WEEK 9 – A MATTER OF OPINION
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Illicit drugs, prescribed drugs, weight loss drugs, laxatives, side effects from prescription
medication
Glandular fever (Epstein Barr virus), HIV aids, microorganism, celiac disease, crohn’s disease,
chronic fatigue
Hyperthyroidism, diabetes, poor diet, kidney disease
Cancer, leukaemia
Anaemia , respiratory disease
Pregnancy, anorexia, bulimia, depression, stress, anxiety
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What we need to know:
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How long is ‘a few months’?
Explanation of weight loss  food intake/ absorption/ diarrhoea/ eating disorder
On any medication
Smoking
Lethargy  does it interfere with activities of daily living? Can you walk/run?
What is glandular fever?
What is chronic fatigue?
Travel
Sexuality
Hyperthyroidism
Diet
Menstrual cycle
Hypothesis:
See DIMTOP
What we found out:
Hyperthyroidism: Results from excessive levels of thyroid hormone. Increased basal metabolic rate
also results in weight loss despite increased appetite.
Glandular Fever: Herpes virus family. It is caused by the Epstein Barr Virus. It affects B lymphocytes.
It can lead to fatigue and lethargy. Most people are exposed in early years and thus don’t present
later, but can present later in life with poor diets. 3 – 5 months of duration. Sore throat, fever,
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enlargement of spleen and liver usually occurs in first few days (up to day 10). It is usually selflimiting – recovery within a few weeks. Often tiredness lasts for up to 2 months.
Chronic Fatigue: Symptoms: 1) extreme exhaustion 2) > 6 months duration 3) subjective
temperature/muscle aches (no evidence on exam). Level of activity that is 50% lower than usual
daily living. All other possibilities must be excluded. It follows viral pathology with no specific virus
associated
Celiac disease: tiredness, malaise associated with anaemia
Crohn’s disease: main symptoms: diarrhoea, abdominal pain, weight loss, malaise, lethargy
Depression: 2x higher in adolescent females than adolescent males. 5% actually have depression as
opposed to sometimes just having symptoms. No actual reason but possibly social role, female
hormones and psychological changes at puberty
Eating disorders in adolescents: approx 0.5 – 0.75% suffer, before puberty boys and girls suffer
equally, after puberty anorexia ratio 1:10 (boys to girls), 1:20 bulimia (boys to girls). Unsure of
reasons – probably linked to changes to body weight/shape
Anaemia: diet  iron deficiency, decreased red blood cells, haemoglobin carries oxygen to parts of
body. Therefore organs and tissues are unable to function. Heart works harder to provide oxygen
rich blood to body = fatigue
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What we need to know?
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BMI
Sexual activity
Vital signs
What causes girls to stop menstruating? (Amenorrhoea – primary/secondary)
Stress relationship to weight loss
Recommended daily intake?
What we found out:
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The metabolic responses to the stress of acute illness significantly modify energy balance.
Acute stress response is characterised by hypermetabolism.
Amenorrhoea: menstrual cycle requires 15% body fat to work normally. Causes include
pregnancy, menopause, hormone imbalance, metabolic disturbance and psychological
disturbance. People with eating disorders go on self-imposed diets, exercise strenuously,
deny problem exists, lost 20-50% of body weight.
Body dimorphism – an obsessive concern about body appearance. Common concern areas
are face, breasts, hands, feet etc. Can lead to consulting plastic surgeons.
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What we need to know:
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Fat content for a healthy teenager girl 15%  21%
Urine Test
Check for glandular fever, diabetes, thyroid levels,
Types of eating disorder
ELFTs
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