№ 6Differential Diagnostic Topics14 min read
Differential diagnosis of unintentional weight loss
1. Big picture
Unintentional weight loss is a warning symptom, not a diagnosis. In the final exam, the key is to organize it clinically:
Confirm true weight loss → decide whether appetite is increased, normal, or reduced → look for red flags → screen for malignancy, chronic infection, endocrine disease, gastrointestinal disease, psychiatric disease, and systemic inflammatory disease.
A very useful bedside split:
| Appetite | Most likely direction |
|---|---|
| Increased or preserved appetite | Hyperthyroidism, uncontrolled diabetes mellitus, malabsorption |
| Reduced appetite/anorexia | Malignancy, chronic infection, depression, chronic organ failure, inflammatory disease |
| Fear/avoidance of eating | Dysphagia, abdominal pain, eating disorder, dementia, social problems |
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