Makindo Medical Notes

⚖️ Unintentional weight loss in adults is a red flag symptom that warrants careful evaluation. 📉 Defined as >5% body weight loss over 6–12 months, it may indicate underlying malignancy, endocrine disease, infection, psychiatric illness, or social causes. 🧠 Clinicians must approach systematically: history → examination → investigations → management.

🩺 Clinical History

1. ⏱️ Onset & Duration: When did weight loss begin? Gradual vs rapid?
2. 📊 Quantify: How much weight lost? (% body weight over time).
3. 🍽️ Appetite & Dietary Changes: Loss of appetite, early satiety, dietary restriction?
4. 🧾 Associated Symptoms: - Fatigue, weakness - GI: nausea, vomiting, diarrhoea, abdominal pain, steatorrhoea - Psychological: depression, anxiety, stress - Infection: fevers, night sweats, cough
5. 📜 Past Medical History: Diabetes, hyperthyroidism, IBD, malignancy.
6. 💊 Medications: Metformin, SSRIs, chemotherapy agents, appetite suppressants.
7. 🏠 Social History: Alcohol, drugs, smoking, food insecurity, bereavement, recent stressors.

👩‍⚕️ Physical Examination

1. 👀 General Inspection: Cachexia, muscle wasting, pallor, jaundice, lymphadenopathy.
2. 📈 Vital Signs: BP, HR, temperature (sepsis, thyrotoxicosis, adrenal crisis).
3. 📏 BMI: Quantify severity of weight loss.
4. 🔍 Systematic Examination: - GI: abdominal masses, hepatomegaly, stigmata of chronic liver disease - Endocrine: goitre, tremor, tachycardia, pigmentation - Respiratory: cachexia, clubbing, chest signs - Neurological: cognitive decline, weakness

🔬 Investigations

1. 🧪 Blood Tests: - FBC (anaemia, malignancy, infection) - LFTs, U&Es, calcium - TFTs (hyperthyroidism) - HbA1c/glucose (diabetes) - ESR/CRP (chronic infection/inflammation) - HIV, TB tests if risk factors
2. 🖥️ Imaging: - CXR (malignancy, TB, CHF, COPD) - Abdominal ultrasound (masses, liver disease) - CT/MRI for unexplained weight loss
3. 🧫 Other Tests: - Stool tests (fat, parasites, occult blood) - Endoscopy/colonoscopy if GI symptoms - Psychiatric/psychological assessment if mood/eating disorder suspected

📚 Causes of Weight Loss

• 🎗️ Malignancy: Lung, pancreatic, GI, lymphoma.
• 🦠 Chronic Infections: TB, HIV, parasitic diseases.
• 🔁 Endocrine: Hyperthyroidism, diabetes, adrenal insufficiency.
• 🍽️ GI/Malabsorption: Coeliac, Crohn’s, chronic liver disease.
• 🧠 Psychiatric: Depression, anxiety, anorexia nervosa.
• 💊 Medications: Metformin, SSRIs, chemotherapy.
• ❤️ Chronic disease: COPD, CHF, CKD.
• 🍺 Substance misuse: Alcohol, drugs.

⚕️ Management Principles

1. 🎯 Treat the underlying cause (thyroid therapy, ART for HIV, chemotherapy for malignancy).
2. 🥗 Nutritional support: Dietitian referral, supplements, enteral feeding if severe.
3. 🧠 Psychiatric support: CBT, SSRIs, eating disorder services where indicated.
4. 🔄 Regular follow-up: Monitor weight, nutrition, functional status.
5. 🤝 Multidisciplinary care: GP, dietitian, psychiatry, oncology, gastroenterology as required.

📊 Summary Table