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.
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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?
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