Loss of Appetite

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of loss of appetite

Severity is ‍mildmoderatesevere

Occurs most frequently during ‍all mealsbreakfast

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diarrhea, ‍ episodes ‍per day, ‍

‍constipation

‍change in taste

‍bloating

‍heartburn

‍dyspepsia

‍unintentional weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths

‍fatigue

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍depressed mood

‍anxiety



Contributing factors:

‍recent stress

‍recent illness or surgery

‍smoking

‍heavy alcohol use

no history of: ‍depression, ‍anxiety, ‍eating disorders, ‍cancer, ‍thyroid disorders

no use of: ‍chemotherapy, ‍antibiotics, ‍antidepressants, ‍NSAIDs, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady





ASSESSMENT:

‍Appetite loss due to psychosocial factors ‍likelysuspectedpossible

DDx: psychosocial factors, depression, anxiety, eating disorders, infection, gastritis, peptic ulcer disease, inflammatory bowel disease, medication side effect, substance abuse, diabetes mellitus, hyperthyroidism, chronic infections (e.g. HIV, tuberculosis), cancer, chronic kidney disease, liver disease, heart failure, COPD, neurocognitive disorders, rheumatologic conditions, chronic pain syndromes, nutritional deficiencies, electrolyte imbalances, vitamin D deficiency, postoperative states, chronic fatigue syndrome, adrenal insufficiency, Cushing syndrome





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍LFTs, ‍albumin, ‍TSH, ‍cortisol, ‍HIV, ‍PSA

- Upper GI endoscopy

- Colonoscopy

- CT scan of thorax, abdomen, and pelvis

Treatments:

- Dietary counseling

- High-calorie diet

- Nutritional supplements

- ‍Appetite stimulants

Further care:

- Referral to dietitian

- Referral to gastroenterologist

- Referral to psychologist

- Follow-up in ‍ ‍weeksmonths

- Return if loss of appetite continues or if new symptoms develop such as weight loss, nausea, or vomiting