Tutorial #27: Unintentional Weight Loss Flashcards
(29 cards)
Clinically significant weight loss is defined as loss of ___% of total body weight over ____ months.
5%; 6-12 months
What are the most common etiologies of unintentional weight loss?
- Malignancy
- Non-malignant GI causes
- Psychiatric causes
What malignancies are particularly associated with weight loss?
Gastrointestinal, pancreatic, lung, lymphoma, renal, and prostate cancers
What are non-malignant GI diseases that can cause unintentional weight loss?
Peptic ulcer disease, diseases that cause malabsorption (eg, celiac disease), and inflammatory bowel disease (IBD).
List symptoms that may suggest a non-malignany GI cause of weight loss.
- Anorexia,
- Abdominal pain,
- Early satiety,
- Dysphagia,
- Odynophagia,
- Diarrhea,
- Steatorrhea,
- Chronic constipation,
- Evidence of chronic bleeding
What are common psychiatric illnesses that can cause unintentional weight loss?
- Depression
- Eating disorders
- Manic phases of bipolar disorder
What endocrinopathies commonly cause unintentional weight loss?
- Hyperthyroidism
- Diabetes mellitus
- Adrenal insufficiency
- Pheochromocytoma
What common chronic infectious etioligies can cause unintentional weight loss?
HIV, tuberculosis, Hepatitis C, helminthic infections
What common advanced chronic disease can cause unintentional weight loss?
- Congestive heart failure
- Chronic lung disease
- Advanced kidney disease
List important elements of the history for a patient with unintentional weight loss.
- Evaluation for eating disorders and intentional weight loss
- Pattern of weight loss
- Associated symptoms (i.e. malignancy, malabsorption, psychiatric disorders)
- Function and social factors
What are the initial tests that are appropriate to order if a patient presents with clinically significant unintentional weight loss WITHOUT an obvious diagnosis?
- CBC with differential
- Electrolytes, calcium
- Glucose and HbA1c
- Renal function and urinalysis
- Hepatic function
- TSH
- Stool hemoccult
- ESR/CRP
- HIV
- Hepatitis C
- CXR
- Age-appropriate cancer screening
How do you manage a patient with clinically significant unintentional weight loss without a suspected diagnosis or abnormal findings after a thorough assessment?
Watchful waiting for one to six months
What are concerning features in a patient’s pattern of unintentional weight loss?
- Recent weight loss in a person whose weight has been stable for many years
- Weight loss that is progressive
- Extreme weight loss (i.e. >10% of total body weight)
What associated symptoms for malignancy should be asked in a patient presenting with clinically significant unintentional weight loss?
- B symptoms (night sweats, fevers, fatigue)
- Age- and risk-factor related symptoms (i.e. bloody or dark stools in patients ≥50 years or at risk for colon cancer, or pulmonary symptoms in patients who are smokers or former smokers).
List 5 prescription medications that may cause unintentional weight loss
- Analgesics and sedatives (NSAIDS, opioids, benzos)
- Antiglycemics/diabetes medications
- Antiepileptics/seizure mediations
- Antiinfective medications: Septra, metronidazole, lamivudine
- Cardiovascular medications: CCB, BB, ASA, statins, diuretics
- Chemotherapy
- Cholinesterase inhibitors used to treat dementia (eg, donepezil, rivastigmine, galantamine)
- Psychiatric medications: antipsychotics, lithium, SSRI, TCAs
…there are many others
List 5 non-prescription drugs that may cause unintentional weight loss
- Alcohol
- Cocaine
- Amphetamines
- Marijuana
- Tobacco
List 3 functional causes of unintentional weight loss
- dysphagia
- poor dentition
- poor cognition/dementia
What associated symptoms for diseases of malabsorption should be asked in a patient presenting with clinically significant unintentional weight loss?
- steatorrhea
- muscle loss
- watery diarrhea
- signs of nutrient deficiency (i.e. increased bruising from vitamin K deficiency)
Which psychiatric disorder should always be screened for when a patient presents with clinically significant unintentional weight loss?
Depression
What are clues for unintentional weight loss on physical exam?
- General appearance – a flat affect can be a sign of psychiatric disease.
- Head and neck – poor dentition is a common cause, less common include ophthalmoplegia, cheilosis and glossitis as signs of nutritional deficiency
- Cardiopulmonary – assess for CHF/COPD/chronic disease
- Abdominal examination – assess for liver disease or malignancy
- Cognitive and neurologic exam – underlying neuro disorder such as dementia or parkinsons
- Lymphadenopathy - for malignancy
How would you manage a patient presenting with unintentional weight loss of less than 5% total body weight?
Patients with <5 percent loss of usual body weight can be closely followed; the interval of follow-up may vary depending on the patient’s age and comorbidities
What are two important caveats to keep in mind when interpreting initial tests for unexplained weight loss?
These tests are often based on small studies and may lack sensitivity
A normal result does not rule out serious, disease clinical suspicion should guide further testing
When should you consider colonoscopy in a patient with unexplained weight loss?
If the patient is over 40 and no cause is apparent on history, exam, or initial testing, even if they are asymptomatic
When might a CT chest/abdo/pelvis be appropriate in the workup of unexplained weight loss?
In patients with ≥20% unintentional weight loss and no diagnosis after history, physical, and basic labs, especially if elderly or with high-risk features.
