Weight loss resident survival guide: Difference between revisions
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*To read about other causes of unintentional weight loss [[Weight loss#Causes|click here]]. | *To read about other causes of unintentional weight loss [[Weight loss#Causes|click here]]. | ||
==Diagnosis== | ==Diagnosis and Management== | ||
Shown below is an algorithm summarizing the diagnosis of [[weight loss]].<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="pmid31330781">{{cite journal |vauthors=Reber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z |title=Nutritional Risk Screening and Assessment |journal=J Clin Med |volume=8 |issue=7 |pages= |date=July 2019 |pmid=31330781 |pmc=6679209 |doi=10.3390/jcm8071065 |url=}}</ref><ref name="pmid12880610">{{cite journal |vauthors=Kondrup J, Allison SP, Elia M, Vellas B, Plauth M |title=ESPEN guidelines for nutrition screening 2002 |journal=Clin Nutr |volume=22 |issue=4 |pages=415–21 |date=August 2003 |pmid=12880610 |doi=10.1016/s0261-5614(03)00098-0 |url=}}</ref><ref name="pmid9673603">{{cite journal |vauthors=Gazewood JD, Mehr DR |title=Diagnosis and management of weight loss in the elderly |journal=J Fam Pract |volume=47 |issue=1 |pages=19–25 |date=July 1998 |pmid=9673603 |doi= |url=}}</ref><ref name="pmid23115205">{{cite journal |vauthors=Hu J, Van Valckenborgh E, Menu E, De Bruyne E, Vanderkerken K |title=Understanding the hypoxic niche of multiple myeloma: therapeutic implications and contributions of mouse models |journal=Dis Model Mech |volume=5 |issue=6 |pages=763–71 |date=November 2012 |pmid=23115205 |pmc=3484859 |doi=10.1242/dmm.008961 |url=}}</ref><ref name="pmid6380395">{{cite journal |vauthors=Biemer JJ |title=Hepatic manifestations of lymphomas |journal=Ann. Clin. Lab. Sci. |volume=14 |issue=4 |pages=252–60 |date=1984 |pmid=6380395 |doi= |url=}}</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> | Shown below is an algorithm summarizing the diagnosis of [[weight loss]].<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="pmid31330781">{{cite journal |vauthors=Reber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z |title=Nutritional Risk Screening and Assessment |journal=J Clin Med |volume=8 |issue=7 |pages= |date=July 2019 |pmid=31330781 |pmc=6679209 |doi=10.3390/jcm8071065 |url=}}</ref><ref name="pmid12880610">{{cite journal |vauthors=Kondrup J, Allison SP, Elia M, Vellas B, Plauth M |title=ESPEN guidelines for nutrition screening 2002 |journal=Clin Nutr |volume=22 |issue=4 |pages=415–21 |date=August 2003 |pmid=12880610 |doi=10.1016/s0261-5614(03)00098-0 |url=}}</ref><ref name="pmid9673603">{{cite journal |vauthors=Gazewood JD, Mehr DR |title=Diagnosis and management of weight loss in the elderly |journal=J Fam Pract |volume=47 |issue=1 |pages=19–25 |date=July 1998 |pmid=9673603 |doi= |url=}}</ref><ref name="pmid23115205">{{cite journal |vauthors=Hu J, Van Valckenborgh E, Menu E, De Bruyne E, Vanderkerken K |title=Understanding the hypoxic niche of multiple myeloma: therapeutic implications and contributions of mouse models |journal=Dis Model Mech |volume=5 |issue=6 |pages=763–71 |date=November 2012 |pmid=23115205 |pmc=3484859 |doi=10.1242/dmm.008961 |url=}}</ref><ref name="pmid6380395">{{cite journal |vauthors=Biemer JJ |title=Hepatic manifestations of lymphomas |journal=Ann. Clin. Lab. Sci. |volume=14 |issue=4 |pages=252–60 |date=1984 |pmid=6380395 |doi= |url=}}</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> | ||
{{familytree/start |summary=Weight loss Diagnostic Algorithm.}} | {{familytree/start |summary=Weight loss Diagnostic Algorithm.}} | ||
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{{familytree | | | | | | | | | | | | | |!| | | | | | | }} | {{familytree | | | | | | | | | | | | | |!| | | | | | | }} | ||
{{familytree | | | | | | | | | | | | | |!| | | | | | | }} | {{familytree | | | | | | | | | | | | | |!| | | | | | | }} | ||
