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Weight Loss



  • 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.


    • 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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