Speciality
Spotlight

 




 


Family Practice


 

 








Weight
Loss

       






A
significant weight loss is
usually a marker of serious
disease. Even if no
underlying cause is found on
initial evaluation it does
not mean that weight loss is
idiopathic. The patient
should be followed at
regular intervals, since any
occult illness causing
weight loss may not be found
for long periods.



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

       








Increased
energy expenditure

Hyperthyroidism

Phechromocytoma

Extensive exercise







 



Increased
energy loss

Diabetes mellitus

(glucose in urine)



Malabsorption
syndromes

1) radiation injury

2) biliary tract
obstruction

3) Chronic
pancreatitis in
alcoholics
 



Decreased
food intake

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.

Second
phase tests

 

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)

 

Chest
Discomfort

      

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




  





 

 

Speciality Spotlight

 

 

Weight Loss
       

A significant weight loss is usually a marker of serious disease. Even if no underlying cause is found on initial evaluation it does not mean that weight loss is idiopathic. The patient should be followed at regular intervals, since any occult illness causing weight loss may not be found for long periods.

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
       

Increased energy expenditure
Hyperthyroidism
Phechromocytoma
Extensive exercise



 

Increased energy loss
Diabetes mellitus
(glucose in urine)

Malabsorption syndromes
1) radiation injury
2) biliary tract obstruction
3) Chronic pancreatitis in alcoholics
 

Decreased food intake
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.

Second phase tests
 
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)

 

Chest Discomfort
      

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


  

 

By |2022-07-20T16:43:29+00:00July 20, 2022|Uncategorized|Comments Off on Weight Loss

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