Podcast
Questions and Answers
Perineal inspection and rectal examination are essential and may reveal abnormalities of the pelvic floor, anal canal or rectum. Most patients will respond to dietary fibre supplementation and the judicious use of ______.
Perineal inspection and rectal examination are essential and may reveal abnormalities of the pelvic floor, anal canal or rectum. Most patients will respond to dietary fibre supplementation and the judicious use of ______.
laxatives
Middle-aged or elderly patients with a short history or worrying symptoms like rectal bleeding, pain or weight loss must be investigated promptly by either barium enema or ______.
Middle-aged or elderly patients with a short history or worrying symptoms like rectal bleeding, pain or weight loss must be investigated promptly by either barium enema or ______.
colonoscopy
For those with simple constipation, investigation usually proceeds with a digital rectal examination, proctoscopy, and sigmoidoscopy to detect anorectal disease, routine biochemistry, and a full blood count. If these are normal, a 1-month trial of dietary fibre and/or ______ is justified.
For those with simple constipation, investigation usually proceeds with a digital rectal examination, proctoscopy, and sigmoidoscopy to detect anorectal disease, routine biochemistry, and a full blood count. If these are normal, a 1-month trial of dietary fibre and/or ______ is justified.
laxatives
If symptoms persist, examination of the colon by barium enema or ______ is indicated to look for structural disease.
If symptoms persist, examination of the colon by barium enema or ______ is indicated to look for structural disease.
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If no cause is found and disabling symptoms are present, then specialist referral for investigation of possible ______ may be necessary.
If no cause is found and disabling symptoms are present, then specialist referral for investigation of possible ______ may be necessary.
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The problem may be one of infrequent desire to defecate known as 'slow transit' or else may result from excessive straining known as 'obstructed ______.'
The problem may be one of infrequent desire to defecate known as 'slow transit' or else may result from excessive straining known as 'obstructed ______.'
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It is neither possible nor appropriate to investigate every person with this very common complaint. Most will respond to dietary fibre supplementation and the judicious use of ______.
It is neither possible nor appropriate to investigate every person with this very common complaint. Most will respond to dietary fibre supplementation and the judicious use of ______.
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For those with simple constipation, investigation usually starts with a digital rectal examination, proctoscopy, and sigmoidoscopy to detect anorectal disease, routine biochemistry, and a full blood count. If these are normal, a 1-month trial of dietary fibre and/or ______ is justified.
For those with simple constipation, investigation usually starts with a digital rectal examination, proctoscopy, and sigmoidoscopy to detect anorectal disease, routine biochemistry, and a full blood count. If these are normal, a 1-month trial of dietary fibre and/or ______ is justified.
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If symptoms persist, examination of the colon by barium enema or ______ is indicated to look for structural disease.
If symptoms persist, examination of the colon by barium enema or ______ is indicated to look for structural disease.
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If no cause is found and disabling symptoms are present, then specialist referral for investigation of possible ______ may be necessary.
If no cause is found and disabling symptoms are present, then specialist referral for investigation of possible ______ may be necessary.
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Study Notes
Weight Loss: Definition and Significance
- Weight loss can be physiological (due to dieting, exercise, or decreased intake with age) or pathological, where a significant loss is more than 3 kg over 6 months.
- Pathological causes include psychiatric illnesses, systemic diseases, gastrointestinal disorders, and advanced organ-system diseases.
Psychiatric Illness
- Conditions such as anorexia nervosa, bulimia, and mood disorders may require professional evaluation for diagnosis.
- Alcoholism often leads to weight loss due to neglect and poor nutrition.
- Depression can contribute to weight loss through reduced appetite.
Systemic Diseases
- Chronic infections (e.g., tuberculosis, recurrent urinary or chest infections) should be considered as potential causes.
- History of foreign travel and symptoms like fever, night sweats, or rigors may indicate infection.
- Sexual promiscuity and drug misuse can suggest HIV-related conditions.
- Weight loss is a common late symptom in disseminated malignancy, usually accompanied by other clinical signs.
Gastrointestinal Diseases
- Almost any gastrointestinal tract disease can result in weight loss.
- Conditions like dysphagia or gastric obstruction impair dietary intake.
- Malignancy can lead to weight loss through mechanical obstruction or cytokine effects.
- Malabsorption, due to pancreatic or small bowel issues, can result in severe weight loss and nutritional deficiencies.
- Inflammatory diseases such as Crohn's disease and ulcerative colitis cause anorexia and loss of nutrients.
Metabolic Disorders and Miscellaneous Causes
- Weight loss may occur with metabolic disorders or in cases of end-stage respiratory and cardiac diseases.
Investigations for Weight Loss
- In cases where weight loss cause is unclear, comprehensive investigations are essential including:
- Urinalysis for sugar, protein, and blood.
- Blood tests like liver function tests and thyroid functions; ESR may indicate infections or malignancy.
- If necessary, invasive tests (e.g., bone marrow biopsy) or imaging (CT) can help diagnose underlying issues.
Malabsorption
- Suspected when weight loss and diarrhea occur despite normal dietary intake.
- Symptoms include watery diarrhea and steatorrhoea (bulky, pale stools indicating fat malabsorption).
- Other symptoms may involve abdominal pain, cramping, and deficiencies of nutrients (e.g., iron, calcium).
Pathophysiology of Malabsorption
- Intraluminal maldigestion: Deficiencies in bile or pancreatic enzymes lead to fat and protein malabsorption.
- Mucosal malabsorption: Conditions damaging intestinal epithelium reduce absorption efficiency.
- Postmucosal lymphatic obstruction: Impairs lipid uptake, causing protein loss in the intestine.
Investigations for Malabsorption
- Confirming malabsorption involves routine blood tests to identify deficiencies:
- Haematological findings: Microcytic and macrocytic anemias, increased prothrombin time.
- Biochemical signs: Hypoalbuminaemia, hypocalcaemia, hypomagnesaemia, deficiencies in phosphate and zinc.
Constipation
- Defined as infrequent passage of hard stools with symptoms of straining and incomplete evacuation.
- Clinical assessment focuses on the onset and duration to identify potential organic disorders.
- Symptoms like rectal bleeding, weight loss, or abdominal pain are critical to diagnosis.
- Examination may reveal underlying gastrointestinal or neurological disorders, particularly spinal cord lesions.
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Description
Test your knowledge on the symptoms of malabsorption, including weight loss, diarrhea, steatorrhea, abdominal distension, and undigested food in stool. Understand the diverse nature and severity of symptoms associated with malabsorption.
