Patient with weight and eating disturbances

Question 1

Differential for weight loss

Answer 1

1. Medical
Malignancies
Endocrine
GIT
Chronic inflammation/infections

2. Eating disorders
   Anorexia
   Bulimia

3. Other psychiatric illness
Depression
OCD
Psychosis
Dementia
Substance misuse

Question 2

History

Answer 2

1. Anorexic symptoms
   Body weight and shape can be important, do you worry?
   Eat less, exercise more, laxatives, diuretics
   Restrict, binge, burge
   How do you feel about your weight/shape
   When was the last time you weighed yourself
2. Bulimic
   Eating out of control
   Make self sick
   Drugs
3. Family history, social, medical
4. Gynaecological->amenirrhea
5. Comorbidities->depression, anxiety, suicide, substance misuse
6. Other systemic signs which may indicate other cause->cancer, thyroid, DM, Crohns/UC/Celiac
7. Risk factors for malignany->smoking, alcohol, exposure to chemicals, obesity
8. Risk for serious infections->travel, sexual history, immunosuppression

Question 3

Investigations

Answer 3

Urea and electrolytes
Thyroid
Liver, FBC, glucose
Serum amylase
amylase, cholesterol
dexamethasone suppression
ECG
Bone density
bHCG

Question 4

Physical examination

Answer 4

Vitals: tachyC, BP, fever
Mental state
Lymphadenopathy
Bone/joint pain
Paraneoplastic
GIT->masses, hepatomegaly, splenomegaly, ascites. Bruits
GU->Mass
CV->murmur (IE), signs of CCF
Pulmonary->edema (malignancy or serositis), hyperI (COPD, CF)
Derm->dermatitis herpetiformis (celiac), JL/ON, rash, livedo reticularis, hyperpigment, skin tight/thickening
Breast examination if appropriate
Dental->poor (IE)

Question 5

Indicators for likely malignancy

Answer 5

> 80, +WBC, +ALP, +LDH