Table of Contents
Weight loss
Exploring symptom
- How much
- Over how long
- Associated symptoms
Relevant system reviews
- Gastrointestinal
- Weight: appetite change
- Work down body: dysphagia, nausea/vomiting, indigestion/heartburn, abdominal pain, bowel habit change, tenesmus, blood/mucus in stool
- Full systems review
- Consider full systems review if diagnosis unclear
Differential diagnoses and clues
Malignancy
- Symptoms of tumour, e.g. breast lump, haemoptysis (lung), prostatic symptoms, change in bowel habit (bowel), haematuria (TCC), jaundice (head of pancreas), post-menopausal bleed (uterine) etc.
Gastrointestinal
- Elderly
- Blood/melaena PR
- Change in bowel habit
- Diarrhoea with blood/mucus
- Abdominal pain
- Diarrhoea, steatorrhoea
- Anaemia symptoms, e.g. SOB, tiredness
- Abdominal discomfort
Endocrinological
- Diarrhoea
- Heat intolerance
- Irritability/restlessness
- Tremor
- Oligomenorrhoea / amenorrhoea
- Polyuria
- Polydipsia
Psychological
- BMI <17.5 in anorexia
- Binge eating in bulimia
- Effort to lose weight (gym, vomiting, laxatives)
- Menstrual cycle disturbance
- Core: low mood, anhedonia
- Biological: poor sleep, lack of energy
- Future: hopelessness, suicidal thoughts
- Organic stress
Others
- Diet changes/malnutrition
- Substance misuse
- End organ failure
- Chronic inflammatory diseases
- Chronic infection (e.g. TB)
- HIV
Tiredness
Exploring symptom
- Timeframe
- Duration
- Onset (sudden or gradual)
- Progression
- Timing (intermittent or continuous)
- Tiredness
- What they mean by tiredness
- Sleep pattern/quality
- How it affects patient
- Associated symptoms
- Anaemia symptoms: breathlessness on exertion
- Hypothyroidism symptoms: constipation, weight gain, cold intolerance etc.
- Depression symptoms: mood
- Diabetes symptoms: polydipsia, polyuria
Full systems review
- Consider full systems review if diagnosis unclear
Differential diagnoses and clues
Haematological
- Breathlessness on exertion
- Weakness
- May get palpitations, worsening angina, worsening claudication
Endocrinological
- Constipation
- Cold intolerance
- Weight gain
- Polydipsia/thirst
- Polyuria
- Weight loss
- Visual disturbance
- Non-specific symptoms
- Postural hypotension
Psychological
- Core: low mood, anhedonia
- Biological: poor sleep, lack of energy
- Future: hopelessness, suicidal thoughts
Respiratory
- Loud snoring
- Night time breathing interrupted by apnoeas / gasping / snorting
- Excessive daytime sleepiness
- Obesity is a risk factor
Others
- Stress
- Post-viral fatigue
- Organ failure
- Drugs (e.g. recreational, β-blockers, diuretics)
- Malignancy
- Chronic inflammatory diseases (e.g. connective tissue diseases)
- Chronic infection (e.g. TB)
Here are a few questions for you
A patient presents with weight loss and chronic diarrhoea. Which conditions would you include in your differential diagnosis? Please structure your answer.
Oops! This section is restricted to members.
Create an account or log in to continue reading.
You see a patient who complains of tiredness and extreme fatigue. A workup excludes other causes and you think they may have chronic fatigue syndrome. Which features may suggest this diagnosis?
Oops! This section is restricted to members.
Create an account or log in to continue reading.
