Weight loss

NOTE: NOT the same as low weight (there needs to be a change in weight)

  • Often 10% (or >3kg) in 6 months is used as a rough guide of what is abnormal
    • However this is not a strict definition

History

  • Clarify how much over what time period (try and procure some evidence for this as well e.g. weight measurements from notes)
    • Clarify if there was any intention or other physiological cause for weight loss
      • Possibly take a dietary and exercise history
    • Have their clothes felt looser?
  • Ask about appetite and satiety.
  • Are there any body image concerns or worries about eating?
  • Any recent changes to social circumstance/lifestyle? Mood
  • Any other symptoms?
    • Change in bowel habit?; tiredness/lethargy?; difficulty swallowing?; vomiting/nausea?; chest/abdominal pain?; features or hyperthyroidism (e.g. agitation, tremor, palpitations etc)?
  • Any medical conditions?
    • Change in symptoms? e.g. worsening SOB in COPD patient
    • Change in drug dosage or regime?

Examination

  • As with other CCP, examine as per suspicion.  However, with weight loss, often there will be little clues as to what/where to examine
  • Good idea to have a good general examination, as well as cardiorespiratory and abdominal examination
    • Checking for lymphadenopathy is also a good idea

Investigations

  • Urinalysis for sugar, protein and blood
  • Blood tests
    • FBC
      • any anaemia, infection
    • CRP/PV
    • U&Es and LFTs
    • Glucose
    • TFTs
    • Autoantibodies (if there is a suspicion of immune mediated cause)
  • Other tests are only really indicated if symptomatic, although if weight loss is severe and rapid, they may be performed as part of work-up
    • CXR
    • Endoscopy/sigmoidoscopy/colonoscopy etc

Causes

  • Physiological- change in physical activity, diet or even social circumstances (the latter can often be difficult to identify as a cause, particularly in elderly patients)
  • Psychiatric illness
    • Anorexia nervosa
    • Bulimia
    • Affective disorders, including depression
    • Alcoholism
  • Systemic diseases
    • Chronic infection e.g. TB, recurrent urinary/chest infections, HIV-related illness, COPD
    • Chronic inflammatory conditions e.g. rheumatoid arthritis; polymyalgia rheumatica; SLE
    • Malignancy
  • GI disease
    • Inflammatory bowel disease
    • Malignancy (particularly pancreatic and gastric)
    • Malabsorption from pancreatic disease or small bowel causes
  • Endocrine/Metabolic causes
    • Diabetes mellitus (particularly type I)
    • Hyperthyroidism
    • Addison’s disease
    • Panhypopituitarism

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