Weight Loss

Question 1

Define weight loss.

Answer 1

Widely accepted definition is a loss of 5% body weight over 6 months.

Question 2

What are the psychosocial causes of weight loss?

Answer 2

• Eating disorders
• Bereavement
• Depression
• Substance misuse
• Neglect

Question 3

What are the gastrointestinal causes of weight loss?

Answer 3

• Oral problems
• Malabsorption
• Malignancy
• Inflammatory bowel disease
• Liver disease

Question 4

What are the endocrine causes of weight loss?

Answer 4

• Diabetes
• Hyperthyroidism
• Addison’s disease

Question 5

What are the cardiac / respiratory / renal / neurological causes of weight loss?

Answer 5

• COPD
• Heart failure
• Advanced CKD
• Neurodegenerative

Question 6

What are the causes of weight loss related to systemic inflammation?

Answer 6

• Vasculitis
• SLE
• Rheumatoid arthritis
• Temporal arteritis

Question 7

What are the infection causes of weight loss?

Answer 7

• Tuberculosis
• GI infections / infestations
• HIV / AIDS

Question 8

What are the malignant causes of weight loss?

Answer 8

• Colorectal
• Gastro-oesophageal
• Prostate
• Pancreatic
• Lung
• Urological

Question 9

What are the different types of medication which can cause weight loss?

Answer 9

• Prescribed: metformin, SSRIs, anti-cancer.
• Drugs of misuse
• Alcohol
• Herbal medicines

Question 10

What should be asked in the history of a patient presenting with weight loss?

Answer 10

• HPC
  
  • How much weight loss? (People can be unreliable at judging their own weight loss).
  • How long? Duration of weight loss.
  • Pattern? Is it progressive or stabilised.
  • Did they intend to lose weight? Changes in caloric intake or physical activity.
• Drug Hx
  
  • ​Prescribed
  • OTC
  • Drugs of misuse
  • Herbal / CAM
• Systems review
  
  • GI
    
    • ​Decreased apetite / early satiety? Oral problems? Dysphagia? Dyspepsia? Abdominal pain? Change in bowel habit? Constipation? Diarrhoea? Bloating? PR bleeding - fresh, mixed with stool, altered blood?
  • Respiratory
    
    • ​Cough? Haemoptysis? SOB? Oedema? Chest pain?
  • GU
    
    • ​LUTS? Visible haematuria? Loin pain? Vaginal bleeding?
  • General
    
    • ​Fever? Night sweats? Tiredness / lethargy?

Question 11

What are you looking for on examination of a patient with weight loss?

Answer 11

• Document weight; Old records helpful
• Hands
  
  • Clubbing? Nail infarcts? Temperature? Stigmata of liver disease? Tremor? Pulse?
• Head
  
  • ​Pallor? Jaundice? Eye signs? Mouth: dentition, ulcers, thrush? Cervical lymphadenopathy?
• Important examinations
  
  • ​Breast examination
  • Skin changes / rashes
  • Respiratory / CVS examination
  • Abdominal examination

Question 12

Describe the investigation of a patient presenting with weight loss.

Answer 12

• There is no single investigation pathway or algorithm as the differential is wide.
• No widely-accepted guidelines for the clinical evaluation of weight loss.
• The hx and examination is crucial to informing future investigations.
• Investigations include:
  
  • Urine
  • Blood tests
  • Targeted investigation

Question 13

Which investigations of urine would be appropriate when investigating weight loss?

Answer 13

• Glucose - diabetes.
• Proteinuria - renal disease.
• Haematuria - intrinsic renal disease, urological malignancy.
• Bence-Jones protein.

Question 14

Which blood tests would be appropriate when investigating weight loss?

Answer 14

• FBC
• LFT
• TFT
• Renal function / U&E
• Glucose / HbA1c
• CRP/ESR
• Calcium

Question 15

What are the targetes investigations which would be appropriate when investigating weight loss?

Answer 15

• CXR
• Faecal occult blood
• PSA/CA125
• CT imaging
• Referral for endoscopic investigation