Unintentional Weight Loss Flashcards
What suggests unintended weight loss is due to a more severe cause?
More rapid and severe weight loss
What initial investigations should be done when someone presents with unintentional weight loss?
- Urine testing for sugar & protein
- FBC
- ESR or CRP
- Fasting blood glucose
- U&E’s
- Calcium & bone profile
- LFT
- PSA
- TSH
- FTY
- CXR
What are the main differential diagnoses for unintended weight loss?
- Any advanced malignancy
- Psychiatric illness
- Non-malignant GI diseases
- Complicated alcoholism
- Undiagnosed or uncontrolled diabetes mellitus
- Thyrotoxicosis
- Pulmonary TB
- Addison’s disease
*
What suggests that an advanced malignancy is the cause of unintentional weight loss?
Progressive onset over weeks or months of specific symptoms, e.g. haemoptysis, neurological deficit, rectal bleeding, change in bowel habit
How is it confirmed that an advanced malignancy is the cause of unintentional weight loss?
- Visualisation of tumour on GI endoscopy or bronchoscopy
- Lymph node biopsy
- Metastases on CXR, CT, or ultrasound
- Leukaemic changes on FBC
How is unintentional weight loss caused by an advanced malignancy managed?
- Dietary advice
- Food supplements
- Counselling
- Analgesia if in pain
- Treatment of underlying diagnosis
What is the main psychatric illness causing unintentional weight loss?
Severe depression
What suggests that a psychiatric illness is the cause of unintentional weight loss?
- Sleep disorder
- Poor concentration
- Social withdrawal
- Lack of interest in usual activity
What confirms that psychiatric illness is the cause of unintentional weight loss?
- History
- Mental state examination
How is unintentional weight loss caused by psychiatric illness treated?
Treatment of psychatric illness, e.g. with psychotherapy or antidepressants
Give 3 non-malignant GI diseases that might cause unintentional weight loss
- Peptic ulcer disease
- Inflammatory bowel disease
- Malabsorption
What suggests that a non-malignant GI disease is the cause of unintentional weight loss?
- Dysphagia
- Vomiting
- Diarrhoea
- Abdominal pain
- Melaena
- Alcohol intake
How is it confirmed that non-malignant GI disease is the cause of unintentional weight loss?
- GI endoscopy
- US scan of abdomen
- Anaemia on FBC
How is unintentional weight loss caused by non-malignant GI disease managed?
- Dietary intervention, e.g. food supplements
- Counselling
- Analgesia if pain
- Treatment of underlying condition
What complications of alcoholism might cause unintentional weight loss?
- Liver disease
- Gastritis
- Peptic ulceration
- Seizures
- Delerium tremens on withdrawal
What suggests that complicated alcoholism is the cause of unintentional weight loss?
- Depression
- Anxiety
- Visual hallucinations
- Social withdrawal
- Lack of interest in non-drinking activities
- Anorexia
What confirms that complicated alcoholism is the cause of unintentional weight loss?
- History of alcohol abuse
- Presence of signs of chronic liver disease
How is unintentional weight loss caused by complicated alcoholism managed?
- Withdrawal of alcohol
- Short course of sedative to prevent withdrawal symptoms
What suggests that unintentional weight loss is caused by undiagnosed or uncontrolled diabetes mellitus?
- Polydipsia
- Polyuria
- Pruritis
How is it confirmed that undiagnosed or uncontrolled diabetes mellitus is the cause of unintentional weight loss?
Fasting blood glucose >7.0mmol/L on two seperate occasions, or random glucose >11.1/L once in the presence of symptoms
How is unintentional weight loss caused by undiagnosed or uncontrolled diabetes mellitus managed?
- Lifestyle modification - diet and exercise, with or without metformin
- Insulin if type 1 or ketotic
What suggests that unintentional weight loss is caused by thyrotoxicosis?
- Heat intolerance
- Nervousness
- Palpitations
- Frequency of bowel movements
- Goitre
- Fine tremor
What confirms that thyrotoxicosis is the cause of unintentional weight loss?
- Decreased TSH
- Increased FT4, with or without increased FT3
- Anti-TSH receptor antibody if Graves’ disease
How is unintentional weight loss caused by thyrotoxicosis treated?
Treatment of underlying cause, using propanolol to control symptoms, and carbimazole or propylthiouracil to reduce T4
