weight loss

Inadvertent weight loss

part (1)

Inadvertent weight loss usually develops within weeks or months. This can be a sign of a significant physical or mental disorder and is associated with an increased risk of death. The cause of the disease may be obvious (e.g., chronic diarrhea due to malabsorption syndrome ) or an unknown etiology (e.g., undiagnosed cancer). This discussion refers to patients who are losing weight, and not to those who lose weight due to the more or less expected consequence of a known chronic disease (for example, metastatic cancer, end-stage COPD).

Weight loss is usually considered a clinically important symptom if it exceeds 5% of body weight or 5 kg for 6 months. However, this traditional definition does not distinguish between the loss of both muscle and body fat, which can lead to different results. Besides, swelling (for example, with heart failure or chronic kidney disease ) can mask the clinically significant loss of muscle mass.

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In addition to weight loss, patients may also have other symptoms, such as anorexia, fever, or night sweats caused by an underlying illness. Depending on the cause and its severity, there may also be symptoms and signs of a nutrient deficiency ( Vitamin deficiency, metabolic disturbance, and overdose ).

The total incidence with significant involuntary weight loss in the United States is about 5% per year. However, the frequency increases with age, often reaching 50% among patients in nursing centers.

Pathophysiology

The results of weight loss are caused by a large number of calories consumed compared to those obtained (consumed with food and absorbed). Diseases that increase consumption or decrease absorption usually cause an increase in appetite. More often, insufficient calorie intake is a mechanism for weight loss, and in such patients, as a rule, there is a decrease in appetite. Sometimes several mechanisms are involved. For example, cancer leads to a decrease in appetite but also increases the basic consumption of calories due to the action of cytokinin mechanisms.
Etiology
Many diseases cause involuntary weight loss, including almost any chronic illness of a sufficient degree of severity. However, many of them are clinically evident and were usually diagnosed at the time of weight loss. Other disorders are most likely manifested as involuntary weight loss ( Some causes of the primary symptoms of involuntary weight loss ).

With the increased appetite associated most common causes of unknown cause involuntary weight loss such as

Hyperthyroidism
Uncompensated diabetes
Malabsorption diseases
With decreased appetite associated most common causes of unknown cause involuntary weight loss such as

Mental illness (e.g. depression )
Cancer
Side effects of drugs
Drug abuse

For some diseases that cause involuntary weight loss, other symptoms are more noticeable, so weight loss is usually not the main complaint. Examples include the following:

Some multisport diseases: gastrointestinal surgery and cystic fibrosis
Chronic inflammatory diseases: severe rheumatoid arthritis
Diseases of the gastrointestinal tract: achalasia, celiac disease, Crohn’s disease, chronic pancreatitis, obstructive disease of the esophagus, ischemic colitis, diabetic enteropathy, peptic ulcer disease, progressive systemic sclerosis, ulcerative colitis (end-stage)
Severe, chronic diseases of the lungs and heart: COPD, heart failure (stage III or IV), pulmonary fibrosis
Mental illnesses (known and poorly controlled): anxiety, bipolar disorder, depression, schizophrenia
Neurological diseases: amyotrophic lateral sclerosis, dementia, multiple sclerosis, myasthenia gravis, Parkinson's disease, stroke
Social Issues: Poverty, Social Exclusion
In chronic kidney disease and heart failure, puffiness can mask the loss of lean body mass.

Survey

The examination should focus on identifying other unknown causes of the disease. Because these reasons are numerous, the examination should be comprehensive.

Anamnesis

The medical history of this disease includes questions about quantitative weight loss and its dynamics. Weight loss reports may not be accurate. Therefore, supporting evidence should be sought, for example, in measuring weight in old medical records, changes in clothing size, or confirmation by family members. The appetite, the eating, and the swallowing process and the image of the intestines should be described. For repeated examinations, patients should keep a nutrition diary because food intake memories are often inaccurate. Non-specific symptoms of possible causes are noted, for example, a feeling of fatigue, malaise, fever and night sweats.

To be continued..........