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62 year-old Chinese male
Weight loss of 8kg in 6 months.
He got…
62 year-old Chinese male
Weight loss of 8kg in 6 months.
He got worried when his friends noticed his weight loss even when he had not been dieting nor increasing his physical activity
Cardiovascular Disease
Cardiac failure cachexia
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Associated with increased mortality independent of New York
Heart Association (NYHA) class, with a prevalence as high as 16%
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HX: SOB (exertional, lying flat). Dry cough. Fatigue. Dizziness. N/V. Chest pain. Palpitation
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WORKUP: CBC. Electrolytes panel. Kidney function test. BNP. Stress test. CXR. ECG. Echocardiogram. MRI.
Cancer (6-36%)
Cause involuntary weight loss of at least 5% in approximately one-third of patients, and becomes nearly universal when terminal
Weight loss appears to be greater in solid tumors, especially GI, pancreatic, and lung cancers, and is associated with increased mortality.
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Respiratory Disease
Advanced COPD
Low body weight and, low muscle mass (fat-free mass) is associated with mortality
Cachexia caused by advanced COPD likely due to a combination of increased energy expenditure from work of breathing as well as neurohormonal changes.
HX; >45y/o. Smoking. Dyspnea. Chronic cough. Purulent
sputum. Exertional dyspnea. Wheeze. Chest tightness.
PE: Resonance on percussion (Hyperinflation).
↓Breath sounds. Wheeze/Crackles. Use of accessory
breathing muscles. Neck veins distention. Tar staining.
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Smoking is a common risk factor for both COPD and lung cancer. However , COPD pt with involuntary weight loss should still be assessed for lung cancer.
Gastrointestinal (6-19%)
Malabsorptive syndromes
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Celiac disease
Typically 10-40y/o
Hx: Diarrhea (pale, greasy, voluminous, foul-smelling stools).
Steatorrhea. Flatulence. ≠Abdo pain.
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Peptic ulcer disease
HX: Upper quadrant abdo pain, worsens with eating. Postprandial belching. Epigastric fullness. Early satiety. Fatty food intolerance. Indigestion. N/V. Hematemesis. Black, tarry stool. NASIDs. Hx of Helicobacter pylori infection. Family hx of GI cancer. Smoking.
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Dental disease (difficulty chewing
leading to decreased caloric intake, especially in elderly)
Renal
Renal failure
Weight gain caused by inadequate renal excretion;
advanced renal failure may lead to protein energy malnutrition
Medical treatments (e.g. diuretic therapy, dialysis)
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Medications
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SSRI (Psychiatry), Bupropion; Stimulants (ADHD)
Causing GI side effects,secondarily cause weight loss from diarrhea.
Metformin, GLP-1 agonists (diabetes)
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