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Weight Loss


Aetiology of weight loss

  • Appetite maintained:
    • DM,
    • Hyperthyroidism
    • Malabsorption
    • Phaeochromocytoma
  • Appetite suppressed:
    • Malignancy
    • Severe cardio or respiratory failure
    • Gut failure
    • Depression
    • HIV


History in weight loss

  • History of presenting complaint
    o Amount and duration of weight loss
    o Any intentional weight loss?
    o Dietary changes
    o Calorie intake
    o ALARMS symptoms (see Dysphagia) and other cancer red flags
    o Full systems review
    o Systemic symptoms – night sweats
    o Psychological history – number of diets, any previous eating disorders, weight fluctuations
  • Past medical history
    o See list of causes
  • Medications
    o Appetite suppressants (including over-the-counter drugs)
  • Family history
    o Cancer
    o Eating disorders
  • Social history
    o Smoking
    o Travel history
    o Risk factors for HIV


Examination of weight loss

  • Cachexia
  • Lymphadenopathy
  • Abdominal masses
  • Evidence of cardio or respiratory failure
  • Signs of hyperthyroidism


Initial management of weight loss

  • Subjective global assessment
  • Skin fold thickness
  • BMI
  • Blood tests:
    • FBC, U&E, LFT, TFT, clotting (for vitamin K)
    • B12, vitamin D
    • Cortisol and SST
    • Tumour markers
    • Coeliac antibodies
  • Treat cause


Further management of weight loss

  • If feeding supplementation needed then start with oral route if GIT working
    o Give thiamine first (to prevent refeeding syndrome)
  • Watch for refeeding
  • Parenteral nutrition



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Common Weight Loss exam questions for medical students, finals, OSCEs and MRCP PACES


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Perfect revision for medical students, finals, OSCEs and MRCP PACES