Simone Lawson
A review of systems (ROS) is a technique used by healthcare providers to obtain a patient's medical history. It is used to identify conditions that lack precise diagnostic tests. Loss of appetite can be a symptom of many conditions, including gastroesophageal reflux disease, inflammatory bowel disease, abdominal cancer, and hyperthyroidism. It can also be a side effect of certain medications, such as chemotherapy for cancer or HIV treatment. The classification of loss of appetite as either a gastro or constitutional symptom in the context of ROS may depend on the underlying cause and the specific system being reviewed.
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What You'll Learn
Fevers, chills, sweats, and weight loss
A review of systems (ROS) is a technique used by healthcare providers to obtain a patient's medical history. It is often used to identify conditions that lack precise diagnostic tests. Fevers, chills, sweats, and weight loss can be indicative of various medical conditions and can be assessed through an ROS.
Fevers can be a symptom of many conditions, including infections such as a simple UTI. Fever may also indicate a more serious infection, such as pneumonia or tuberculosis (TB). Chills often accompany fevers and can be a symptom of similar conditions, including pneumonia. Sweats, or diaphoresis, can also be indicative of certain conditions, particularly when occurring at night or in a drenching fashion.
Weight loss can be a symptom of numerous conditions, including hyperthyroidism, inflammatory bowel disease, and cancer. It can also be a result of chronic nausea, abdominal pain, and diarrhea caused by medications such as chemotherapy or HIV treatments. Weight loss may also be related to psychological conditions such as anorexia, which is characterised by a chronic and progressive loss of appetite, hyper-concern about weight and body image, and binge-purge cycles.
To determine the cause of these symptoms, healthcare providers will often ask follow-up questions to localise the symptoms to specific organs. For example, urinary burning, frequency, and urgency can indicate a urinary tract infection. Other factors that can influence the likelihood of specific infections include age, co-morbidities, past medical history, travel history, and immune status.
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Localized symptoms and infections
Infections and their localised symptoms can manifest in various organ systems:
Respiratory System
Respiratory infections may present with symptoms such as a cough, sore throat, nasal discharge, or post-nasal drip. Pertussis, for example, is characterised by a persistent cough that can last for several weeks and may be accompanied by vomiting. Pulmonary emboli can cause acute chest pain with breathing and hemoptysis (coughing up blood).
Gastrointestinal System
Gastrointestinal infections or disorders can cause abdominal pain, nausea, vomiting, diarrhea, constipation, or weight loss. Gastroesophageal Reflux Disease (GERD) often worsens after meals or when lying down after eating and may be associated with a bad taste in the mouth. Mesenteric/small bowel ischemia can lead to generalized abdominal pain, weight loss, and food avoidance. Inflammatory Bowel Disease can present with weight loss, diarrhea, bloody stools, cramps, and constipation.
Ocular System
Infections or inflammations in the eye can lead to visual loss, unilateral or bilateral eye pain, redness, or yellowing of the conjunctiva (icterus). Acute angle-closure glaucoma, for instance, causes unilateral visual loss and a hard feeling globe.
Auditory System
Infections or conditions affecting the ears may result in a change in hearing acuity. Rhinosinusitis, for instance, can impact hearing.
Genitourinary System
Infections in this system can cause urinary burning, frequency, and urgency, as previously mentioned, but they can also lead to unusual vaginal discharge or irritation, increased urination, and redness, soreness, or swelling in the genital area.
Integumentary System
Skin infections may present with localized symptoms such as redness, swelling, pain, or warmth at the site of infection. Cellulitis, for example, often causes redness, swelling, and warmth in the affected area.
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Malignancies and cancer
Loss of appetite is a common side effect of cancer and its treatment. Tumours can interfere with the body's hunger signals in several ways. For instance, cancers of the head, neck and gastrointestinal tract may cause difficulty swallowing, make eating painful or create a feeling of fullness despite an empty stomach. Ovarian, lung, stomach and pancreatic cancers also commonly cause loss of appetite. Tumours release hormones that may distort the body's perception of hunger, making individuals feel full when they are not.
The cancer itself may also cause appetite-reducing symptoms such as nausea, pain, stress, depression and dehydration. Treatments such as surgery and chemotherapy can also cause loss of appetite. For example, cancer treatment can cause taste changes, mouth ulcers, nausea and vomiting, which can reduce appetite. Cancer diagnosis may also be accompanied by pain, fatigue, anxiety, distress, and depression, all of which can reduce motivation and desire to eat.
Loss of appetite can have serious implications. Malnutrition due to appetite loss causes 20% of cancer deaths. Significant weight loss from an extreme breakdown of lean muscle mass is called cachexia, which can be life-threatening. Cachexia is the result of a marked decrease in appetite and insufficient intake of nutrients, causing protein, vitamin and mineral levels to plummet, and the body to weaken.
