STATION 2

Question 1

Symptom analysis of weight loss

Answer 1

• How much weight have you lost?
• Over how long?
• Is it intentional or unintentionally?
• Is it coincide with a chnage in diet,physical activity or -lifestyle?
• How is your appetite? Are you enjoying your food?

Question 2

D/D: flow for weight loss

Answer 2

Involuntary weight loss with preserved appetite

• uncontrolled diabetes mellitus
• hyperthyroidism
• malabsorption
• Pheochromocytoma
• Addison

Involuntary weight loss with loss of appetite

• malignancy
• severe cardiac or respiratory failure
• advanced renal diease
• oesophageal disease (causing dysphagia,odynophagia)
• gastroduodenal disease (vomiting,pain)
• depression
• HIV
• chronic inflammatory disease of any cause/infection

Question 3

D/D: you might miss in weight loss

Answer 3

malabsorption (Coeliac disease)
pheochromocytoma
Addison
Illicit drug (cocaine,amphetamine)

Question 4

Symptom analysis of change in bowel habit

Answer 4

• What has been troubles with your bowel recently?
• Can you tell me exactly what you mean by diarrhoea/constipation?
• How is this different from your normal bowel habit?

Question 5

Symptom analysis of constipation

Answer 5

• Can you tell me exactly what you mean by constipation?
• How is this different from your normal bowel habit?
• How often do you open your bowels in average week?
• What do you pass?
• Is the stool hard or soft?
• Does it hurt or do you strain when you pass stool?
• Have you noticed any blood in your toilet or in your stool?
• When you finish,do you ever feel that you still need to open your bowel?
• Are you still passing wind?
• IMPACT

ALARMS (cardinal signs of GI)

• Anorexia
• Loss of weight
• Anemia
• Recently progressive
• Melena or haematoschezia
• Swallowing difficulty

Question 6

D/D: flow for constipation

Answer 6

HD CODAC
H - hypothyroidism,hyperparathyroidism (MEN)
D - opiates,CCBs,TCA,atropine,laxative dependency,iron,
aluminium containing antacid
C - ^Ca : sarcoidosis,cancer,hyperparathyroidism (MEN)
O - pain,vomiting,history of Sx,hypokalemia
D - diverticular disease (pain,fever,bleeding)
durable disease (Parkinsonism,DM)
A - anal fissure/crohn’s fissure,haemorrhoids
acromegaly (Ca)
C - colon cancer

Irritable bowel syndrome

Question 7

D/D: for acromegaly+constipation

Answer 7

• Ca colon (risk++)
• MEN syndrome ( hyperparathyroidism)

whenever there is acromegaly,you need to exclude MEN syndrome.

Gland pathology တစ်ခုတွေ့တိုင်း associated ဖြစ်နိုင်လောက်တဲ့ syndrome တွေရှာပါ

Question 8

Must included screening questions in diarrhoea prompt

Answer 8

eye,joint pain,back pain,rash