Weight Loss
Overview
In assessing a patient with weight loss, it is important to determine whether the loss has been intentional or non-intentional. While intentional weight loss may have been a desired outcome, non-intentional weight loss is a concerning symptom which may herald underlying systemic disease.
Aetiology
Causes of Weight Loss
- Lifestyle changes - reduced food intake, increased physical activity
- Malignancy
- Gastrointestinal - peptic ulcer disease, obstruction, IBD, chronic pancreatitis, coeliac disease, gastric bypass surgery
- Chronic infection - TB, HIV, chronic bacterial infection
- Endocrine - hyperthyroidism, poorly controlled diabetes, Addison's, phaeochromocytoma
- Neurological - stroke, Parkinson's, dementia
- Medications - chemotherapy, opioids, metformin, digoxin, antipsychotics, SSRIs, caffeine, thyroxine
- Drugs of abuse - alcohol, tobacco, amphetamines, cocaine, opioids
- Organ failure - renal failure, liver failure, CCF, respiratory failure
- Psychiatric - eating disorders, depression, schizophrenia
- Dysphagia
- Poor dentition
- Dry mouth
- Loss of taste sensation
History of Presenting Complaint
Intent
- Whether the weight loss was intentional or unintentional.
Severity
- Amount of weight loss over how long.
Associated Symptoms
- Nausea / vomitingNonspecific symptom, but think about DKA or Addison's
- DiarrhoeaNonspecific symptom that can also result in weight loss
- Abdominal PainSuggestive of GI pathology or potentially Addison's
- Malaena / HaematemesisSuggestive of bleeding peptic ulcer or cirrhosis with varices
- Increased appetiteSuggestive of hyperthyroidism, poorly controlled diabetes or malabsorption
- FeversSuggestive of infection, inflammation or malignancy
- Night sweatsRed flag for malignancy or infection
- Heat intoleranceSuggestive of hyperthyroidism
- TremorSuggestive of hyperthyroidism or alcohol withdrawal
- Fear of weight gainA feature of anorexia nervosa
- Leg swellingSuggestive of CCF, liver failure or renal failure
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