{{familytree | | | | | | | | | | | | | M01 | | | | | | | M01=<div style="float: left; text-align: left; width: | {{familytree | | | | | | | | | | | | | M01 | | | | | | | M01=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Physical exam'''<div class="mw-collapsible mw-collapsed"><br> | ||
❑ Appearance of the [[patient]]:<br>[[Cachexia]] is observed among [[patients]] with [[malignancy]]. Surgical scar marks demonstrating previous surgery for intentional weight loss or [[malignancy]] treatment<br> | ❑ Appearance of the [[patient]]:<br>[[Cachexia]] is observed among [[patients]] with [[malignancy]]. Surgical scar marks demonstrating previous surgery for intentional weight loss or [[malignancy]] treatment<br> | ||
❑ [[Vital signs]]<br> | ❑ [[Vital signs]]<br> | ||
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❑ Mini mental state examination to assess the [[cognitive function]], and [[mood]] assessment.}} | ❑ Mini mental state examination to assess the [[cognitive function]], and [[mood]] assessment.}} | ||
{{familytree | | | | | | | | | | | | | |!| | | | | | |}} | {{familytree | | | | | | | | | | | | | |!| | | | | | |}} | ||
{{familytree | | | | | | | | | | | | | U01 | | | | | | | U01='''Initial screening labs'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; width: | {{familytree | | | | | | | | | | | | | U01 | | | | | | | U01='''Initial screening labs'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; width: 15em; padding:1em;"> | ||
❑ [[CBC]] with differential and [[peripheral smear]]<br> | ❑ [[CBC]] with differential and [[peripheral smear]]<br> | ||
❑ [[ESR]], [[CRP]], [[LDH]]<br> | ❑ [[ESR]], [[CRP]], [[LDH]]<br> | ||
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{{familytree | B07 | | B01 | | B02 | | B03 | | B04 | | B05 | | B06 | |B07= Provisional diagnosis established| B01=Progressive [[oropharyngeal]] or [[esophageal]] [[dysphagia]]|B02=[[Stomach ulcer|Stomach]]/ [[duodenal ulcer]]<br> [[celiac sprue]], [[whipple disease]]|B03=Potential [[depression]] or [[cognitive impairment|Cognitive dysfunction]]|B04=Suspected [[malignancy]]|B05=Nutritional deficiency is suspected|B06=<div style="float: left; text-align: center; width: 15em;">[[Infection]] is suspected}} | {{familytree | B07 | | B01 | | B02 | | B03 | | B04 | | B05 | | B06 | |B07= Provisional diagnosis established| B01=Progressive [[oropharyngeal]] or [[esophageal]] [[dysphagia]]|B02=[[Stomach ulcer|Stomach]]/ [[duodenal ulcer]]<br> [[celiac sprue]], [[whipple disease]]|B03=Potential [[depression]] or [[cognitive impairment|Cognitive dysfunction]]|B04=Suspected [[malignancy]]|B05=Nutritional deficiency is suspected|B06=<div style="float: left; text-align: center; width: 15em;">[[Infection]] is suspected}} | ||
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!|}} | {{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!|}} | ||
{{familytree |C07| | C01 | | C02 | | C03 | | C04 | | C05 | | C06 | |C07=<div style="float: left; text-align: left; width: | {{familytree |C07| | C01 | | C02 | | C03 | | C04 | | C05 | | C06 | |C07=<div style="float: left; text-align: left; width: 15em;">Specific tests:<div class="mw-collapsible mw-collapsed">❑ Dental issues: Refer to the [[dentist]].<br> | ||
❑ [[Nephrotic syndrome]]: [[24-hour urine collection]] ([[urine]] protein >3.5 g/day). <br> | ❑ [[Nephrotic syndrome]]: [[24-hour urine collection]] ([[urine]] protein >3.5 g/day). <br> | ||
❑ [[Nephritic syndrome]]: Assess [[complement levels]], [[HBV]], [[HCV]], [[HIV]] serologies, [[c-ANCA]] and [[p-ANCA]], and [[anti-dsDNA antibodies]].<br> | ❑ [[Nephritic syndrome]]: Assess [[complement levels]], [[HBV]], [[HCV]], [[HIV]] serologies, [[c-ANCA]] and [[p-ANCA]], and [[anti-dsDNA antibodies]].<br> | ||
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❑ [[Stroke]]: [[CT]] or [[MRI]] head.<br> | ❑ [[Stroke]]: [[CT]] or [[MRI]] head.<br> | ||
