Clin - Fatigue and Unintentional Weight Loss Flashcards
5 GI related ddx for fatigue
1) occult GI bleed
2) cancer
3) IBD
4) chronic liver cdz
5) malnutrition/malabsorption
4 GI related ddx for unintentional weight loss
1) cancer
2) malabsorption syndromes
3) IBD
4) poor dentition
how much weight loss prompts further evaluation
5-10% body weight over 6 months
what GI-specific aspects of the history should you ask in pts with unintentional weight loss
- difficulty eating?
- distorted sense of taste? (dysgeusia)
- dysphagia?
- anorexia?
- nausea?
- change in bowel habits?
what physical exam features should be performed in pts with unintentional weight loss
men: rectal exam including prostate
women: pelvic exam
both: test the stool for occult blood, look at dentition
describe occult GI bleed
bleeding that is not apparent to the patient
sx occult GI bleed
signs of anemia: fatigue, SOB
diagnostic tests in pts with occult GI bleed
fecal occult blood test (FOBT): positive
fecal immunochemical test (FIT): positive
iron deficiency anemia in absence of visible blood loss
in a pt with occult GI bleed, when do you do a colonoscopy and when do you do a colonoscopy AND upper endoscopy
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
patients with occult GI bleed and iron deficiency anemia should also be evaluated for _____
possible celiac dz with either IgA anti-TTG or duodenal biopsy
management of nonfamilial adenomatous and serrated polyps
colonoscopic polypectomy with postpolypectomy surveillance
CEA antigen > 5ng/mL indicates ____
colorectal cancer
- used to determine if you should do surgery
sx hepatocellular carcinoma
cachexia, abd pain, fever, jaundice, asthenia, hepatoplenomegaly
tx/management of hepatocellular carcinoma
surgical resection or liver transplant, ablation
classic risk factors for cholangiocarcinoma (bile duct cancer)
1) primary sclerosing cholangitis (PSC)
2) biliary duct cysts
3) hepatolithiasis
sx cholangiocarcinoma
weight loss, malaise, abd discomfort, jaundice
how to diagnose cholangiocarcinoma
requires pathological confirmation
MRI/MRCP visualizes ductal system
CA19-9 elevation (although not specific)
sx gallbladder CA
jaundice, pain, weight loss
imaging for gallbladder CA
MRCP, CT, PET
porcelain gallbladder on imaging
sx cirrhosis
- anorexia, weight loss
- N/V/D, vague RUQ pain
- fatigue, weakness
- fever
- jaundice
- amenorrhea, impotence, infertility
- disturbed sleep
- muscle cramps,
spider telangiectasia is associated with what dz process
cirrhosis
palmar erythema is associated with what dz process
cirrhosis
dupuytren contractures is associated with what dz process
cirrhosis
lab results for pt with cirrhosis
anemia, pancytopenia, hypoalbuminemia, prolonged PT
tx/management for cirrhosis
abstinence from alcohol
HAV, HBV, pneumococcal, and influenza vaccines
classic signs of malabsorption
steatorrhea and weight loss
high yield malabsorption syndromes
- celiac sprue
- whipple dz
- crohn dz
- cystic fibrosis
- pancreatic carcinoma/insufficiency
lab results from the exocrine pancreas in pancreatic insufficiency
decreased fecal chymotrypsin and decreased pancreatic fecal elastase
causes of bile salt malabsorption
resection of terminal ileum (like in crohn’s dz)
bacterial overgrowth, massive acid hypersecretion, medications
sx bile salt malabsorption
mild steatorrhea
weight loss
impaired absorption of DEAK vitamins
watery secretory diarrhea
