Surgery - Weight loss, anorexia and associated symptoms

Question 1

Weight loss, anorexia and associated symptoms

Answer 1

• Marked weight loss (cachexia) and loss of appetite (anorexia) are frequently manifestations of serious, insidious, often malignant abdominal disorders.
• There may be other symptoms such as malaise, bloating, nausea, sporadic vomiting and regurgitation.
• These symptoms may have been unnoticed or dismissed as trivial by the patient and are only elicited by direct questioning.

Question 2

Weight loss, anorexia and associated symptoms

Causes

Answer 2

The diseases which cause these symptoms may be grouped into four broad categories:

Intra-abdominal malignancies,

• e.g. carcinoma of stomach or pancreas, metastatic disease in the liver or widespread across the peritoneal cavity (arising particularly from stomach, large bowel, ovary, breast or bronchus), bowel lymphomas

‘Medical’ conditions,

• e.g. alcoholism and cirrhosis, viral diseases (e.g. hepatitis or infectious mononucleosis), uncontrolled diabetes or thyrotoxicosis, malabsorption, renal failure, cardiac cachexia

Psychological disorders,

• e.g. anxiety, depression, anorexia nervosa, bulimia

Chronic visceral ischaemia,

• a very uncommon condition resulting from atherosclerotic narrowing of at least two of the three main visceral arteries—the coeliac axis and the superior mesenteric and the inferior mesenteric arteries—resulting in ‘fear of food’ and massive weight loss