Unintentional weight loss is often a manifestation of significant underlying disease and should never be ignored. The timeframe and amount of weight loss should be noted. A dietary history is required to determine the amount and type of food ingested. Decreased dietary intake may result from loss of appetite or loss of interest in eating due to depression. On the other hand, patients with thyrotoxicosis lose weight, despite a voracious appetite. Enquiries should be undertaken regarding perception of body image, as patients with anorexia nervosa believe that they are overweight, despite being severely underweight. Risk factors for HIV should be screened for and a sexual history as well as information regarding intravenous drug use should be obtained. Systemic enquiry is required to identify features suggestive of malignancy or organ failure in each system to account for unintentional weight loss. A butterfly rash may be present in cases of SLE. Dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea and peripheral oedema are symptoms suggestive of congestive cardiac failure. With longstanding cardiac failure, cardiac cachexia results from loss of total body fat and lean body mass. Currently, the most common aetiology is end-stage heart failure. Dyspnoea without accompanying orthopnoea or paroxysmal nocturnal dyspnoea suggests respiratory disease. With any chronic respiratory disorder, basal metabolic rate is increased as a result of the increased work of breathing. The presence of haemoptysis may be due to malignancy or TB. A long smoking history is a strong predisposing factor for the development of bronchial carcinoma and COPD. Night sweats and weight loss may be accompanying features of both TB and Hodgkin’s disease.
Weight Loss
History
General
Cardiorespiratory system
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