Anorexia and weight loss

Loss of body fluid for any reason, e.g. diuretic therapy, can produce rapid and dramatic weight loss I l litre of water -I kilogram). Otherwise, weight loss arises from a reduction

TABLE 5.6 Common causes of haematemesis and melaena

Cause

Frequency %

Gastric ulcer

30

Duodenal ulcer

20

Erosive gastritis or duodenitis

30

Oesophagilis or Mallory-Weiss tear

15

Oesophageal/gastric varices

2

Upper Gl malignancy

2

in both adipose and fat-free mass. Weight loss is more commonly the result of reduced energy intake than of increased energy expenditure. Reduced energy intake arises from dieting, loss of appetite or malabsorption. Energy loss occurs in marked glycosuria. Increased energy expenditure occurs in hyperthyroidism, fever or a change to a more energetic lifestyle. Since 7000 kcal is ihe equivalent of I kg of human adipose tissue, a net calorie dcficil of 1000 kcal per day will produce a weight loss of approximately I kg per week. Greater weight losses during the initial stages of energy restriction arise from loss of lat-free mass especially salt and water loss and depletion of hepatic glycogen stores.

Significant weight loss occurring as an isolated symptom is rarely associated with serious organic disease. However, a careful history may elicit other symptoms and alert the clinician to the underlying cause. While some patients can accurately quantify their weight loss, many cannot. The patient may assess the rate and severity of weight loss from ill-fitting clothes. Whenever possible such subjective assessment should be confirmed objectively. Review of previously documented weights from case records may avoid needless investigation in patients who mistakenly believe they are losing weight. The significance of weight loss relates to its duration and extent together with the presence or absence of anorexia (loss of appetite) or deliberate reduction in food intake. Weight loss of less than 3 kg in the previous 6 months is rarely of significance. Weight loss accompanied by severe anorexia or other alimentary symptoms may not necessarily be due to intraabdominal disease: such features may occur, for example, in depression. Weight loss may result from physical, psychological or social factors, Grief, depression and chronic

CASE HISTORY

A 14-year-old girl piesented with a history of weight loss of 6 kg over the previous year. Though menarche had occurred at the age of 12. menstruation had stopped 6 months previously, raising the possibility of anorexia nervosa, On further questioning it emerged fhal 1 year previously she had developed generalised aches and pains with arthralgia associated with a painful skin rash over the lower limbs. She remembered the date of onset as her grandfather had returned to Jamaica following his visit to the UK For 3 months she had complained of night sweals and a dry cough The probability of pulmonary tuberculosis was suggested by a family history of TB. presumed erythema nodosum, persistent febrile symptoms and Ihe absence of BCG Inoculation. The diagnosis was rapidly confirmed by chest radiograph and spulum microscopy.

Learning points

• Weight loss >3 kg In 6 months Is significant.

• Weight loss from any cause may result in cessation of menstruation.

• Eliciting a history of illness In other family members is important.

• Presenting symptoms may not relate to the organ or system most affected.

alcohol abuse arc commonly associated with weight loss. Weight loss with anaenorrhoea in an adolescent female suggests the possibility of anorexia nervosa. In addition to a search for serious underlying disease, the physician should enquire of changes in the social well-being and lifestyle of the patient.

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