Clin - Fatigue and Unintentional Weight Loss

Question 1

5 GI related ddx for fatigue

Answer 1

1) occult GI bleed
2) cancer
3) IBD
4) chronic liver cdz
5) malnutrition/malabsorption

Question 2

4 GI related ddx for unintentional weight loss

Answer 2

1) cancer
2) malabsorption syndromes
3) IBD
4) poor dentition

Question 3

how much weight loss prompts further evaluation

Answer 3

5-10% body weight over 6 months

Question 4

what GI-specific aspects of the history should you ask in pts with unintentional weight loss

Answer 4

• difficulty eating?
• distorted sense of taste? (dysgeusia)
• dysphagia?
• anorexia?
• nausea?
• change in bowel habits?

Question 5

what physical exam features should be performed in pts with unintentional weight loss

Answer 5

men: rectal exam including prostate
women: pelvic exam
both: test the stool for occult blood, look at dentition

Question 6

describe occult GI bleed

Answer 6

bleeding that is not apparent to the patient

Question 7

sx occult GI bleed

Answer 7

signs of anemia: fatigue, SOB

Question 8

diagnostic tests in pts with occult GI bleed

Answer 8

fecal occult blood test (FOBT): positive

fecal immunochemical test (FIT): positive

iron deficiency anemia in absence of visible blood loss

Question 9

in a pt with occult GI bleed, when do you do a colonoscopy and when do you do a colonoscopy AND upper endoscopy

Answer 9

asymptomatic + positive fecal occult blood test or fecal immunochemical test –> colonoscopy

symptomatic + positive fecal occult blood test or fecal immunochemical test or iron deficiency anemia –> colonoscopy w/ upper endoscopy

Question 10

patients with occult GI bleed and iron deficiency anemia should also be evaluated for _____

Answer 10

possible celiac dz with either IgA anti-TTG or duodenal biopsy

Question 11

management of nonfamilial adenomatous and serrated polyps

Answer 11

colonoscopic polypectomy with postpolypectomy surveillance

Question 12

CEA antigen > 5ng/mL indicates ____

Answer 12

colorectal cancer

- used to determine if you should do surgery

Question 13

sx hepatocellular carcinoma

Answer 13

cachexia, abd pain, fever, jaundice, asthenia, hepatoplenomegaly

Question 14

tx/management of hepatocellular carcinoma

Answer 14

surgical resection or liver transplant, ablation

Question 15

classic risk factors for cholangiocarcinoma (bile duct cancer)

Answer 15

1) primary sclerosing cholangitis (PSC)
2) biliary duct cysts
3) hepatolithiasis

Question 16

sx cholangiocarcinoma

Answer 16

weight loss, malaise, abd discomfort, jaundice

Question 17

how to diagnose cholangiocarcinoma

Answer 17

requires pathological confirmation

MRI/MRCP visualizes ductal system

CA19-9 elevation (although not specific)

Question 18

sx gallbladder CA

Answer 18

jaundice, pain, weight loss

Question 19

imaging for gallbladder CA

Answer 19

MRCP, CT, PET

porcelain gallbladder on imaging

Question 20

sx cirrhosis

Answer 20

• anorexia, weight loss
• N/V/D, vague RUQ pain
• fatigue, weakness
• fever
• jaundice
• amenorrhea, impotence, infertility
• disturbed sleep
• muscle cramps,

Question 21

spider telangiectasia is associated with what dz process

Answer 21

cirrhosis

Question 22

palmar erythema is associated with what dz process

Answer 22

cirrhosis

Question 23

dupuytren contractures is associated with what dz process

Answer 23

cirrhosis

Question 24

lab results for pt with cirrhosis

Answer 24

anemia, pancytopenia, hypoalbuminemia, prolonged PT

Question 25

tx/management for cirrhosis

Answer 25

abstinence from alcohol

HAV, HBV, pneumococcal, and influenza vaccines

Question 26

classic signs of malabsorption

Answer 26

steatorrhea and weight loss

Question 27

high yield malabsorption syndromes

Answer 27

• celiac sprue
• whipple dz
• crohn dz
• cystic fibrosis
• pancreatic carcinoma/insufficiency

Question 28

lab results from the exocrine pancreas in pancreatic insufficiency

Answer 28

decreased fecal chymotrypsin and decreased pancreatic fecal elastase

Question 29

causes of bile salt malabsorption

Answer 29

resection of terminal ileum (like in crohn’s dz)

bacterial overgrowth, massive acid hypersecretion, medications

Question 30

sx bile salt malabsorption

Answer 30

mild steatorrhea

weight loss

impaired absorption of DEAK vitamins

watery secretory diarrhea