Timing questions: Since when, is weight loss progressive or has it stabilised
How much weight loss, over what time period, are your clothes looser,
Past fluctuations in weight
Changes in appetite
Changes in diet. What do you eat in an average day?
Changes in exercise
Intentional or unintentional weight loss
Gastro systems review questions:
Abdominal pain, dysphagia, odynophagia, nausea, vomiting +haematemesis, early satiety, indigestion, heart burn, jaundice, bowels and stools including PR bleeding and diarrhoea and steatorrhoea, increased bruising (malabsorption of vit k), distension
PMH GI e.g. peptic ulcers, IBD
Malignancy: night sweats/fever/fatigue. Smoking history and SOB, haemoptysis. rectal bleeding, change in bowel habit, lumps/bumps, prostatic symptoms, haematuria etc
Mood. Over the past two weeks how often have you had little interest or pleasure in doing things/felt down, depressed, hopeless. Trouble falling/staying asleep/sleeping too much. Trouble concentrating. Change in memory.
Hyperthyroidism: Sweating, weight loss, appetite, tremor, flushing, loose stool, periods, eye changes, neck swelling, mood, feeling hot, anxiety, palpitations
Uncontrolled Diabetes: thirst, polyuria
Addisons: dizziness, weakness, pigmentation
Phaeochromocytoma: flushing, HT, headache
HIV: sexual history. Ever injected drugs, ever had sex with a man/bisexual man, ever had sex with anyone from another country, ever paid money for sex/been paid for sex, ever had sex with anyone known to have HIV
TB: fever, night sweats, cough, haemoptysis, chest pain, PMH TB, Fx TB, contact of TB, travel history, country of origin
Hepatitis C: ivdu, blood transfusion pre-1991, sexual contact with person with Hep C, mother with hep C, chronic haemodialysis
Heart failure: SOB, ankle swelling
Neurological: weakness, sensation, speech, swallow, vision, walking, memory
Giant cell arteritis: headache, jaw claudication, scalp tenderness, shoulder pain and stiffness
Rheumatological: joint pains and stiffness, raynauds, rashes, hair loss, mouth ulcers
Eating disorder: Do you make yourself Sick because you feel uncomfortably full? Do you worry you have lost Control over how much you eat? Do you believe yourself to be fat when others say you are too thin? Would you say that food dominates your life? Are you satisfied with your eating patterns? Do you ever eat in secret? (Yes is abnormal Does your weight affect the way you feel about yourself? Have any members of your family suffered with an eating disorder? Do you currently suffer with or have you ever suffered in the past with an eating disorder?
PMH GI problems, heart, lung, renal, liver, neuro
Fx GI problems
Dx: anticonvulsants, diabetes medications, thyroid medication, withdrawal of antipsychotics, non-prescription medications and herbal remedies, medication changes
Sx: travel history, sexual history, alcohol, cocaine/amphetamine/cannabis, smoking, social isolation
Systems review: CVS, Resp, Neuro, GU, MSK etc.
Causes
Malignancy e.g. GI, lung, lymphoma, leukaemia, renal, prostate
Non-malignant GI disease e.g. Peptic ulcers, coeliac, IBD, achalasia, hiatus hernia, pyloric stenosis, chronic pancreatitis, GI infection, hepatobiliary disease
Psychiatric disorders particularly depression, anxiety, eating disorders, bereavement, delusions about food
Endocrine causes e.g. hyperthyroidism, diabetes, adrenal insufficiency, gut hormone tumours e.g. VIPoma
Infectious diseases e.g. HIV, viral hepatitis, TB, chronic fungal/bacterial/helminth disease
Advanced chronic disease g. heart failure, pulmonary cachexia, renal failure, liver failure
Neurologic disease e.g. stroke, dementia, Parkinson’s disease, MND
Medications/substances e.g. alcohol, cocaine, amphetamines, drug withdrawal, tobacco, excess thyroid medications, diuretics
Rheumatic diseases e.g. RA, GCA, SLE
Chronic vigorous exercise e.g. long distance runners
State you would examine the following systems:
CVS, Resp, Abdo, Neuro+AMTS, thyroid, lymph nodes
Investigations according to symptoms and most likely cause:
Bloods- FBC, U+E, LFTs, ESR, CRP, bone profile, TFTs, glucose/Hba1c, coeliac serology, iron/B12/folate, cortisol, HIV test, Hep C screen, autoimmune screen, LDH, blood film, PSA
CXR
Urine dipstick
Stool sample- H pylori, microscopy+culture, Faecal occult blood, ova, cysts and parasites, calprotectin
Ultrasound, CT chest/abdomen/pelvis
OGD, Colonoscopy, barium swallow
Written by Dr Sarah Kennedy
Resources used to write this document include those listed in the references section of this webpage and also:
https://patient.info/doctor/abnormal-weight-loss