Weight loss resident survival guide: Difference between revisions
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===Common Causes=== | ===Common Causes=== | ||
====Age >65 years<ref name="pmid28388637">{{cite journal |vauthors=Bosch X, Monclús E, Escoda O, Guerra-García M, Moreno P, Guasch N, López-Soto A |title=Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients |journal=PLoS ONE |volume=12 |issue=4 |pages=e0175125 |date=2017 |pmid=28388637 |pmc=5384681 |doi=10.1371/journal.pone.0175125 |url=}}</ref>==== | |||
*[[ | *[[Malignancy|Malignancies]] (specifically digestive and non-hematologic) | ||
* [[Dementia]] | |||
* [[Stroke]] | |||
* [[Parkinson's disease]] | |||
*[[Polymyalgia rheumatica]] | |||
* [[Oral]] disorders. | |||
====Age <65 years<ref name="pmid28388637">{{cite journal |vauthors=Bosch X, Monclús E, Escoda O, Guerra-García M, Moreno P, Guasch N, López-Soto A |title=Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients |journal=PLoS ONE |volume=12 |issue=4 |pages=e0175125 |date=2017 |pmid=28388637 |pmc=5384681 |doi=10.1371/journal.pone.0175125 |url=}}</ref>==== | |||
*[[Endocrine]] disorders | |||
* [[Infections]] such as [[TB]] and [[HIV]] | |||
* [[Psychiatric disorders]] such as [[depression]], [[anxiety]], and [[OCD]] | |||
* [[Malignancy|Malignancies]] such as [[hematology|hematologic]] | |||
====Common causes classified==== | |||
*The chart below demonstrates the cause of unintentional weight loss in adult population. The incidence describes the full range of occurrence described in five studies in older individuals.<ref name="Alibhai2005">{{cite journal|last1=Alibhai|first1=S. M.H.|title=An approach to the management of unintentional weight loss in elderly people|journal=Canadian Medical Association Journal|volume=172|issue=6|year=2005|pages=773–780|issn=0820-3946|doi=10.1503/cmaj.1031527}}</ref><ref name="WuBosch2017">{{cite journal|last1=Wu|first1=Wen-Chih Hank|last2=Bosch|first2=Xavier|last3=Monclús|first3=Esther|last4=Escoda|first4=Ona|last5=Guerra-García|first5=Mar|last6=Moreno|first6=Pedro|last7=Guasch|first7=Neus|last8=López-Soto|first8=Alfons|title=Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients|journal=PLOS ONE|volume=12|issue=4|year=2017|pages=e0175125|issn=1932-6203|doi=10.1371/journal.pone.0175125}}</ref><ref name="pmid24784334">{{cite journal |vauthors=Gaddey HL, Holder K |title=Unintentional weight loss in older adults |journal=Am Fam Physician |volume=89 |issue=9 |pages=718–22 |date=May 2014 |pmid=24784334 |doi= |url=}}</ref><ref name="pmid11168783">{{cite journal |vauthors=Lankisch P, Gerzmann M, Gerzmann JF, Lehnick D |title=Unintentional weight loss: diagnosis and prognosis. The first prospective follow-up study from a secondary referral centre |journal=J. Intern. Med. |volume=249 |issue=1 |pages=41–6 |date=January 2001 |pmid=11168783 |doi=10.1046/j.1365-2796.2001.00771.x |url=}}</ref><ref name="pmid28388637">{{cite journal |vauthors=Bosch X, Monclús E, Escoda O, Guerra-García M, Moreno P, Guasch N, López-Soto A |title=Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients |journal=PLoS ONE |volume=12 |issue=4 |pages=e0175125 |date=2017 |pmid=28388637 |pmc=5384681 |doi=10.1371/journal.pone.0175125 |url=}}</ref><ref name="pmid23633816">{{cite journal |vauthors=Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S |title=Addison's disease |journal=Contemp Clin Dent |volume=3 |issue=4 |pages=484–6 |date=October 2012 |pmid=23633816 |pmc=3636818 |doi=10.4103/0976-237X.107450 |url=}}</ref><ref name="pmid1512386">{{cite journal |vauthors=Brymer C, Winograd CH |title=Fluoxetine in elderly patients: is there cause for concern? |journal=J Am Geriatr Soc |volume=40 |issue=9 |pages=902–5 |date=September 1992 |pmid=1512386 |doi=10.1111/j.1532-5415.1992.tb01987.x |url=}}</ref><ref name="pmid8919685">{{cite journal |vauthors=Guigoz Y, Vellas B, Garry PJ |title=Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation |journal=Nutr. Rev. |volume=54 |issue=1 Pt 2 |pages=S59–65 |date=January 1996 |pmid=8919685 |doi=10.1111/j.1753-4887.1996.tb03793.x |url=}}</ref><ref name="pmid8201141">{{cite journal |vauthors=Morley JE, Kraenzle D |title=Causes of weight loss in a community nursing home |journal=J Am Geriatr Soc |volume=42 |issue=6 |pages=583–5 |date=June 1994 |pmid=8201141 |doi=10.1111/j.1532-5415.1994.tb06853.x |url=}}</ref><ref name="pmid2022802">{{cite journal |vauthors=Thompson MP, Morris LK |title=Unexplained weight loss in the ambulatory elderly |journal=J Am Geriatr Soc |volume=39 |issue=5 |pages=497–500 |date=May 1991 |pmid=2022802 |doi=10.1111/j.1532-5415.1991.tb02496.x |url=}}</ref> | *The chart below demonstrates the cause of unintentional weight loss in adult population. The incidence describes the full range of occurrence described in five studies in older individuals.<ref name="Alibhai2005">{{cite journal|last1=Alibhai|first1=S. M.H.|title=An approach to the management of unintentional weight loss in elderly people|journal=Canadian Medical Association Journal|volume=172|issue=6|year=2005|pages=773–780|issn=0820-3946|doi=10.1503/cmaj.1031527}}</ref><ref name="WuBosch2017">{{cite journal|last1=Wu|first1=Wen-Chih Hank|last2=Bosch|first2=Xavier|last3=Monclús|first3=Esther|last4=Escoda|first4=Ona|last5=Guerra-García|first5=Mar|last6=Moreno|first6=Pedro|last7=Guasch|first7=Neus|last8=López-Soto|first8=Alfons|title=Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients|journal=PLOS ONE|volume=12|issue=4|year=2017|pages=e0175125|issn=1932-6203|doi=10.1371/journal.pone.0175125}}</ref><ref name="pmid24784334">{{cite journal |vauthors=Gaddey HL, Holder K |title=Unintentional weight loss in older adults |journal=Am Fam Physician |volume=89 |issue=9 |pages=718–22 |date=May 2014 |pmid=24784334 |doi= |url=}}</ref><ref name="pmid11168783">{{cite journal |vauthors=Lankisch P, Gerzmann M, Gerzmann JF, Lehnick D |title=Unintentional weight loss: diagnosis and prognosis. The first prospective follow-up study from a secondary referral centre |journal=J. Intern. Med. |volume=249 |issue=1 |pages=41–6 |date=January 2001 |pmid=11168783 |doi=10.1046/j.1365-2796.2001.00771.x |url=}}</ref><ref name="pmid28388637">{{cite journal |vauthors=Bosch X, Monclús E, Escoda O, Guerra-García M, Moreno P, Guasch N, López-Soto A |title=Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients |journal=PLoS ONE |volume=12 |issue=4 |pages=e0175125 |date=2017 |pmid=28388637 |pmc=5384681 |doi=10.1371/journal.pone.0175125 |url=}}</ref><ref name="pmid23633816">{{cite journal |vauthors=Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S |title=Addison's disease |journal=Contemp Clin Dent |volume=3 |issue=4 |pages=484–6 |date=October 2012 |pmid=23633816 |pmc=3636818 |doi=10.4103/0976-237X.107450 |url=}}</ref><ref name="pmid1512386">{{cite journal |vauthors=Brymer C, Winograd CH |title=Fluoxetine in elderly patients: is there cause for concern? |journal=J Am Geriatr Soc |volume=40 |issue=9 |pages=902–5 |date=September 1992 |pmid=1512386 |doi=10.1111/j.1532-5415.1992.tb01987.x |url=}}</ref><ref name="pmid8919685">{{cite journal |vauthors=Guigoz Y, Vellas B, Garry PJ |title=Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation |journal=Nutr. Rev. |volume=54 |issue=1 Pt 2 |pages=S59–65 |date=January 1996 |pmid=8919685 |doi=10.1111/j.1753-4887.1996.tb03793.x |url=}}</ref><ref name="pmid8201141">{{cite journal |vauthors=Morley JE, Kraenzle D |title=Causes of weight loss in a community nursing home |journal=J Am Geriatr Soc |volume=42 |issue=6 |pages=583–5 |date=June 1994 |pmid=8201141 |doi=10.1111/j.1532-5415.1994.tb06853.x |url=}}</ref><ref name="pmid2022802">{{cite journal |vauthors=Thompson MP, Morris LK |title=Unexplained weight loss in the ambulatory elderly |journal=J Am Geriatr Soc |volume=39 |issue=5 |pages=497–500 |date=May 1991 |pmid=2022802 |doi=10.1111/j.1532-5415.1991.tb02496.x |url=}}</ref> | ||
