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3/4: YX - Diagnosis > Unintentional Weight Loss > Flashcards

Unintentional Weight Loss Flashcards

1
Q

What suggests unintended weight loss is due to a more severe cause?

A

More rapid and severe weight loss

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2
Q

What initial investigations should be done when someone presents with unintentional weight loss?

A
  • Urine testing for sugar & protein
  • FBC
  • ESR or CRP
  • Fasting blood glucose
  • U&E’s
  • Calcium & bone profile
  • LFT
  • PSA
  • TSH
  • FTY
  • CXR
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3
Q

What are the main differential diagnoses for unintended weight loss?

A
  • Any advanced malignancy
  • Psychiatric illness
  • Non-malignant GI diseases
  • Complicated alcoholism
  • Undiagnosed or uncontrolled diabetes mellitus
  • Thyrotoxicosis
  • Pulmonary TB
  • Addison’s disease
    *
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4
Q

What suggests that an advanced malignancy is the cause of unintentional weight loss?

A

Progressive onset over weeks or months of specific symptoms, ​e.g. haemoptysis, neurological deficit, rectal bleeding, change in bowel habit

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5
Q

How is it confirmed that an advanced malignancy is the cause of unintentional weight loss?

A
  • Visualisation of tumour on GI endoscopy or bronchoscopy
  • Lymph node biopsy
  • Metastases on CXR, CT, or ultrasound
  • Leukaemic changes on FBC
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6
Q

How is unintentional weight loss caused by an advanced malignancy managed?

A
  • Dietary advice
  • Food supplements
  • Counselling
  • Analgesia if in pain
  • Treatment of underlying diagnosis
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7
Q

What is the main psychatric illness causing unintentional weight loss?

A

Severe depression

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8
Q

What suggests that a psychiatric illness is the cause of unintentional weight loss?

A
  • Sleep disorder
  • Poor concentration
  • Social withdrawal
  • Lack of interest in usual activity
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9
Q

What confirms that psychiatric illness is the cause of unintentional weight loss?

A
  • History
  • Mental state examination
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10
Q

How is unintentional weight loss caused by psychiatric illness treated?

A

Treatment of psychatric illness, e.g. with psychotherapy or antidepressants

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11
Q

Give 3 non-malignant GI diseases that might cause unintentional weight loss

A
  • Peptic ulcer disease
  • Inflammatory bowel disease
  • Malabsorption
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12
Q

What suggests that a non-malignant GI disease is the cause of unintentional weight loss?

A
  • Dysphagia
  • Vomiting
  • Diarrhoea
  • Abdominal pain
  • Melaena
  • Alcohol intake
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13
Q

How is it confirmed that non-malignant GI disease is the cause of unintentional weight loss?

A
  • GI endoscopy
  • US scan of abdomen
  • Anaemia on FBC
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14
Q

How is unintentional weight loss caused by non-malignant GI disease managed?

A
  • Dietary intervention, e.g. food supplements
  • Counselling
  • Analgesia if pain
  • Treatment of underlying condition
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15
Q

What complications of alcoholism might cause unintentional weight loss?

A
  • Liver disease
  • Gastritis
  • Peptic ulceration
  • Seizures
  • Delerium tremens on withdrawal
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16
Q

What suggests that complicated alcoholism is the cause of unintentional weight loss?

A
  • Depression
  • Anxiety
  • Visual hallucinations
  • Social withdrawal
  • Lack of interest in non-drinking activities
  • Anorexia
17
Q

What confirms that complicated alcoholism is the cause of unintentional weight loss?

A
  • History of alcohol abuse
  • Presence of signs of chronic liver disease
18
Q

How is unintentional weight loss caused by complicated alcoholism managed?

A
  • Withdrawal of alcohol
  • Short course of sedative to prevent withdrawal symptoms
19
Q

What suggests that unintentional weight loss is caused by undiagnosed or uncontrolled diabetes mellitus?

A
  • Polydipsia
  • Polyuria
  • Pruritis
20
Q

How is it confirmed that undiagnosed or uncontrolled diabetes mellitus is the cause of unintentional weight loss?

A

Fasting blood glucose >7.0mmol/L on two seperate occasions, or random glucose >11.1/L once in the presence of symptoms

21
Q

How is unintentional weight loss caused by undiagnosed or uncontrolled diabetes mellitus managed?

A
  • Lifestyle modification - diet and exercise, with or without metformin
  • Insulin if type 1 or ketotic
22
Q

What suggests that unintentional weight loss is caused by thyrotoxicosis?

A
  • Heat intolerance
  • Nervousness
  • Palpitations
  • Frequency of bowel movements
  • Goitre
  • Fine tremor
23
Q

What confirms that thyrotoxicosis is the cause of unintentional weight loss?

A
  • Decreased TSH
  • Increased FT4, with or without increased FT3
  • Anti-TSH receptor antibody if Graves’ disease
24
Q

How is unintentional weight loss caused by thyrotoxicosis treated?

A

Treatment of underlying cause, using propanolol to control symptoms, and carbimazole or propylthiouracil to reduce T4

25
Q

What suggests that pulmonary tuberculosis is the cause of unintentional weight loss?

A
  • Night sweats
  • Fever
  • Malaise
  • Chronic cough
26
Q

What confirms that pulmonary tuberculosis is the cause of unintentional weight loss?

A

Presence of acid-fast bacilli in sputum on microscopy and culture

27
Q

How is unintentional weight loss caused by pulmonary tuberculosis managed?

A

Treatment of cause, with initiation of antituberculous antibiotic regimen

28
Q

What suggests that Addison’s disease is the cause of unintentional weight loss?

A
  • Lethargy
  • Weakness
  • Dizziness
  • Pigmentation (of buccal mucosa or scars)
  • Hypotension
29
Q

How is it confirmed that Addison’s disease is the cause of unintentional weight loss?

A
  • Decreased 9am plasma cortisol
  • Impaired response to short Synacthen test
30
Q

What acute infections can cause unintentional weight loss?

A
  • HIV
  • Subacute bacterial endocarditis
  • Parasites
31
Q

What drugs can cause unintentional weight loss?

A
  • Digoxin
  • Metformin
  • Levodopa
32
Q

What neurological diseases can cause unintentional weight loss?

A
  • Stroke
  • Parkinson’s disease
  • Dementia
33
Q

What connective tissue diseases can cause unintentional weight loss?

A
  • SLE
  • Scleroderma

3/4: YX - Diagnosis (11 decks)

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