty eating, dysgeusia, dysphagia, anorexia, nausea, and change in bowel habits.
Previous illness or surgery
Diseases in family members.
Travel history
Risk factors for HIV should be assessed.
Signs of depression, evidence of dementia, and social factors, including isolation, loneliness, and financial issues that might affect food intake, should be considered.
Social history use of cigarettes, alcohol, and drugs
What should be considered on physical exam?
Weight and vital signs.
Skin ➡️ pallor, jaundice, turgor, surgical scars, and stigmata of systemic disease.
ENT ➡️ oral thrush, dental disease, thyroid gland enlargement, and adenopathy
Respiratory, cardiac and abdominal exam
Men ➡️ rectal examination, including the prostate
Women ➡️ pelvic examination
Stool for occult blood.
Neurologic examination should include mental status assessment and screening for depression.
Differentials for weight loss Endocrine GIT Cardio Respiratory Other
Endocrine and metabolic causes ➡️Hyperthyroidism ➡️Diabetes mellitus ➡️Pheochromocytoma ➡️Adrenal insufficiency Gastrointestinal disorders ➡️Malabsorption ➡️Obstruction ➡️Peptic ulcer ➡️Celiac disease ➡️Inflammatory bowel disease ➡️Pancreatitis ➡️Pernicious anemia Cardiac disorders ➡️Chronic ischemia ➡️ Chronic congestive heart failure Respiratory disorders ➡️ Emphysema Chronic obstructive pulmonary disease Renal insufficiency Rheumatologic disease
Other differentials
Infections
Medications
Dental/mouth
Infections ➡️ HIV ➡️ Tuberculosis ➡️ Parasitic infection ➡️ Subacute bacterial endocarditisMedications Sedatives ➡️ Antibiotics ➡️ Nonsteroidal anti-inflammatory drugs ➡️ Serotonin reuptake inhibitors ➡️Metformin ➡️ Levodopa ➡️ ACE inhibitors Other Disorders of the mouth and teeth ➡️Caries ➡️Dysgeusia
More differentials?
Age related
Neurological
Psychiatric
Age-related factors
➡️Physiologic changes
➡️Decreased taste and smell
➡️Functional disabilities
Neurologic causes
➡️Stroke
➡️ Parkinson’s disease
➡️Neuromuscular disorders
➡️Dementia
Social causes
➡️Isolation
➡️Economic hardship
Psychiatric and behavioral causes
➡️Depression
➡️ Anxiety
➡️ Bereavement
➡️ Alcoholism
➡️ Eating disorders
➡️ Increased activity or exercise
Idiopathic
What initial investigations can be considered?
⭐️Initial testing CBC Electrolytes, calcium, glucose Renal and liver function tests Urinalysis Thyroid-stimulating hormone Chest x-ray Recommended cancer screening
What additional test can be considered for weight Loss?
⭐️Additional testing
HIV test
Upper and/or lower gastrointestinal endoscopy
Abdominal ultrasound
