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Extreme weight loss, loss of energy, popping sound under rib, heart palpitations, headaches, blood work, MRI normal. Causes ?

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Practicing since : 2000
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I'm seeking assistance on behalf of a friend. He has become very sick recently, and we have had little to no progress with the local hospitals. He is 6ft 3in in height, and was a strong fit man, 30 years of age. In the last 2 months, he has lost 15-20kg and is now fitting into his jeans that he wore when he was 19, his appearance is gaudy and feint and he rapidly loses energy while doing the most trivial of tasks such as getting off a chair, or walking to the end of a corridor.

He explained his symptoms as follows:

If he eats some food, he feels & hears a popping sound beneath his left rib, so this is perhaps the Transverse colon or pancreas, or somewhere in this region. Then within his chest he is overcome with a strange feeling, his heart starts to palpitate rapidly, and he becomes rapidly exhausted. He is suffering headaches a lot now too.. Sometimes these symptoms happen even when he has not eaten.

I'm unsure if he is losing weight indirectly because he is eating less, or if this problem is causing him to lose weight directly.

So, he has been to the hospitals. They have confirmed his blood is clean. An MRI indicated no problems either. They can find no traces of cancer, though he does look like an advanced cancer / leukemia patient due to his loss of colour and weight. Previously the doctors said there was a shadow on his pancreas, but have since said there is no shadow. so, we need to find out more about why they believed there was one initially. He was diagnosed last week with having Barretts disease, but the doctors have said this is incorrect also. The hospital then discharged him, and requested he keep a mobile heart monitor on for the next few days. He did so, and returned it to the hospital. We await their reply.

I hope you can help assist in diagnosing what the problem could be. If we have a few solid suggestions, we can work with this and seek local professionals who deal explicitly with these symptoms.

best regards,
Posted Tue, 8 May 2012 in Weight Loss
Answered by Dr. Poorna Chandra K.S 3 hours later

Thanks for posting your query.

I appreciate your concern for your friend.

Any loss of >10% of body weight in the last 6months or >5% of body weight in 3 months would constitute a significant weight loss. Such a loss if it is involuntary it is usually due to -
1) Immunodefeciency diseases- Primary / Secondary (Immunoglobulin assay, HIV status, CD4 & CD8 counts)
2) Disseminated malignancies (CT/MRI, endoscopies)- less likely at this age
3) Disseminated tuberculosis (CT/MRI, endoscopies, Mantoux, Quantiferon)
4) Severe malabsorption states (Stool, breath, blood tests and endoscopiec biopsies)
5) Septic conditions like cholangitis or with an underlying pancreatitis/ chronic meningitis (blood / fluid tests)
6) Severe megaloblastic anemia/ Vitamin B12 defeciencies ( blood test)
7) Mesenteric ischaemia ( CT angio/ Angiography) )- less likely at this age

These would require some dedicated test to look at individual disorders . I would perform the aforementioned tests (in brackets) in any patients with significant weight loss. Cardiac conditions usually lead to a bloated condition and gain in weight.

You should consult your physcian to help you priortise the investigations and help in rehabilitation

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