Involuntary Weight Loss

A patient is losing weight, without trying.  We approach this as follows (see Full Text for explanation of the various parts of the work-up)

1.  Take a medical history, looking for clues like:

  • Diarrhea (significant): likely explanation (see topic Diarrhea for work-up & causes)
  • Blood (coughing it, vomiting it, pooping/peeing it, etc): investigate the lungs
  • Symptoms pointing to a specific organ (trouble swallowing, hoarseness, pain, etc.): investigate that organ (endoscopy, x-ray / images, biopsies, etc.)
  • Nausea / Vomiting: if all tests normal, might be a Stomach Ulcer (refer for endoscopy, or try treating)
  • Sweats at night (drenching)  —  could be Infection or Cancer.  Needs tests in #3 below, maybe CT scan of abdomen & pelvis
  • New Lump or Mole, or changes in previous one — suspect Cancer. Biopsy it.

2.  Perform a Physical Exam, looking for clues like:

3.  Order basic Laboratory Tests like:

4.  If any Upper Abdominal Pain, or Nausea / Vomiting, we may try treatment with high-dose Proton Pump Inhibitor (PPI) for possible stomach ulcer (see Antacid Medicines).

  • If it helps symptoms, lower to standard dose
  • BEWARE:  PPIโ€™s can relieve the pain of stomach cancer.  We’d change soon to an “H-2 Blocker” (also cure ulcers but won’t help cancer pain)  (see Antacid Medicines).
  • If pain returns, or weight doesn’t improve rapidly, we refer to Gastroenterologist for Endoscopy to rule-out Stomach Cancer.

5.  If None of the Above (no symptoms suggesting possible Ulcer, and all of history, physical exam, & lab tests are normal), we explore the possibility of various psychiatric disorders, especially Depression

6.  Everything is Normal —  if weight still declines during 2-3 weeks from initial visit, patient needs bigger work-up (for various Cancers):

  • Abdominal and Pelvic CT scans
  • Colonoscopy if the patient is over 45 and hasnโ€™t had one recently (for Colon Cancer)
  • Mammogram if over 40 & no recent exam (for Breast Cancer)
  • If signs of very rare Adrenal Insufficiency (new tanning of skin; or a drop in blood pressure between lying down & abrupt standing) — refer to an Endocrinologist

See Weight Loss โ€” Full Text for more in-depth explanations and discussions.

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