ANOREXIA

Ask the following questions:

1. Is it acute or chronic? Acute anorexia would most likely be due to an acute febrile disease or acute psychiatric disturbance.
2. Is there a history of drug or alcohol ingestion? Alcoholics frequently have a loss of appetite. Patients on aspirin and digitalis and many other drugs may lose their appetite.
3. Is there an abdominal mass? The abdominal mass may be either an enlarged liver or other mass. The most likely abdominal mass to produce anorexia as the only symptom would be an early pancreatic neoplasm. When the neoplasm advances, jaundice should be present. Other neoplasms may be felt and/or metastasize to the liver and cause hepatomegaly.
4. Is there a cough? If there is a chronic cough, one should consider tuberculosis or carcinoma of the lung.
5. Is there hepatomegaly? Hepatomegaly without any other masses present in the abdomen would certainly bring to mind a cirrhosis. This could be of cardiac origin, so congestive heart failure should be ruled out. Also, the hepatomegaly may be related to a collagen disease or metastatic carcinoma.

DIAGNOSTIC WORKUP

If the general physical examination is normal, it may be wise to obtain a psychiatric consult at the outset. All patients with anorexia as the major sign should have a CBC, sedimentation rate, chemistry panel, thyroid profile [free thyroxine index (FT ₄ I) and thyroid-stimulating hormone-sensitive assay ( S-TSH)] , and a chest x-ray. A referral to a gastroenterologist may be wise if these are negative. However, if the clinician wishes to proceed on his own, then a search for a neoplasm should be conducted and should include an upper GI series, barium enema, abdominal CT scan, and bone scan. If these are negative, a gastroscopy or colonoscopy may be required.

A complete endocrinologic workup by an endocrinologist may be indicated if all the above studies are negative. Patients with a normal physical examination and normal diagnostic studies should be referred to a psychiatrist.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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