Skip to main content
WardSpace
Presentations

Approach to unintentional weight loss

The same eight steps, every presentation: threats first, then the history and exam that discriminate, one honest sentence, a mechanism-grouped differential, and the tests read in order.

  1. Immediate threats

    • Occult malignancy, especially GI, pancreatic, and lymphoma
    • New diabetes presenting with catabolism
    • Thyrotoxicosis in the elderly, often masked

  2. History that discriminates

    • Quantify it: kilograms and timeframe; over 5% in six months earns a workup
    • Appetite up (thyroid, diabetes, malabsorption) versus down (malignancy, depression, uremia)
    • The systems audit: dysphagia, early satiety, bowel habit change, blood anywhere
    • Mood, memory, medications, and who does the cooking: the geriatric half of the story

  3. Examination

    • Weight now against any documented weight ever
    • Lymph nodes, thyroid, abdomen, rectal
    • Oral health and swallow: mechanical causes hide in plain sight
    • Cognitive screen in the older patient

  4. Problem representation

    Six kilograms in three months with iron deficiency in a 68-year-old (GI tract until scoped) versus weight loss with tremor, heat intolerance and a suppressed TSH (thyrotoxicosis).

  5. Differential, by mechanism

    Malignant

    • GI and pancreatic cancer
    • Lymphoma
    • Lung cancer

    Non-malignant organic

    • Thyrotoxicosis
    • Diabetes
    • Malabsorption/celiac
    • COPD and heart failure cachexia
    • Chronic infection (TB, HIV)

    Functional and social

    • Depression
    • Dementia
    • Poverty and isolation
    • Medication anorexia

  6. Investigations

    • First tier: CBC, ferritin, TSH, glucose or HbA1c, celiac serology, LFTs, calcium, ESR/CRP, urinalysis, CXR
    • Iron deficiency without explanation is a GI referral, not an iron prescription
    • Age-appropriate cancer screening brought up to date
    • CT when the first tier points somewhere or the loss is relentless

  7. Interpretation

    • A normal thorough first tier with a well patient supports watchful reweighing over scanning everyone
    • In the elderly, depression and medications explain more weight loss than cancer does

  8. Next steps

    • Document a target reweigh date; weight is the test that interprets itself over time
    • Treat what was found; and involve nutrition early regardless of cause

Connected

LabsIron deficiency, worked upScriptHypercalcemia of malignancy

Take it further

Copy this page as study notes, then paste them into QSpace for practice questions or AnkiGen for flashcards.

Open QSpace Open AnkiGen