Unexplained weight loss Final.pdf

Unexplained Weight Loss PRESENTED BY GROUP D2 GROUP MEMBERS 1. Annan Evans 8. Arthur Jesse Denyansah 2. Sasu Manasseh 9. Quashie Michael Selasie 3. Addo Naa Aku 10. Hayfron Rebecca Winnie 4. Quarshie Benjamin 11. Oduro Kofi-Quakyi 5. Darko Ntim Nana Yaa 12. Donkor E...

Unexplained Weight Loss PRESENTED BY GROUP D2 GROUP MEMBERS 1. Annan Evans 8. Arthur Jesse Denyansah 2. Sasu Manasseh 9. Quashie Michael Selasie 3. Addo Naa Aku 10. Hayfron Rebecca Winnie 4. Quarshie Benjamin 11. Oduro Kofi-Quakyi 5. Darko Ntim Nana Yaa 12. Donkor Elsie Darkowaa 13. Tete-Marmon James 6. Miah John Kwasi 14. Amponsah Emmanuel 7. Atiapah Emmanuel 15. Asiome Wise 2 Introduction Unexplained or unintentional weight los s is defined as weight loss of at least 5% of the patient’s usual body weight that occurs within the preceding 6 to 12 months, and that is not the expected consequence of treatment of a known illness. (e.g. weight loss from diuretic therapy in patients with heart failure) 3  Definition of related terms Cachexia Sarcopenia Malnutrition It is defined as It is a geriatric It is a deficiency, weight loss from syndrome excess or loss of muscle characterized by imbalance in mass ( with or loss of muscle individual intake without fat loss) in mass, strength of energy and the presence of and performance, nutrients. the metabolic which may or may effects of an not be underlying illness accompanied by as seen in cancer unintentional or advanced heart weight loss. failure. 4  Epidemiology of unexplained weight loss Prevalence of unexplained weight loss varies between 7% and 13% The prevalence in those over 65 is reportedly 15-20%, with as many as 27% of community dwelling elderly people and 50% to 60% of nursing home residents being affected, in certain populations 5  Etiology of unexplained weight loss Decreased Intake Malabsorption Increased energy expenditure Psychiatric disorders ( Small bowel disease (e.g. Cancer Depression, eating Crohn’s disease, Celiac disorders) disease) Chronic Alcohol abuse Pancreatic insufficiency Hyperthyroidism Side effects of drugs such Cholestatic liver disease Chronic cardiac failure as metformin and chemotherapeutic drugs Dementia Protein-losing Enteropathy Chronic renal failure (e.g. Inflammatory Bowel Disease) Dysphagia due to Upper GI Adrenal insufficiency disorder Poorly controlled Diabetes Mellitus HIV Chronic infections 6 Etiology of unexplained weight loss cont’d 7 Evaluation of Unexplained Weight loss 8 Approach to weight loss assessment Currently, there are no widely-accepted guidelines for the clinical evaluation of unexplained weight loss. Initial evaluation of the patient involves: A detailed history Comprehensive clinical examination Baseline investigations The findings should be used to guide further investigation. 9  Weight loss assessment algorithm Close follow-up if No weight loss < 5% Documented weight loss ≥ 5% of usual No suspected diagnosis body weight over 6- 12months Complete history and Yes physical examination Suspected diagnosis 10 History overview Documenting weight loss Pattern of weight loss Evaluation of eating disorders and intentional weight loss Malnutrition screening Associated symptoms Drug history Functional and social factors 11 Documentation Previous records Query family members about the patient's weight history, including usual weight prior to the period of weight loss. 12 Pattern of weight loss Determine the duration and pattern of weight loss Past fluctuations in weight Is weight loss progressive or stable? Other factors to consider: Changes in appetite Caloric intake Physical activity. 