EMQ: 28
Loss of Weight
a)
Achalasia of the cardia
b)
Carcinoma of the stomach
c)
Bowel cancer with liver metastases
d)
Crohn’s disease
e)
Ulcerative colitis
f)
Coeliac disease
g)
Short gut syndrome
h)
Oesophageal cancer
i)
Peptic stricture of the oesophagus
j)
Giardiasis
1) A 20-year-old Irish female presents with loose
motions, mouth ulcers and an itchy rash. The stools are bulky and difficult to
flush away.
On examination she appears to have lost weight and she
has a vesicular rash over her lower back. Most of vesicles have been scratched
away leaving crusts.
Investigations reveal a macrocytic anaemia.
Answer: f) Coeliac disease
Loose bulky motions with loss of weight suggest
malabsorption. With a history of mouth ulcers in an Irish patient one should
consider coeliac disease. The history of the itchy vesicular rash would
suggest dermatitis herpetiformis, which occurs in coeliac disease
2) A 24-year-old female presents with a rash over her
lower legs. She gives a long-standing history of diarrhoea and abdominal pain.
She has lost a considerable amount of weight.
On examination she appears to have lost weight, there are
tender erythematous nodules over her shins and there is a mass in the right
iliac fossa.
Answer: d) Crohn’s disease
Diarrhoea and abdominal pain in a young female, one would
think of inflammatory bowel disease
The description of the rash suggests erythema nodosum
A mass in the right iliac fossa would be in keeping with
an inflammatory mass associated with Crohn’s disease.
3) A 67-year-old male presents with progressive dysphagia
over several months duration. The dysphagia affects solid more than liquids.
He smokes 20 cigarettes a day and drinks 35 units of alcohol a week.
On examination he looks emaciated and has hepatomegaly.
Answer: h) Oesophageal cancer
Dysphagia in an older patient with solids affected more
than liquids would point to a malignancy
The enlarged liver suggesting liver metastases is further
evidence in favour of this
4) A 70-year-old female presents with severe anorexia and
loss of weight. On examination she looks emaciated and has a palpable lymph
node in the right supraclavicular region.
Answer: b) Carcinoma of the stomach
An elderly patient presenting with anorexia should make
one think of cancer of the stomach
The fact that she is emaciated is in favour of this and
the lymph node in the supraclavicular fossa, Virchow’s node, (Troisier’s sign)
is further evidence in favour of this
5) A 35-year-old female presents with loss of weight and
diarrhoea. She has had multiple operations for Crohn’s disease of the small
and large bowel.
On examination she looks emaciated, there are multiple
scars on her abdominal wall.
There are no peripheral signs of chronic inflammatory
disease and investigations reveal that inflammatory markers are not raised
Answer: g) Short gut syndrome
Diarrhoea and weight loss should suggest malabsorption.
In the light of multiple resections of the gut short gut syndrome would be the
most likely option.
Revision Tip
Revise the causes of nutritional failure
ACES for PACES page 291
