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Speciality Spotlight
Diagnosis of the cause of weight loss is usually not difficult and is revealed by histroy, physical examination and routine laboratory screening.
The
most likely causes:
In young persons:
1) Diabetes Mellitus
2) Hyperthyroidism
3) Anorexia
nervosa
4) HIV
infection
In
elderly persons:
1) Cancer
2) Alzheimer’s disease
3)
Depression
Hyperthyroidism
Phechromocytoma
Extensive exercise
Diabetes mellitus
(glucose in urine)
Malabsorption syndromes
1) radiation injury
2) biliary tract obstruction
3) Chronic pancreatitis in alcoholics
1) Infection(HIV, Tuberculosis and endocarditis)
2) Obstruction of G.I tract
3) Anorexia nervosa
4) Cancer
5) Depression
6) Alzheimer’s disease
Diagnosis
First
phase tests
These tests are done on every
patient
1) Multiple chemistry tests
(To dectect diabetes mellitus,
renal failure, liver disease, or
gastrointestinal diseases)
2) T.S.H. (for hypethyroidism)
3) HIV test
4) Chest X-ray
5) Stool test for occult blood
6) C.B.C
7) E.S.R
8) Urine test.
These tests are done only if the fist phase tests are unable to dectect the cause of weight loss.
1) C.T. Scan of abdomen
2) Serum parathyroid hormone(PTH)
3) Mammography
4) ACTH test
5) Upper G.I. Endoscopy
6) Colonoscopy
7) Blood culture (for fever with weight loss)
8) 72 hr tool fat(in presence of chronic diarrhoea)
9) MRI(for weight loss with neurological symptoms)
10) Vitamin B12 levels( in unexplained weight loss)
It is one of the most frequent complaints for which patients seek medical attention. There are various causes for it and there is little relation between the severity of chest discomfort and the gravity of its cause. Therefore, it is necessary to distinguish a trivial complaint from coronary artery disease and other serious disorders.
Causes
of Chest Discomfort
CARDIAC
Coronary
artery disease :
(a) Angina Pectoris
(b)
Myocardial Infarction
Pericarditis
VASCULAR
Pulmonary
embolism
Aortic
dissection
PULMONARY
Pleural
effusion
Bronchitis
G.I.T.
Peptic
ulcer
Acute cholecystitis
Esophageal reflux
MUSCULOSKELETAL:
Chostochondritis
EMOTIONAL
Cardiac
Coronary Artery Disease
a)
Angina pectoris:
Heaviness,
pressure, sensation of
constriction in chest, discomfort in
substernal region radiates to
interscapular region, arms,
shoulder
or teeth.
Develops gradually during exertion,
after heavy meals, with anger and
excitement.
Not precipitated by coughing or
respiratory movements.
Pain disappears mere rapidly (within
5 minutes) after sublingual nitro-
glycerine.
b) Myocardial infarction
Discomfort similar to angina, but of
longer duration and greater intensity.
Pain is not relieved by rest or by
sublingual nitroglycerine.
Pericarditis
Pain at the tip of the shoulder
and neck.
It
is related to respiratory movements
and
aggravated by cough and deep
breathing.
VASCULAR
Pulmonary embolism
Pain is caused by focal pulmonary
infarction and located more laterally.
Pain is due to irritation of pleural
surface, and sometimes associated with
hemoptysis.
Aortic Dissection
It develops as a result of a subintimal hematoma due to a tear in the intima of the aorta.
Pain begins abruptly, increased in severity, lasts for hours and requires unusually large amounts of analgesics. It is a true pain and not a vague discomfort seen in angina. The pain is not aggravated by changes in position or respiration.
Chest
Discomfort – Diagnosis and Treatment
CARDIAC
1.
Angina
pectoris :
Risk
factors
Family history
Diabetes mellitus
Hypertension
Hyperlipidemia
Smoking
Precipitating factors
1. Exertion : Exercise ,Sexual activity
2. Emotion: Anger, fright
3.
Exposure
to cold.
Laboratory tests
1. Chest x-ray
2. E.C.G
3. Stress testing
4. Coronary angiography
Treatment
1.
Drugs: Sublingual nitrates
Beta blockers
Calcium antagonist
2.
Treatment of risk factors
e.g. high cholesterol, diabetes, hypertension.
3. Coronary angioplasty
4. Coronary bypass surgery
