Weight loss resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Javaria Anwer M.D.[2]
Synonyms and keywords: weight loss management guide, unintentional weight loss management guide, loss of weight resident survival guide, pathologic weight loss resident survival guide.

Lymphadenopathy resident survival guide microchapters
Overview
Causes
Management
Do's
Don'ts

Overview

Weight loss may be intentional or unintentional.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Life threatening cause 1
• Life threatening cause 2
• Life threatening cause 3

Common Causes

• Malignancies (specifically digestive and non-hematologic), dementia, stroke, parkinson's disease, polymyalgia rheumatica, and oral disorders are more prevalent among individuals >65 years old.
• Endocrine disorders, infections such as TB and HIV, psychiatric disorders such as depression, anxiety, OCD, and malignancies such as hematologic ones are more prevalent among patients, <65 years of age.

• The chart below demonstrates the cause of unintentional weight loss in adult population. The incidence describes the full range of occurrence described in five studies in older individuals.

Causes of weight loss

Intentional weight loss

Unintentional weight loss

Non-Malignant (~60%)

Malignant (19 - 39%) ❑ Gastrointestinal (53%) based on one study : Oesophageal cancer, stomach cancer, colon cancer, and rectal cancer. ❑ Renal: Renal cancer and renal pelvis cancer. ❑ Pulmonary: Bronchial cancer and lung cancer ❑ Hepato-pancreatic: HCC, pancreatic cancer, intra-hepatic bile duct cancer. ❑ Genitourinary: Ovarian cancer, cervical cancer, endometrial cancer, prostate cancer, ureter cancer, bladder cancer ❑ Hematologic: Hodgkin's lymphoma and Non-Hodgkin's lymphoma ❑ Breast cancer ❑ Malignant neoplasms

Infectious (2 - 8%) ❑ Chronic diarrhea ❑ Tuberculosis (TB) ❑ HIV ❑ infective endocarditis ❑ Infective colitis and gastroenteritis.

Autoimmune (2 - 7%) ❑ SLE ❑ Rheumatoid arthritis ❑ Polyarteritis nodosa ❑ Polymyalgia rheumatica ❑ Giant cell arteritis with polymyalgia rheumatica

Psychologic/ Psychiatric (9 - 42%) ❑ Depression ❑ Bipolar disorder ❑ Somatoform disorder ❑ Schizophrenia ❑ OCD ❑ Anxiety ❑ Dementia ❑ Social exclusion or rejection ❑ Neglect ❑ Disability

Organ system based ❑ Gastrointestinal (6 - 30%): Gastric and duodenal ulcers, IBD, celiac disease, malabsorption, steatorrhea, vascular disorders affecting intestines, non-infective gastroenteritis and colitis, swallowing pathologies, and dental issues. ❑ Renal (4%): Pyelonephritis, nephritic syndrome, and nephrotic syndrome ❑ Cardiopulmonary (2-10%): Heart failure, COPD, lung abscess (without pneumonia), interstitial lung disease (fibrotic or idiopathic), pleural effusion, and pyothorax (without fistula). ❑ Neurologic (2 - 7%): Stroke, parkinson's disease, and motor neuron disease. ❑ Endocrine (4 - 11%): Type I diabetes, type 2 diabetes, hyperthyroidism, primary hyperparathyroidism, Addison's disease, and subacute thyroiditis.

Drug-induced (6 - 8%) ❑ Cocaine ❑ Opioids ❑ Alcohol (4 - 8%) ❑ Psychedelic drugs,

Unexplained / Unknown (6 - 36%)

• To read about other causes of unintentional weight loss click here.

Diagnosis

Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

History ❑Patient age (age may help determine possibility of malignancies) ❑ Duration of symptoms (weeks in acute/severe versus years in chronic conditions) ❑ Past medical history suggestive of immunodeficiency (recurrent infections), diagnosed malignancy, malabsorption (chronic diarrhea), HF, dyspepsia ❑ Sexual history suggestive of HIV AIDS ❑ Family history of certain malignant disorders (breast cancer, ovarian cancer, colon cancer, or stomach cancer)) ❑ Exposure to communicable infectious diseases/ travel to high-risk areas ❑ Environmental exposure such as UV (skin cancer risk)/ animals/ occupational exposure ❑ Social history such as tobacco, alcohol use, opioid, cocaine use ❑ Associated symptoms such as pain, fever, weight loss, anorexia, cough, or recurrent UTIs

Physical exam Appearance of the patient Cachexia or surgical scar marks demonstrating previous malignancy treatment ❑ Vital signs ❑ Temperature: High-grade / low-grade fever may demonstrate infection. ❑ Heart rate: Tachycardia with regular pulse may demonstrate infection. ❑ Respiratory rate: Tachypnea may demonstrate respiratory system involvement (infection\ metastasis). ❑ Blood pressure: Chronic hypertension or hypotension (may indicate sepsis as a complication). ❑ Oxygen saturation: may be low if the respiratory system is affected. ❑ HEENT ❑ Cardiovascular examination ❑ Respiratory examination ❑ Gastrointestinal system exam includes oral examination, abdominal examination, and digital rectal exam. ❑ Splenomegaly) may demonstrate IM, hodgkin's/ non-Hodgkin's lymphoma, and sarcoidosis ❑ Extremities exam ❑ Skin exam: Evaluate for the lesions that indicate malignancy such as melanoma/ potential inoculation sites for germ such as traumatic lesions.

Labs ❑ CBC with differential ❑ ESR ❑ CMP ❑ Peripheral smaer ❑ LFTs Labs may be required at a later stage pf diagnosis

Do's

• Perform a thorough physical exam to evaluate for cause of weight loss.

Don'ts

• The content in this section is in bullet points.

References

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