Major Diseases

Weight loss

Weight loss may be physiological, due to dieting, exercise,starvation, or the decreased nutritional intake which accompanies old age. Weight loss of more than 3 kg over 6 months is significant and often indicates the presence of an underlying disease. Hospital and general practice weight records may be valuable in confirming that weight loss has occurred, as may reweighing patients at intervals; sometimes weight is regained or stabilises in those with no obvious cause.

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Obesity

Obesity is widely regarded as a pandemic, with potentially disastrous consequences for human health. Over one-quarter of adults in the UK were obese . There is increasing public awareness of the health implications of obesity. Many patients will seek medical help for their obesity, others will present with one of the complications of obesity, and increasing numbers are being identified during health screening examinations.

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Diabetes mellitus

Hyperglycaemia is a very common biochemical abnormality. It is frequently detected on routine biochemical analysis of asymptomatic patients, following routine dipstick testing of urine showing glycosuria, or during severe illness.

Occasionally, patients present as an emergency with acute metabolic decompensation. The key goals are to establish whether the patient has diabetes, and if so, what type of diabetes it is and how it should be treated.

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Thyroid Disorder

The most common presentations are

Hyperthyroidism

Hypothyroidism
enlargement of the thyroid (goitre or thyroid nodule).

Wide spread availability of thyroid function tests has led to the increasingly frequent identification of patients with abnormal results who are either asymptomatic or have non-specific complaints such as tiredness and weight gain.

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Benign prostate enlargement

Benign prostatic enlargement (BPE) is extremely common. It has been estimated that about half of all men aged 80 years and over will have lower urinary tract symptoms associated with BPE.

Clinical features
The primary symptoms of BPE arise because of difficulty in voiding urine due to obstruction of the urethra by the prostate; they consist of hesitancy, poor urinary flow and a sensation of incomplete emptying. Other symptoms include urinary frequency, urgency of micturition
and urge incontinence, although these are not specific to BPE.

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Renal stone disease

It is common, affecting individuals of all countries and ethnic groups. In some regions, the risk is higher, most notably in countries like Saudi Arabia, where the lifetime risk of developing a renal stone in men aged 60–70 is just over 20%.

Causes

Environmental and dietary causes

• Low urine volumes: high ambient temperatures, low fluid intake
• Diet: high protein, high sodium, low calcium
• High sodium excretion
• High oxalate excretion
• High urate excretion
• Low citrate excretion

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Hepatitis C

This is caused by an RNA flavivirus. Acute symptomatic infection with hepatitis C is rare. Most individuals are unaware of when they became infected and are only identified when they develop chronic liver disease.

Hepatitis C is the cause of what used to be known as ‘non-A, non-B hepatitis’

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Hepatitis B

The hepatitis B virus consists of a core containing DNA The core of the virus is surrounded by surface protein .The virus, also called a Dane particle, and an excess of its surface protein circulate in the blood.

Humans are the only source of infection.

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Cirrhosis

Cirrhosis is characterised by diffuse hepatic fibrosis and nodule formation. It can occur at any age, has significant morbidity and is an important cause of premature death. Worldwide, the most common causes are chronic viral hepatitis, prolonged excessive alcohol consumption and Cirrhosis is the most common cause of portal hypertension

The causes of cirrhosis are

• Alcohol
• Chronic viral hepatitis (B or C)
• Non-alcoholic fatty liver disease
• Immune Primary sclerosing cholangitis
• Autoimmune liver disease

Biliary
Primary biliary cirrhosis
Secondary biliary cirrhosis
Cystic fibrosis

SIGN AND SYMPTOM IN PATIENT
Hepatomegaly (although liver may also be small)

• Jaundice
• Ascites
• Circulatory changes: spider telangiectasia, palmar erythema, cyanosis
• Endocrine changes: loss of libido, hair loss

Men: gynaecomastia, testicular atrophy, impotence

Women: breast atrophy, irregular menses, amenorrhoea

Portal hypertension: splenomegaly, collateral vessels, variceal bleeding

Hepatic encephalopathy

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Jaundice

Jaundice is usually detectable clinically when the plasma bilirubin exceeds  ~2.5 mg/Dl . In a patient with the causes of jaundice overlap with the causes of abnormal jaundice it is useful to consider whether the cause might be pre-hepatic, hepatic or post-hepatic and there are often important clues in the history .

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