13 Evaluation for eating disorders and intentional weight loss Probe into possible intentional weight loss either from dieting or eating disorders. Look out for features of anorexia nervosa Look out for features of bulimia nervosa 14 Malnutrition screening There are several validated screening tools to help identify patients at risk for malnutrition, all of which include a measure of unintentional weight loss. MUST (Displayed) ESPEN 15 Associated symptoms Gastrointestinal: Nausea, vomiting, abdominal pain, diarrhea Malignancy: Recurrent infections, unexplained fever, fatigue, loss of appetite Malabsorption: steatorrhea, muscle loss, watery diarrhoea, increased bruising (vit. K) Psychiatric: insomnia, decreased activity, guilt, lack of concentration, suicidal thoughts 16 Medications/substances Identify all medications including prescription, nonprescription and herbal medications Common drugs that are implicated include: Alcohol Metformin Chemotherapeutic agents Drug withdrawal symptoms Herbal non-prescription drugs 17 Functional factors Poor dentition dysphagia Poor cognition Dementia 18 Social factors Social factors related to food How food is obtained Who cooks Travel history Sexual history in appropriate patients to asses risk for infectious aetiologias 19 Exploring Physical examination & Management 20 Physical examination findings General appearance Abdominal examination Flat affect can be a sign of psychiatric Tenderness disease Ascites Head and neck Hepatosplenomegaly Ophthalmoplegia and stigmata of Abdominal masses nutritional deficiencies Cognitive assessment Cheilosis Neurological deficits Glossitis Cardiopulmonary examination Dental examination Chronic cardiac conditions 21 Probable Investigations BLOOD URINE/ STOOL IMAGING & OTHERS FBC with differential Urine dipstick Chest X-ray Glucose and HbA1c Urinalysis Abdominal ultrasound Serum electrolytes Urine culture and Upper and lower GI LFT, RFT, TSH sensitivity Endoscopy Inflammatory markers: Stool microscopy Echocardiography ESR/CRP Fecal occult blood test Cancer screening (age- appropriate) HIV, Hep C viral screen Fecal fat 22  Evaluation of Investigation Findings If no abnormal findings If any abnormal findings Watchful waiting for 1-6 months Targeted diagnostic evaluation Shorter interval for patients with Targeted treatment progressive weight loss During follow-up, careful attention should be paid to : Dietary history Possibility of psychosocial causes Surreptitious drug intake New manifestations of occult illness 23  Non-pharmacological Management Optimize food intake  Work with a dietician to create a meal plan that helps increase caloric intake  Encourage eating well-balanced diets  Eating in company or with assistance is useful Oral nutritional supplements (if recommended) Regular physical activity  Stimulates appetite  Prevents sarcopenia Ensure adequate oral health Stress reduction Adequate social support Abstinence from alcohol and substance use 24  Pharmacological Management Pharmacotherapy varies and depends on underlying cause Treat acute illnesses present and optimise chronic conditions Benefits should outweigh risks Ensure rational drug use Monitor RFT Pharmacological agents such as: Megestrol acetate (increased risk of thrombosis, delirium), Anabolic agents (testosterone , glucocorticoids, growth hormone and IGF-1 etc.) (increased mortality risk) 25 COMPLICATIONS OF UNEXPLAINED WEIGHT LOSS 26  CONCLUSION The incidence of unexplained weight loss is on the rise and thus appropriate measures should be put in place to identify the cause so that management can be initiated. 27 References Sullivan (1991) Am J Clin Nutr 53:599-605 [PubMed] Lacy C; American Pharmacists Association. Drug Information Handbook. 17th ed. Hudson, Ohio: Lexi-Comp; 2008. Wong, Christopher J. “Evaluation of Unintentional Weight Loss - Differential Diagnosis of Symptoms | BMJ Best Practice US.” Bestpractice.bmj.com, bestpractice.bmj.com/topics/en-us/548. “Unintentional Weight Loss.” Fpnotebook.com, fpnotebook.com/Endo/Geri/UntntnlWghtLs.htm. Accessed 11 Dec. 2022. 28 29