{{familytree/start |summary=Weight loss causes Algorithm.}} | {{familytree/start |summary=Weight loss causes Algorithm.}} |
Revision as of 20:22, 6 September 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Javaria Anwer M.D.[2]
Synonyms and keywords: weight loss management guide, unintentional weight loss management guide, loss of weight resident survival guide, pathologic weight loss resident survival guide.
Lymphadenopathy resident survival guide microchapters |
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Overview |
Causes |
Diagnosis and Management |
Do's |
Don'ts |
Overview
Weight loss may be intentional or unintentional.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Age >65 years[1]
- Malignancies (specifically digestive and non-hematologic)
- Dementia
- Stroke
- Parkinson's disease
- Polymyalgia rheumatica
- Oral disorders.
Age <65 years[1]
- Endocrine disorders
- Infections such as TB and HIV
- Psychiatric disorders such as depression, anxiety, and OCD
- Malignancies such as hematologic
Common causes classified
- The chart below demonstrates the cause of unintentional weight loss in adult population. The incidence describes the full range of occurrence described in five studies in older individuals.[2][3][4][5][1][6][7][8][9][10]
- To read about other causes of unintentional weight loss click here.
Diagnosis and Management
Shown below is an algorithm summarizing the diagnosis of weight loss.[8][11][12][13][14][15][4]
Patient presents with weight loss/ incidental finding | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Loss of >5% of the usual body weight within 6 - 12 months | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
History ❑ Source of history:
❑ Systemic review: Communicable infectious diseases/ travel to high-risk areas. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical exam ❑ Appearance of the patient:
❑ BMI assessment or simply weight among immobile or bed-ridden patients.
❑ Observing the patient having a meal may demonstrate
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Initial screening labs ❑ CBC with differential and peripheral smear
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Provisional diagnosis established | Progressive oropharyngeal or esophageal dysphagia | Stomach/ duodenal ulcer celiac sprue, whipple disease | Potential depression or Cognitive dysfunction | Suspected malignancy | Nutritional deficiency is suspected | Infection is suspected | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Specific tests: ❑ Dental issues: Refer to the dentist. ❑ Nephrotic syndrome: 24-hour urine collection (urine protein >3.5 g/day). | Specific tests: ❑ Upper or lower GI endoscopy with biopsy ❑ Stool fat, anti-transglutaminase antibodies, elastase, lactoferrin ❑ Upper GI and small bowl series | Specific tests: ❑ CT (chest, abdomen, pelvis, head, etc) ❑PET scan | Specific tests ❑ Serum ferritin | Specific tests: ❑ Chronic diarrhea: Stool osmotic gap, culture, ova and parasite, electrolytes, leukocytes, lactoferrin, and C. difficile test. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- Perform a thorough physical exam to evaluate for cause of weight loss.
