Loss of Appetite
Differential Overview
❑ Depression
❑ Drugs
❑ Anorexia nervosa
❑ Congestive heart failure
❑ Hepatitis
❑ Cancer
❑ HIV infection
❑ Uremia
❑ Addison disease
❑ Mesenteric ischemia
❑ Hypothalamic lesion
Diagnostic Approach
This differential refers to protracted loss of appetite. Acute anorexia may occur as a migraine prodrome or in early appendicitis.
Anorexia must be differentiated from early satiety or odynophagia (aversion to swallowing due to pain).
Clinical Findings
Depression Depressed mood, anhedonia, sleep disturbance, and inertia are key symptoms.
Drugs Digoxin, narcotics, diuretics, amphetamines, antidepressants (SSRIs), and antihypertensives (especially ACE inhibitors) are common causes.
Anorexia nervosa Loss of appetite is less common than an avoidance of food due to an abnormal body perception. Suspect anorexia nervosa in very thin young women. Hypothermia, constipation, and downy lanugo hair are additional findings.
Congestive heart failure Because anorexia only occurs in advanced heart failure, signs such as edema, dependant rales, and S3 gallop are readily evident.
Hepatitis Anorexia may precede the appearance of clinical jaundice, but right upper quadrant discomfort and tenderness are present.
Cancer Anorexia is prominent in gastric and pancreatic cancer and in cancer with liver metastases. A humoral substance such as tumor necrosis factor may play a role. Weight loss that is out of proportion to the anorexia is common.
HIV infection Anorexia can occur as a primary phenomenon in the wasting syndrome, due to opportunistic infection or to medication side effects.
Uremia Waxy edema, sallow color, and oliguria are frequent findings.
Addison disease Associated signs include fatigue, hypotension, and hyperpigmentation, especially of the palmar creases and buccal mucosa.
Mesenteric ischemia The patient will avoid eating because of resulting abdominal discomfort. Systemic vascular disease and an abdominal bruit usually coincide.
Hypothalamic lesion Lesions such as sarcoidosis or tumor also cause visual field defects and metabolic/thermoregulatory disorders.
Book Source Details
- Book Title: Field Guide to Bedside Diagnosis
- Author(s): David S. Smith
- Year of Publication: 2007
- Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Excessive hunger
Read excerpts from these other book chapters related to Excessive hunger:
Medical Books Excerpts
- POLYPHAGIA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Polyphagia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2008 Williams & Wilkins.
More About Causes of Excessive hunger
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More About This Book:
Title: Field Guide to Bedside Diagnosis
Authors: David S. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 0-78178-165-5
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» Next page: Polyphagia (Signs & Symptoms: A 2-in-1 Reference for Nurses)
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