Module: WEIGHT LOSS

1. Give 3 differential diagnoses. Give your basis based on history and physical findings.

3 Differential Diagnoses:1. Gastrointestinal Malignancy2. Malabsorption Syndrome3. Gastrointestinal Tuberculosis

GASTROINTESTINAL MALIGNANCY- The gastro intestinal tract is the second most

common noncutaneous site for cancer and the second major cause of cancer-related mortality in the United States.

- It can either be esophageal, gastric, tumor of the small intestine or colorectal.

History of Present Illness• Bowel Irregularities

- Diarrhea- Constipation 2-3x/week of bowel

movement • Stools have become like goat droppings• Poor appetite• Increasing fatigue and body weakness• Weight Loss • Non-productive cough and DOB

Family History• (+) Myelodysplatic Syndrome – Mother

Social and Environmental History• Smoker: 32 pack years• Drinker: 3 bottles of beer/week and 6-7

shots of brandy/week• Diet: High Red Meat Consumption• Sedentary Lifestyle

Physical Examination• General Survey: Weak looking, Cachectic• Vital Signs: Cardiac Rate 101/min

BMI: 17.95 (Below Normal)• HEENT: Slightly icteric palpebral conjunctiva,

sunken cheeks, dry oral mucosa, (+) buccal ulcers, erythematous, tongue is covered with whitish plaques

• Cardiac: Tachycardic, soft midsystolic murmur at mitral area, soft heart sounds

• Respiratory: Decreased fremiti T7 down on the L, dullness T7 down on the L, Decreased breath sounds T7 down on the L, (+) egophony and bronchophony T7-T8 on the L, Coarse Inspiratory crackles on posterior R hemithorax

• GIT: Prominent vascular markings, (+)evident peristaltic waves on the Left hemiabdomen, (+)1x1 cm firm subcutaneous nodules over the abdomen, slight direct tenderness on the left hemiabdomen, hypoactive bowel sounds, hemorrhoids

• MSK: (+) Muscle wasting on extremities• GUT: (-) ulcers, discharge

MALABSORPTION SYNDROME- Diminished intestinal absorption of one

or more dietary nutrients.- The only clinical situations in which

absorption is increased are hemochromatosis and Wilson’s Disease.

- Most, but not all, Malabsorption syndromes are associated with steatorrhea, an increase in stool fat excretion of >5% of dietary fat intake.

Physical Examination and HPI• Bowel Irregularities• Fatty Liver Changes• Poor Appetite• Dehydration• Hypoactive bowel sounds• Slightly Icteric Palpebral Conjunctiva

Social and Environmental History• Smoker: 32 pack years• Drinker: 3 bottles of beer/week and 6-7

shots of brandy/week• Diet: High Red Meat Consumption• Sedentary Lifestyle

GASTROINTESTINAL TUBERCULOSIS- GI TB is uncommon, making up 3.5% of

extrapulmonary cases in the United States.

- Various Pathogenic mechanisms are involved:a. Swallowing of sputum with direct

seedingb. Haematogenous spreadc. Ingestion of milk from cows affected

by bovine TB.- Most common sites of GI tract affected

by TB are the terminal ileum and cecum.- Diagnosis can be established by

histologic examination and culture of specimens obtained intraoperatively.

History of Present Illness• Weight Loss• Loss of appetite• Non-productive Cough• Difficulty of Breathing

Family History• (+) Emphysema - Father

Social and Environmental History• Smoker: 32 pack years• Sedentary Lifestyle

Physical Examination• Othopnea • Bowel Irregularities• Egophony • Bronchophony • Decreased Fremitus • Decreased Breath Sounds• Coarse Inspiratory Crackles• Tachycardia• Murmurs

DEPALOBOS, DON JAYRIC V.MED I-BModule: Weight LossReference: Harrison’s Principles of Internal Medicine 18th Edition