Don'ts
- The content in this section is in bullet points.
References
- ↑ 1.0 1.1 1.2 Bosch X, Monclús E, Escoda O, Guerra-García M, Moreno P, Guasch N, López-Soto A (2017). "Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients". PLoS ONE. 12 (4): e0175125. doi:10.1371/journal.pone.0175125. PMC 5384681. PMID 28388637.
- ↑ Alibhai, S. M.H. (2005). "An approach to the management of unintentional weight loss in elderly people". Canadian Medical Association Journal. 172 (6): 773–780. doi:10.1503/cmaj.1031527. ISSN 0820-3946.
- ↑ Wu, Wen-Chih Hank; Bosch, Xavier; Monclús, Esther; Escoda, Ona; Guerra-García, Mar; Moreno, Pedro; Guasch, Neus; López-Soto, Alfons (2017). "Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients". PLOS ONE. 12 (4): e0175125. doi:10.1371/journal.pone.0175125. ISSN 1932-6203.
- ↑ 4.0 4.1 Gaddey HL, Holder K (May 2014). "Unintentional weight loss in older adults". Am Fam Physician. 89 (9): 718–22. PMID 24784334.
- ↑ Lankisch P, Gerzmann M, Gerzmann JF, Lehnick D (January 2001). "Unintentional weight loss: diagnosis and prognosis. The first prospective follow-up study from a secondary referral centre". J. Intern. Med. 249 (1): 41–6. doi:10.1046/j.1365-2796.2001.00771.x. PMID 11168783.
- ↑ Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S (October 2012). "Addison's disease". Contemp Clin Dent. 3 (4): 484–6. doi:10.4103/0976-237X.107450. PMC 3636818. PMID 23633816.
- ↑ Brymer C, Winograd CH (September 1992). "Fluoxetine in elderly patients: is there cause for concern?". J Am Geriatr Soc. 40 (9): 902–5. doi:10.1111/j.1532-5415.1992.tb01987.x. PMID 1512386.
- ↑ 8.0 8.1 Guigoz Y, Vellas B, Garry PJ (January 1996). "Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation". Nutr. Rev. 54 (1 Pt 2): S59–65. doi:10.1111/j.1753-4887.1996.tb03793.x. PMID 8919685.
- ↑ Morley JE, Kraenzle D (June 1994). "Causes of weight loss in a community nursing home". J Am Geriatr Soc. 42 (6): 583–5. doi:10.1111/j.1532-5415.1994.tb06853.x. PMID 8201141.
- ↑ Thompson MP, Morris LK (May 1991). "Unexplained weight loss in the ambulatory elderly". J Am Geriatr Soc. 39 (5): 497–500. doi:10.1111/j.1532-5415.1991.tb02496.x. PMID 2022802.
- ↑ Reber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z (July 2019). "Nutritional Risk Screening and Assessment". J Clin Med. 8 (7). doi:10.3390/jcm8071065. PMC 6679209 Check
|pmc=
value (help). PMID 31330781. - ↑ Kondrup J, Allison SP, Elia M, Vellas B, Plauth M (August 2003). "ESPEN guidelines for nutrition screening 2002". Clin Nutr. 22 (4): 415–21. doi:10.1016/s0261-5614(03)00098-0. PMID 12880610.
- ↑ Gazewood JD, Mehr DR (July 1998). "Diagnosis and management of weight loss in the elderly". J Fam Pract. 47 (1): 19–25. PMID 9673603.
- ↑ Hu J, Van Valckenborgh E, Menu E, De Bruyne E, Vanderkerken K (November 2012). "Understanding the hypoxic niche of multiple myeloma: therapeutic implications and contributions of mouse models". Dis Model Mech. 5 (6): 763–71. doi:10.1242/dmm.008961. PMC 3484859. PMID 23115205.
- ↑ Biemer JJ (1984). "Hepatic manifestations of lymphomas". Ann. Clin. Lab. Sci. 14 (4): 252–60. PMID 6380395.