Weight loss

Question 1

Causes:

This is where it is so important to go through VITAMINS

Answer 1

• Gastrointestinal: peptic ulcer disease, gastritis, UC, CD, Coeliac disease
• Infection
• Malignancy
• Endocrine: hyperthyroidism, uncontrolled diabetes mellitus, Addison’s
• Respiratory: TB, CF, bronchiectasis
• Renal: CKD
• Neurological: dementia
• Psychiatric: depression, eating disorder
• Drugs: diuretics, metformin, laxatives, thyroxine

Question 2

Aetiology of malabsorption leading to weight loss:

Answer 2

• Gastrointestinal: Crohn’s disease, short bowel syndrome, IBS
• Surgery: bariatric surgery, gastrectomy
• Infection: TB of the small bowel, HIV-related malabsorption, parasites (giardiasis (!), fish tape worm, hookworm), diarrhoea, tropical sprue
• Pancreatic insufficiency: carcinoma of pancreas, chronic pancreatitis. CF
• Bile acid: bacterial overgrowth, obstructive jaundice

Question 3

Aetiology of increased demand leading to weight loss:

Answer 3

• Malignancy
• Chronic infection: HIV, TB
• Endocrine: thyrotoxicosis

Question 4

Aetiology of increased loss leading to weight loss:

Answer 4

• Uncontrolled diabetes – polyuria and loss of glucose in urine
• Fluid loss such as diuretics and diabetes insipidus

Question 5

Weight loss history:

Answer 5

• How much? Over what time period? Are your clothes looser?
• Past fluctuations in weight?
• Changes in appetite? Changes in diet?
• Changes in exercise?
• Gastrointestinal systems review: abdominal pain, dysphagia, N&V, early satiety, indigestion etc. In each case, how progressive have these symptoms presented e.g., progressive dysphagia is highly suggestive of malignancy?
• Malignancy: night sweats, fever, fatigue, SOB, change in bowel habit, bleeding
• Endocrine

o Hyperthyroidism: sweating, weight loss, appetite, flushing, tremor

o Diabetes: uncontrolled; thirst, polyuria

o Addison’s: dizziness, weakness, pigmentation

• Psychiatric history
• Other systems
• Drug history
• Social history: travel history, sexual history (HIV), alcohol, cocaine, social isolation

Question 6

Examinations:

Answer 6

• Bloods: FBC (RDW is high – suggests anisocytosis), LFTs, U&Es, CRP, bone profile, TFTs, glucose, coeliac serology, iron/B12/folate, cortisol, HIV test, Hep C screen, LDH
• CXR
• Urine dipstick
• Stool sample (H. pylori, FIT, parasites)
• US, CT chest/abdomen/pelvis
• ODG, colonoscopy

Question 7

Iron consumption indicator?

Answer 7

The body is bad at absorbing iron, hence why the most common anaemia is IDA. You know that iron is not being absorbed/you’re eating a lot, because it will blacken your stool if it is not absorbed.

Question 8

Complications of hypoalbuminemia?

Answer 8

Hypoalbuminemia leads to pleural effusions and ascites