DSA 7: Fatigue, Unintentional Weight Loss Flashcards
where are:
iron, calcium, folate, fats, carbs, triglycerides absorbed?
proximal small intestine
- absorbed as micelles after solubilization by bile salts
where are:
vitamin B12, bile salts and water absorbed?
distal small intestine
where are:
water and electrolytes absorbed?
colon
what should be on your DDX for fatigue? (5)
- occult GIB
- cancer
- IBD
- chronic liver dz
- malnutrition/malabsorption
what should be on you DDX for unintentional wt loss? (4)
- cancer
- malabsorption syndromes
- IBD
- poor dentition
how does fatigue typically present?
difficulty initiating or maintain voluntary mental or physical activity
what ROS finding should raise you suspicious for an occult infection or malignancy?
presence of fever, chills, night sweats, or weight loss
what should be used instead of 10/10 scale for severity of fatigue?
impact of fatigue on daily functioning
what should be included for diagnosis of fatigue?
- CBC with diff
- electrolytes
- thyroid function
- testing for HIV
- adrenal function
- erythrocyte sedimentation rate (ESR), just helps support other findings
rapid fluctuation of weight over days suggest what?
loss or gain of fluid
long-term changes usually involve what?
loss of tissue mass
loss of how much weight should prompt further evaluation?
loss of 5-10% of body weight over 6 months
hx of GI symptoms should be obtained, including difficulty eating, dysgeusia (distorted sense of taste), dysphagia, anorexia, nausea, and change in bowel habits
for unintentional weight loss
causes of weight loss McGowan wants us to know
- cancer
- malabsoprtion
- obstruction
- peptic ulcer
- celiac disease
- IBD
- pancreatitis
- pernicious anemia
iron deficiency anemia is most commonly attributed to what, in premenopausal women?
menstrual bleeding and pregnancy-associated iron loss
what is the diagnostic eval for occult bleeding?
positive FOBT -> colonoscopy
pt with iron deficiency anemia should be evaluated for what?
possible celiac disease with either IgA anti-tissue TG or duodenal biopsy
what is the first think you should think of in a person over 45 with iron deficiency anemia?
colon cancer
what are the main complications of colonoscopy?
perforation and clinically significant bleeding
hundreds-thousands of colonic adenomatous polyps
- 90% have mutation in APC gene (AD)
- 10% have mutation in MUYTH gene (AR)
familial adenomatous polyposis (FAP)
what is the tx of FAP?
complete prostocolectomy with ileoanal anastomosis before age 20
- prophylactic colectomy recommended to prevent inevitable colon cancer
defect in one/several genes that are important in detection and repair of DNA base-pair mismatches (MLH1, MSH2, MSH6, PMS2)
- polyps believed to undergo rapid transformation over 1-2 years from normal tissue -> adenoma -> cancer
Lynch syndrome (aka HNPCC) - lifetime risk of colorectal cancer (22-75%), endometrial cancer (30-60%), ovarian, renal/bladder develop at a YOUNG age
what is the tx of HNPCC?
subtotal colectomy with ileorectal anastomosis (followed by ANNUAL surveillance of rectal stump)
- prophylactic hysterectomy and oophorectomy recommended in women over 40, or once they have finished childbearing
hamartomatous polyps throughout GI tract (esp small intestine)
- mucocutaneous pigmented macules on the lips, buccal mucosa and skin
- AD inheritance, serine threonine kinase 11 gene mutation
Peutz-Jeghers syndrome
