History of presenting complaint
o Amount and duration of weight loss
o Any intentional weight loss?
o Dietary changes
o Calorie intake
o ALARMS symptoms (see Dysphagia) and other cancer red flags
o Full systems review
o Systemic symptoms – night sweats
o Psychological history – number of diets, any previous eating disorders, weight fluctuations
Past medical history
o See list of causes
Medications
o Appetite suppressants (including over-the-counter drugs)
Family history
o Cancer
o Eating disorders
Social history
o Smoking
o Travel history
o Risk factors for HIV
Examination of weight loss
Cachexia
Lymphadenopathy
Abdominal masses
Evidence of cardio or respiratory failure
Signs of hyperthyroidism
Initial management of weight loss
Subjective global assessment
Skin fold thickness
BMI
Blood tests:
FBC, U&E, LFT, TFT, clotting (for vitamin K)
B12, vitamin D
Cortisol and SST
Tumour markers
Coeliac antibodies
Treat cause
Further management of weight loss
If feeding supplementation needed then start with oral route if GIT working
o Give thiamine first (to prevent refeeding syndrome)
