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2011 | OriginalPaper | Hoofdstuk
3 Gewichtsverlies
Auteurs : H. de Vries, V.J.F. van Gool, J.F. Bastiaans, F.J. van Ittersum
Gepubliceerd in: Diagnostiek van alledaagse klachten
Uitgeverij: Bohn Stafleu van Loghum
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Samenvatting
Onbedoeld gewichtsverlies wordt veelal als pathologisch beschouwd indien het meer dan 5% van het uitgangsgewicht betreft, ontstaan in zes maanden. De oorzaken variëren van ernstige organische aandoeningen (bijv. maligniteiten, infecties, endocriene afwijkingen, malabsorptiesyndromen) tot psychiatrische stoornissen, waaronder depressie het vaakst gevonden wordt als oorzaak bij ouderen in de huisartspraktijk. Incidenteel wordt een anorexia nervosa vastgesteld. Er zijn bijzonder weinig onderzoeksgegevens beschikbaar over de diagnostiek in eerstelijnspopulaties. In een aantal gevallen kan het gewichtsverlies aan een reeds bekende aandoening worden toegeschreven. De huisarts wordt naar schatting minstens eenmaal per maand geconfronteerd met gewichtsverlies als contactreden voor een nieuwe ziekte-episode.
Een systematische anamnese gericht op de factoren die van invloed zijn op het lichaamsgewicht (inname, opname, verbruik, verlies) levert de belangrijkste bijdrage aan de diagnostiek. Er zijn aanwijzingen dat een algeheel lichamelijk onderzoek zinvol is. De meeste auteurs bevelen verder screenend bloed- en urineonderzoek aan.
Wat aanvullend onderzoek betreft, zijn er argumenten om bij ouderen een X-thorax aan te vragen. Verdergaand specialistisch onderzoek dat zonder aanwijzingen uit de anamnese of het lichamelijk onderzoek wordt gedaan, wordt niet zinvol geacht, zodat een afwachtend beleid gevoerd kan worden indien de hier genoemde onderzoeken geen afwijkingen opleverden.
Aan specifieke oorzaken van gewichtsverlies bij ouderen (o.a. onvoldoende zorg, dementie, slikproblemen, maligniteiten, ernstige orgaandisfunctie en medicatie) dient aandacht besteed te worden.
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Metagegevens
- Titel
- 3 Gewichtsverlies
- Auteurs
-
H. de Vries
V.J.F. van Gool
J.F. Bastiaans
F.J. van Ittersum
- Copyright
- 2011
- Uitgeverij
- Bohn Stafleu van Loghum
- Boek
-
Diagnostiek van alledaagse klachten
Print ISBN: 978-90-313-8363-4
Elektronisch ISBN: 978-90-313-8364-1
Copyright: 2011
- DOI
- https://doi.org/10.1007/978-90-313-8364-1_4