Makindo Medical Notes

🍽️ Decreased appetite (anorexia) = reduced desire to eat. It is a non-specific symptom seen in many physical, psychological, and social conditions. Recognising red flags (weight loss, systemic illness, malignancy) is key in clinical practice.

🩺 Clinical Features

• ⚖️ Weight loss: Unintentional, may indicate malnutrition or malignancy.
• 😴 Fatigue: Reduced energy due to poor caloric intake.
• 🧩 Associated symptoms:
  • Abdominal pain, nausea, vomiting → GI disorders
  • Fever → infection
  • Low mood, anhedonia → psychological cause

🔍 Diagnostic Approach

• 🗣️ History: Onset, duration, associated GI or systemic symptoms, recent illness, medications.
• 👀 Physical exam: Signs of malnutrition, abdominal tenderness, neurological deficits.
• 🧪 Laboratory tests:
  • FBC (anaemia, infection)
  • U&E, Ca²⁺, Mg²⁺, Phosphate
  • LFTs, TFTs, coeliac screen
  • Glucose, HbA1c
• 🖼️ Imaging:
  • Abdominal USS/CT → malignancy, IBD
  • CXR → TB, lung tumour, fibrosis
• 🧠 Psychological assessment: Screen for depression, anxiety, eating disorders.

🧪 Common Causes of Decreased Appetite (Anorexia)

• Gastrointestinal (GI) Disorders
  • Gastritis, peptic ulcer disease (PUD)
  • Gastro-oesophageal reflux disease (GORD)
  • Inflammatory bowel disease (Crohn’s, ulcerative colitis)
  • Gastroenteritis (viral, bacterial, parasitic)
  • GI malignancy (stomach, pancreas, colon, liver)
• Infections
  • Acute: influenza, pneumonia, urinary tract infection
  • Chronic: tuberculosis, HIV, hepatitis, endocarditis
• Psychological & Psychiatric
  • Depression 😔
  • Anxiety 😰
  • Eating disorders (anorexia nervosa, bulimia)
  • Stress, bereavement, social isolation
• Medications 💊
  • Chemotherapy drugs
  • Opioids
  • Antibiotics (e.g., metronidazole, macrolides)
  • Metformin
  • Digoxin
  • SSRIs and antipsychotics
• Endocrine & Metabolic
  • Hypothyroidism
  • Diabetes mellitus (esp. uncontrolled or DKA)
  • Adrenal insufficiency (Addison’s disease)
  • Hypercalcaemia
  • Chronic kidney disease (uraemia)
  • Chronic liver disease (cirrhosis, hepatitis)
• Malignancy 🧬
  • Cancer cachexia (due to cytokine release)
  • Common: gastric, pancreatic, lung, lymphoma
• Neurological
  • Dementia
  • Parkinson’s disease
  • Stroke (esp. brainstem)
  • Raised intracranial pressure (tumour, bleed, infection)
• Other Systemic Causes
  • Chronic heart failure
  • COPD with hypoxia
  • Post-surgery / prolonged hospital admission
  • Old age / frailty

🛠️ Management Principles

• 🎯 Treat underlying cause: infections, endocrine disease, GI disorders.
• 🥗 Nutritional support: Supplements, dietitian referral, enteral/parenteral feeding if needed.
• 💊 Appetite stimulants: Consider mirtazapine, megestrol, or steroids (esp. in palliative settings).
• 🧠 Psychological support: CBT, counselling, psychiatry referral.
• 💊 Medication review: Identify and adjust drugs causing anorexia.

📈 Prognosis

Prognosis depends on cause. ✅ Short-term anorexia from infection often resolves with treatment. ⚠️ Chronic causes (e.g., cancer, CKD, dementia) require long-term supportive care and may carry poor prognosis if untreated. Early recognition + targeted management can prevent malnutrition and improve outcomes.