❑ [[Hyperparathyroidism]]: Serum [[calcium]], [[phosphate]] levels to identify the type.<br> | ❑ [[Hyperparathyroidism]]: Serum [[calcium]], [[phosphate]] levels to identify the type.<br> | ||
❑ Drug-induced|C01=<div style="float: left; text-align: left; width: | ❑ Drug-induced|C01=<div style="float: left; text-align: left; width: 15em;">❑ Video[[fluoroscopy]]<br>❑ [[Dysphagia barium swallow]]|C02=<div style="float: left; text-align: left; width: 15em;">Specific tests:<div class="mw-collapsible mw-collapsed">❑ Upper or lower [[gastrointestinal system|GI]] [[endoscopy]] with [[biopsy]]<br> | ||
❑ [[Fecal fat|Stool fat]], [[anti-transglutaminase antibodies]], [[elastase]], [[lactoferrin]]<br>❑ Upper GI and small bowl series|C03=<div style="float: left; text-align: left; width: | ❑ [[Fecal fat|Stool fat]], [[anti-transglutaminase antibodies]], [[elastase]], [[lactoferrin]]<br>❑ Upper GI and small bowl series|C03=<div style="float: left; text-align: left; width: 15em;"> | ||
❑ [[Geriatric Depression Scale]]<br> | ❑ [[Geriatric Depression Scale]]<br> | ||
❑ [[MoCA]]|C04=<div style="float: left; text-align: left; width: | ❑ [[MoCA]]|C04=<div style="float: left; text-align: left; width: 15em;">Specific tests:<div class="mw-collapsible mw-collapsed">❑ [[CT]] ([[chest]], [[abdomen]], [[pelvis]], [[head]], etc)<br> | ||
❑[[PET scan]]<br> | ❑[[PET scan]]<br> | ||
❑ [[Colonoscopy]]<br> | ❑ [[Colonoscopy]]<br> | ||
❑ [[Mammogram]]<br> | ❑ [[Mammogram]]<br> | ||
❑ [[Protein electrophoresis]]|C05=<div style="float: left; text-align: left; width: | ❑ [[Protein electrophoresis]]|C05=<div style="float: left; text-align: left; width: 15em;">Specific tests<div class="mw-collapsible mw-collapsed"> | ||
❑ Serum [[ferritin]]<br> | ❑ Serum [[ferritin]]<br> | ||
❑ Vitamins: [[Beta carotene]], [[vitamin D]], [[tocopherol]], [[vitamin B12]], and [[folic acid]]<br> | ❑ Vitamins: [[Beta carotene]], [[vitamin D]], [[tocopherol]], [[vitamin B12]], and [[folic acid]]<br> | ||
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{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!|}} | {{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!|}} | ||
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!|}} | {{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!|}} | ||
{{familytree | D07 | | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | | |D07=<div style="float: left; text-align: left; width: | {{familytree | D07 | | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | | |D07=<div style="float: left; text-align: left; width: 15em;">Treatment<div class="mw-collapsible mw-collapsed">[[Nephrotic syndrome medical therapy|Nephrotic syndrome treatment]]<br>[[Hyperthyroidism medical therapy|Hyperthyroidism treatment]]<br>[[Hepatitis medical therapy|Hepatitis treatment]]<br>[[Chronic cholecystitis medical therapy|Chronic cholecystitis treatment]]|D01=|D02=|D03=|D04=|D05=|D06=<div style="float: left; text-align: left; width: 15em;">Treatment<div class="mw-collapsible mw-collapsed"> | ||
❑ [[Chronic diarrhea medical therapy|Chronic diarrhea treatment]]<br> | ❑ [[Chronic diarrhea medical therapy|Chronic diarrhea treatment]]<br> | ||
❑ [[Tuberculosis medical therapy|Tb treatment]]<br> | ❑ [[Tuberculosis medical therapy|Tb treatment]]<br> |
Revision as of 20:14, 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 |
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
- Malignancies (specifically digestive and non-hematologic), dementia, stroke, parkinson's disease, polymyalgia rheumatica, and oral disorders are more prevalent among individuals >65 years old.[1]
- Endocrine disorders, infections such as TB and HIV, psychiatric disorders such as depression, anxiety, OCD, and malignancies such as hematologic ones are more prevalent among patients, <65 years of age.[1]
- 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. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
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.