There are several ways to manage loss of appetite. It is important to eat when you feel hungry, rather than waiting for set mealtimes. Eating several small meals or snacks throughout the day, rather than large meals, is recommended. Eating with loved ones in a calm, relaxed setting may also help. It is also important to focus on eating foods that you enjoy to help stimulate your appetite. It is recommended to try new foods and recipes, and to eat foods that smell good. Light physical activity, such as walking or yoga, can also help stimulate the appetite.
There are also medical options to help increase appetite. Prescription medications such as metoclopramide, megestrol acetate, olanzapine, and dexamethasone (steroid) can help. Over-the-counter medicines for gas and other problems that may not need a prescription can also help. Cannabis is being studied for its possible benefits in helping to manage loss of appetite and nausea from cancer and its treatment. Two cannabinoid medicines, dronabinol and nabilone, have FDA approval to help manage nausea.
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Medication side effects
A review of systems (ROS) is a technique used by healthcare providers to obtain a patient's medical history. It is often used to identify conditions that do not have precise diagnostic tests. Medication side effects are one of the many topics that can be covered in an ROS.
When it comes to medication side effects, it is important to consider a wide range of possibilities. Some medications can cause chronic nausea, abdominal pain, and diarrhea. For example, chemotherapy for cancer and HIV medications are known to have these side effects. Other medications may affect the patient's appetite, leading to unintentional weight loss or even anorexia. This could be a sign of an underlying eating disorder or body image issues. It is also important to consider the patient's mental health and any history of substance abuse, as this can impact their appetite and eating habits.
In addition to appetite loss, medications can also cause other digestive issues such as swallowing problems, which may indicate gastroesophageal reflux disease (GERD) or esophageal spasms. Certain medications can also increase the risk of gastrointestinal (GI) issues such as abdominal pain and distention. This could be a result of conditions like inflammatory bowel disease or abdominal cancer.
Furthermore, medication side effects can present as systemic symptoms, including fevers, chills, sweats, and fatigue. These symptoms could indicate an infection or an inflammatory response. It is also important to consider the patient's past medical history, including any known allergies or reactions to medications. This information can help identify if the patient's current symptoms are related to their medication or other factors.
The impact of medication on appetite loss can vary depending on the specific drugs involved and the individual's response. It is always important to monitor for any changes in a patient's condition and to adjust the treatment plan accordingly. Healthcare providers should also be aware of the potential for medication side effects to impact patient compliance and overall health outcomes. A comprehensive ROS can help to identify these issues early on and guide clinical decision-making.
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Gastroesophageal reflux disease
Symptoms of GERD include a burning sensation in the chest (heartburn), which might worsen when lying down or after meals, a sour or bitter taste in the mouth, difficulty swallowing, regurgitation of food or sour liquid (acid reflux), among others.
The exact causes of GERD are unclear, but several factors are believed to contribute. These include a weak lower oesophageal sphincter (a ring of muscle at the bottom of the oesophagus), hiatal hernia (when part of the stomach protrudes upward into the diaphragm), specific foods and drinks (like chocolate, caffeine, alcohol, and fried or fatty foods), obesity, pregnancy, smoking, and certain medications.
GERD can be diagnosed through various methods, including:
- Barium swallow X-ray: Drinking a liquid containing barium, which coats the digestive tract and allows it to be seen on X-ray.
- Oesophageal manometry: Measuring oesophageal muscle strength and coordination by passing a tube down the throat.
- Ambulatory acid probe test: Measuring acid levels in the oesophagus by placing a thin tube through the nose into the oesophagus.
Treatment options for GERD include:
- Lifestyle changes: Losing weight, quitting smoking, avoiding trigger foods, and not lying down right after meals.
- Medications: Over-the-counter or prescription medications, such as antacids, proton pump inhibitors (PPIs), or H2 receptor blockers, can reduce acid production and protect the oesophagus.
- Surgery: In severe cases, surgery may be recommended to reinforce the lower oesophageal sphincter.
It is important to note that while loss of appetite may be a symptom of GERD, it is not specifically mentioned in the context of "constitutional" or "gastro" in the sources provided. However, loss of appetite can be a symptom of other conditions, as indicated in the sources.
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Frequently asked questions
A review of systems (ROS) is a technique used by healthcare providers to obtain a patient's medical history. It is often structured as a component of an admission note covering the organ systems, focusing on the subjective symptoms perceived by the patient.
HPI (history of present illness) and ROS are distinct but related. HPI focuses on the patient's current illness, while ROS covers a broader range of systems and can be used to identify conditions that do not have precise diagnostic tests.
Loss of appetite can be assessed through a comprehensive history and examination, including weight loss confirmation and other indicators such as clothing no longer fitting. It can be classified as gastro or constitutional based on the specific symptoms and their relation to the organ systems.
Gastrointestinal conditions that can lead to loss of appetite include gastroesophageal reflux disease (GERD), inflammatory bowel disease, abdominal cancer, and small bowel ischemia. These conditions can cause symptoms such as swallowing problems, weight loss, food avoidance, diarrhea, and abdominal pain.
