Weight loss +/- Anorexia

Weight Loss with Anorexia:

• • Malignancy

  • Psychiatric d/o: depression; anorexia nervosa (in a female Pt <25 yo); alcoholism

  • Uremia

  • Liver disease

  • Chronic lung disease

  • CHF

  • Chronic infections and chronic inflammatory disease

  • Addison's disease

  • Hypercalcemia

Weight Loss without Anorexia:

• • DM (insulin dependent)

  • Thyrotoxicosis

  • Pheochromocytoma

  • Carcinoid syndrome

  • Malabsorption syndrome: intestinal parasitic inf

  • Bulimia

  • Decreased food intake:

    • Secondary to painful oral lesions

    • poor dentition

    • esophageal disease

    • duodenal ulcer with outlet obstruction

    • post-gastrectomy syndrome

    • IBD

Iatrogenic causes:

• • Medications: amphetamines; digitalis; propranolol; broad-spectrum oral ABx; fenfluramine; salicylates; methylphenidate; antimetabolic drugs; codeine; opiates; radiation therapy.

H & P:

• • In female patients anorexia nervosa usually begins before age of 25 or shortly after puberty, rarely later than the middle twenties.

  • Rapid changes in wt over few days suggest changes in body fluids, not tissues.

  • Bulimia patients typically don't have wt. loss, realize that their eating pattern is maladaptive.

  • Mode of onset and duration: how long? how much wt loss x time?...average wt, max wt, min wt; fluctuation in wt?.

  • Character: appetite? binge eating? induced vomiting...diuretics, laxatives, fasting, overactivity; feelings of guilt after binge, fear of becoming obese, feel fat?

  • Aggravating factors: routine meal times (breakfast, lunch, dinner), food faddism and aversions; food allergies; diets?, dental problems, money problems, painful oral lesions, stressors - anxiety, grief, etc.

  • Associated sx: abdominal discomfort, anorexia, change in bowel habits, chronic diarrhea, constipation, melena, dysphagia, nausea, vomiting, polydipsia, polyuria, fever, chills, night-sweats, cold intolerance, heat intolerance, palpitations, fatigue, amenorrhea, depression (SIG EM CAPS), anxiety.

  • Iatrogenic factors: review med. list.

  • Personal and social hx: smoking, alcohol, drugs, education, occupation, exercise, financial, meal preparation, sexual orientation, STIs.

  • PMH/PSH: Abd. surgery, CXR, AbXR, endoscopy

  • Anorexia patients have intense fear of becoming obese and feel fat. They are thin, have leg edema, and typically parotid enlargement. At least 25% of original body wt. loss.

  • Fever, tachycardia/bardycaria, hyotension

  • Tremor, warm moist/dry skin, goiter.

  • Lanugo hair, skin changes over dorsum of hand

  • Examine oral cavity, dentition, dental erosions

  • Parotid gland enlargement

  • LAD, hepatomegaly, splenomegaly

  • Neurological deficits

  • Labs/Dxtic: CBC, electrolytes, BUN, Cr, ESR, FBS, total protein, prealbumin, albumin, transferrin, TSH, FT4, UA, Stool for microscopy, O & P, fat, FOBT, PPD, CXR, GI series

  • Consult: Nutrition counseling, Psych eval if indicated.