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:
| Any 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:
| Colon cancer | – Elderly – Blood/melaena PR – Change in bowel habit |
| Inflammatory bowel disease | – Diarrhoea with blood/mucus – Abdominal pain |
| Coeliac disease | – Diarrhoea, steatorrhoea – Anaemia symptoms, e.g. SOB, tiredness – Abdominal discomfort |
Endocrinological:
| Thyrotoxicosis | – Diarrhoea – Heat intolerance – Irritability/restlessness – Tremor – Oligomenorrhoea / amenorrhoea |
Psychological:
| Anorexia / bulimia nervosa | – BMI <17.5 in anorexia – Binge eating in bulimia – Effort to lose weight (gym, vomiting, laxatives) – Menstrual cycle disturbance |
| Depression | – Core: low mood, anhedonia – Biological: poor sleep, lack of energy – Future: hopelessness, suicidal thoughts |
| Stress | – Organic stress |
Others:
| Other differentials | Diet changes/malnutrition, Substance misuse, End organ failure, Diabetes mellitus type 1, Chronic inflammatory diseases, Chronic infection (e.g. TB), HIV/AIDS |
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:
| Anaemia | – Breathlessness on exertion – Weakness – May get palpitations, worsening angina, worsening claudication |
Endocrinological:
| Hypothyroidism | – Constipation – Cold intolerance – Weight gain |
| Diabetes | – Polydipsia/thirst – Polyuria – Weight loss – Visual disturbance |
Psychological:
| Depression | – Core: low mood, anhedonia – Biological: poor sleep, lack of energy – Future: hopelessness, suicidal thoughts |
Respiratory:
| Sleep apnoea | – Loud snoring – Night time breathing interrupted by apnoeas / gasping / snorting – Excessive daytime sleepiness – Obesity is a risk factor |
Others:
| Other differentials | 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), Addison’s disease / adrenal insufficiency |
